Keterangan
The squamous cells in your mouth cavity are where oral cancer begins. Following behaviors are present in approximately 75% of those who acquire mouth cancer. Use tobacco products that are smokeless, including chewing tobacco, dip, snuff, or water pipes (hookah or shush), smoke cigarettes, cigars, or pipes, have human papillomavirus (HPV), or have a family history of oral cancer. Utilizing the TNM method, oral malignancies are staged. Chemotherapy, radiation therapy, and surgery are the three primary types of treatment for oral (mouth) cancer.
Ringkasan
- Oral cancer is prevalent in India, often linked to tobacco use. The age of onset is decreasing, with cases seen in individuals as young as 30. Risk factors include smoking, tobacco chewing, and alcohol consumption. Interestingly, some female patients develop oral cancer without these habits, and tongue cancer is more common than buccal mucosa cancer in these cases.
- Suspicion arises with oral cavity ulcers that don't heal within three weeks, accompanied by pain, altered speech articulation (particularly in tongue cancer), and difficulty opening the mouth. Advanced stages may involve neck nodes. Weight loss and appetite loss are typically late-stage symptoms, mainly observed in metastatic settings. Necrotic ulcers can cause foul odor.
- Treatment goals involve resection, reconstruction, and radiation. The aim is to remove the disease in the oral cavity and neck to reduce recurrence. Reconstruction focuses on improving function over purely aesthetic aspects and enhancing the quality of life.
- Surgical principles include resection with clear margins and appropriate neck dissection. Reconstruction should match the tissue type resected (soft tissue replaced with soft tissue, bone with bone). However, these surgeries must be adapted based on age, comorbidities, and affordability.
- Resection depends on the oral cavity location. Tongue resections can range from partial to subtotal glossectomy, while buccal mucosa resections vary from wide local excision to total maxillectomy. Postoperative morbidities include aspiration, shoulder/chest pain, donor site defects, and radiation side effects.
- Reconstructive options involve local advancement flaps, regional flaps from the chest or forehead, and free flaps. Free flaps use distant tissue transfer with blood supply, anastomosed to vessels in the neck to ensure the tissue survives for reconstruction.
- AJCC staging classifies oral cancer based on size and depth of invasion. The final stage is determined after histopathological examination. Adjuvant therapy decisions are based on stage, with stages one and two not usually requiring it. Stages three to four A typically involve radiation alone, while four B may need chemotherapy along with radiation.
- Surgical resection is the primary curative modality for operable oral cancer, and adjuvant radiation is used to prevent recurrence in advanced cases. Chemotherapy alone is not curative and is reserved for advanced stages to prolong life. Cure rates decrease significantly when surgery is not an option. Oral cancer affects all aspects of a patient's life, and support is crucial.
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