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UPFRONT SURGERY IN LOCALLY ADVANCED ORAL CANCER ( NOT PREFERING CHEMOTHERAPY AS FIRST TREATMENT)


Oral Cancer is sixth most common cancer in the world.

In India 40% of all cancers reported are oral cavity and throat cancer.(Collectively called as Head & Neck cancer).

Buccal mucosa ( Inner surface of cheek) and retromolar triangle are the commonest sites of such cancers in India.

This is mainly due to widespread practice of tobacco and pan chewing and bidi smoking.


WHAT IS LOCALLY ADVANCED ORAL CANCER?

Oral cavity includes buccal mucosa, upper and lower gums , hard palate , oral tongue and floor of mouth.

When a cancer in any area is more than 4 cm. In size and / or the cancer invades through nearby muscles , bone or skin of the face then it is called Locally Advanced Cancer. At times it reaches bony structures near base of skull.


SURVIVAL RATES IN LOCALLY ADVANCED ORAL CANCER:

An average of 41% of patients in stage III and 15% of patients in stage IV are alive at 5 years or more.

In India majority of patients present in stage III and IV. A proper treatment planning is necessary in order to even achieve this results in our setup.


OTHR RELATED ISSUES IN ORAL CANCER TREATMENT:

Along with survival other important issues in Oral cavity cancers are ability to chew and swallow properly , a proper and understandable speech and socially acceptable cosmetic look.

As all these factors are important while treating locally advanced oral cancer a consideration is given to neoadjuatnt chemotherapy. ( I.e. giving fixed numbers of cycles of chemotherapy prior to committing patient for surgery).

There is evidence to prove that this approach has helped patients having laryngeal and pharyngeal cancers.

However the evidence for the same approach to Oral Cavity cancer is not very clear.


WE RECOMMEND UPFRONT SURGERY IN MAJORITY SUITABLE CASES:

Our reasons for suggesting surgery first in majority of stage III and stage Iva stages are based on our following observations;

Chemotherapy may produce macroscopic response but the percentage of patients having presence of microscopic disease remains same in both the cases.( So extent of resection can not be reduced after response to chemotherapy.)

Some patients do not respond to chemotherapy and have progressive disease. Their chance for potentially curative surgery is lost forever.

Some patients who respond very well to chemotherapy assume that their disease is cured forever and refuse for further treatment like Surgery or Radiotherapy. ( Even excellent response to chemotherapy is is not permanent ).

Chemotherapy produces adverse effects like nausea , vomiting ,loss of hair , anaemia , decreased white cell count etc. and this may need additional treatment.

Also there is additional cost and additional hospitalisation involved every time chemotherapy cycle is given. ( All currently given chemotherapy is in injectable form and is to be given over 3 to 4 days.)

Long term survival is not always improved by adding chemotherapy.

Availability of modern reconstructive surgeries have made it possible to reconstruct major facial and oral defects after surgical removal of that part of face and mouth.


WE RECOMMEND UPFRONT SURGERY IN MAJORITY SUITABLE CASES:

CASE OF LOCALLY ADVANCED BUCCAL MUCOSA CANCER TREATED WITH PRIMARY SURGERY AND RECONSTRUCTION;

Cancer Doctor in Kota


Dr. Bhargav Maharaja,

Cancer Surgeon,
Shrey Hospital,
Navrangpura,Ahmedabad.