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Surgery of the Oral Cavity
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Cancers of the oral cavity and oropharynx affect over 30,000 Americans each year. These tumors are most common in patients between the ages of 50 and 70 and are much more common in men. Over 90% of these tumors are squamous cell carcinoma (SCCA). The most frequent risk factors for getting SCCA in the oral cavity are smoking or chewing tobacco and moderate to heavy alcohol consumption. There are a small group of patients with oral cavity cancer that do not fit into this category and have a presumed genetic component. Similarly there are a group of patients with oropharynx tumors that are also non-smokers with tumors linked to the human papilloma virus (the same virus implicated in cervical cancer). Tumors in the oral cavity and oropharynx come in a wide spectrum of sizes that vary from small pre cancerous lesions to large bulky tumors that affect the patients ability to speak or swallow.
Although each case is different, the majority of tumors in the oral cavity itself (lip, tongue, floor of mouth, and gums) are treated initially with surgery. Sometimes due to tumor size, inability to remove the entire tumor or invasion of local nerves a patient may require post-operative radiation. Because oral cancers have a propensity to spread to lymph nodes in the neck, with the exception of most lip tumors, patients that have tumors of a certain thickness may also undergo a neck dissection at the time of tumor removal (for an explanation of neck dissection click here). Many tumors can be removed by going through the mouth, however more advanced tumors may require an incision outside of the mouth to ensure complete removal.
After removal of small tumors of the mouth the tissue is either closed on itself or left open and allowed to heal on its own. With larger tumors or those that involve the floor of mouth the surgeon may place a skin graft to facilitate healing. Tumors that are of an advanced stage may require more extensive reconstruction with either local flaps (such as from the pectoralis muscle) or distant vascularized flaps (from the forearm, leg etc).
Most patients do quite well after oral cavity surgery, however risks include changing a person's ability to speak and articulate words as well as to swallow. As a result after this type of surgery, your surgeon may refer you to a speech and swallowing specialist. Patients may also require a temporary tracheostomy and or a feeding tube to avoid problems with breathing and swallowing while healing occurs (for more information on tracheostomy click here or about a feeding tube click here). Other complications of oral cavity surgery include a risk of bleeding, infection, recurrence, scar, fistula formation, as well as damage to nerves that move the tongue and give it sensation. Although no complication is completely avoidable, head and neck surgeons are trained to limit the risk of these occurrences through careful and meticulous technique.
Oropharynx cancers are those of the soft palate, tonsil, base of tongue and walls of the throat. Small tumors in these areas are still usually amenable to surgery. However, due to the critical involvement in all of these structures in speaking and swallowing, more and more patients are being treated with radiation and chemotherapy. This allows preservation of critical structures and results in good local control rates. Patients that still have tumors after this type of treatment may need to undergo salvage surgery.
Risks of surgery in tumors of the oropharynx are similar to those of the oral cavity with higher risk of postoperative problems with speaking, swallowing and breathing. To prevent complications associated with these deficiencies patients may require a temporary tracheostomy or feeding tube (for more information about tracheostomy click here or about feeding tube click here).
Once you have been diagnosed with an oral cavity tumor there is always a chance that you may develop another one later on (about 2-5% of patients per year) or may have a recurrence of the lesion (most common in the first two years). Therefore your surgeon will probably see you on a regular basis to monitor for such problems.
If you suspect that yourself or a family member has oral cavity cancer or have received this diagnosis and wish to discuss treatment options please give us a call.
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