Oral cancers are more commonly seen in the middle-aged group and elderly, affecting men more than women.
Patients usually present with non-healing ulcers of more than 3 weeks despite medication. Other complaints include:
A thorough head and neck examination is performed which includes examination of the oral cavity, the neck and a nasoendoscopy. A biopsy of the oral cavity lesion is then performed under local anesthesia as a clinic procedure. A fine needle aspiration cytology is also performed on any neck node. Either a computed tomography scan or magnetic resonance imaging (CT or MRI) is done to evaluate the extent of the oral cavity lesion and possible neck node involvement. If the biopsy confirmed the diagnosis of cancer, then a CT scan of the thorax and liver are done as part of the staging work-up, looking for distant spread to the lungs or the liver.
All cases will be discussed at the multidisciplinary tumour board where the best recommended treatment options will be detailed. Treatment modality depends on:
The preferred treatment is surgery of the oral cavity cancer and the associated lymphatic/nodal drainage pathway in the neck. The surgical defect may require reconstruction to ensure a functional and cosmetic outcome (refer to chapter on Head & Neck Reconstruction). Postoperative radiotherapy with or without chemotherapy will be decided based on tumour characteristics.
Even after completing treatment of the cancer, patients often have to undergo months of rehabilitation as surgery can result in altered speech and swallowing. Hence, intensive speech and swallowing therapy as well as regular dietician review is to be expected by our patients.
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