Is it possible to treat tongue and oral cancer?
Yes. The main treatment for this disease is surgery, and the probability of recovery is quite high, especially in the early stages. In more advanced stages, survival rates may decrease depending on the spread of the disease.
Who undertakes the treatment of tongue and oral cancer?
In our country and in many parts of the world, the treatment of oral and throat cancers is provided. Ear, Nose and Throat physicians (especially those experienced in head and neck surgery), radiotherapy (radiation therapy) specialists, and medical oncologists (physicians who apply chemotherapy) often undertake this task together.
In addition, coping with problems that may occur during or after treatment. Nurses, dentists, nutritionists, psychiatrists, speech and swallowing treatment specialists and algology (pain management) specialists can come into play for this purpose.
How is the treatment of tongue and oral cancer planned?
After the disease is recognized, diagnosed by biopsy, detailed examinations and staging with imaging methods such as MR, CT and PET, the treatment planning phase begins.
The type of treatment and the methods to be used are especially planned, taking into account the patient's preferences. In advanced stage tumors, it is decided with the participation of physicians from other specialties such as radiation oncology and medical oncologists.
What methods are used to treat tongue and oral cancer?
Basic methods in the treatment of cancers of the oral and throat area. ;
- Surgical Treatment
- Radiotherapy
- Chemotherapy
- It is a target-oriented treatment.
These methods are used alone or together, depending on the stage of the disease, the patient's medical condition or preferences.
How is tongue and oral cancer surgery performed?
When it comes to tumors, what is meant by surgical treatment? is to remove the tumor with some healthy tissue around it, that is, to remove it from the body.
The purpose of removing the tumor with some healthy tissue around it is to make sure that no tumor tissue is left behind. For a very early stage tongue cancer, this is done by injecting the tumor through the mouth without any incision in the skin of the neck. While the removal of a specific area (such as the side part of the tongue, a part of the cheek, a part of the soft palate or the uvula, etc.), in case of a tumor that has reached and occupied the lower jaw bone, the tongue, the floor of the mouth tissues adjacent to it and a sufficient part of the lower jaw bone are removed and It may mean using bones and tissues from other areas for subsequent repair.
In order to minimize the possibility of leaving a tumor behind during the removal of the tumor area, biopsies are often taken for control purposes from the parts of the remaining tissues adjacent to the removed area after the tumor is removed. After the samples are first frozen in the operating room during the surgery and thin sections are taken, they are examined under a microscope by pathology specialist doctors to ensure that the remaining tissues do not contain tumors. This process is called frozen 'frozen' examination.
When the result of the frozen examination, which is a very important stage of surgery, is negative (tumor-free, clean), the repair of the operating field begins. However, if the pathologist detects a tumor by frozen examination in the samples sent for control purposes, the tissue removal process is continued in that area until the new control biopsies are reported as clean.
When it comes to surgical treatment for mouth and throat cancers, it is almost always the lymph in the neck. Removing the glands in a planned and systematic way is also an important part of the work to be done. This procedure is called 'neck dissection'.
This procedure can be performed for the treatment of the neck in the presence of a visible tumor in the lymph nodes in the neck, or in cases where metastatic tumor is not detected in examination and imaging studies such as ultrasound, CT, and MRI. It can also be done to protect against metastases.
Lymph nodes in the neck are classified into regions named with numbers from one to seven. In neck dissection surgeries, the areas most likely to harbor metastases are cleaned. For cancers located in the mouth and throat areas, areas 1A - 1B, 2A - 2B and 3 of the neck are generally cleared areas. However, depending on the surgeon's preference or the presence of metastasis in the neck, regions 4 and 5A – 5B can also be cleaned during the dissection surgery. Knows.
During tongue cancer surgeries, a procedure called tracheotomy is sometimes used. By making a hole in the front of the neck, a tube is placed in the trachea (windpipe) and the patient is allowed to breathe during anesthesia. Thus, during the surgery and in the days after the surgery, the patient's airway is secured and a tube extending from the mouth to the trachea, which would complicate the procedures during surgery, is avoided. This opened hole; After the patient begins to recover and the edema (swelling) in the surgery area decreases, it is usually closed within a week to ten days and the patient begins to breathe normally again and make sounds and speak easily.
At the end of this whole process, the patient's mouth is closed. Discharge comes to the fore after the patient becomes able to feed, breathe and talk comfortably.
What is the role of radiotherapy in the treatment of tongue and oral cancer?
Radiotherapy basically consists of giving radiation for a certain period of time every day. It is a treatment method applied by entering a device. The total duration is calculated by the radiotherapy specialist who will apply the radiotherapy and generally covers a period of 25 to 35 working days.
This is a type of radiotherapy in which external beams are administered. Apart from this treatment, there is another treatment method called 'brachytherapy'. Brachytherapy is basically performed by placing small tubes containing radioactive material, called 'implants', in and around the tumor for a certain period of time, especially if the tumor still exists after surgery or classical radiotherapy treatments are completed. Brachytherapy is a treatment method that is not widely applied in our country.
Radiotherapy can sometimes be used as a non-surgical treatment alternative for cancers in areas such as tonsils and tongue base (back 1/3 of the tongue). However, it is not possible to use radiotherapy alone as an option to surgery in tongue cancers.
Radiotherapy is mainly used as a complement to surgical treatment in advanced stage tongue cancers or to regress the disease in cases where surgery cannot be applied for some reasons. It is also used together with chemotherapy.
To explain once again, the tongue and the floor of the mouth are For cancers located in the front part of the stomach, on the lip, radiotherapy alone will not be enough for the patient to leave the disease behind. However, it is really beneficial in preventing the recurrence of the disease in advanced stage tumors (if the size of the tumor in the tongue is larger than 4 cm, if there is a tumor in more than one lymph node in the neck, etc.). The session of radiotherapy is decided by radiotherapy specialist doctors, taking into account the initial location of the disease, its stage, spread and some factors specific to the patient.
Radiotherapy damages the healthy cells and tissues around it as well as the tumor cells. This damage may cause side effects during and after treatment. The problems caused by radiotherapy can sometimes appear as more serious problems. These side effects and dangerous complications (negative consequences caused by the treatment method) have decreased considerably with the high-tech radiotherapy devices used today. However, it is not possible to completely eliminate the side effects.
What is the role of chemotherapy in the treatment of tongue and oral cancer?
Chemotherapy essentially means treatment by giving medication. As with many tumors in the head and neck region, it is also used as an adjunct to surgery and especially radiotherapy in oral and tongue cancers. Most often, the main goal is to increase the effectiveness of radiotherapy.
Chemotherapy is a treatment method that may cause some side effects and problems. It will probably be used more intensively in the future with the development of smart drugs that target only the tumor cell and do not harm other cells and tissues.
You can consult your medical oncology specialist for more information.
Language and tissues. What is the role of targeted therapy in the treatment of oral cancer?
Targeted therapy is a treatment method that uses certain drugs and substances that target cancer cells while causing little harm to healthy cells. As in all types of cancer, this treatment is promising for tongue and oral cancers. Targeted therapy drugs work differently than classical chemotherapy drugs and are sometimes found to be insufficient.
The side effects of these drugs are different from chemotherapy drugs and are generally milder.
You can consult your medical oncology specialist for more information.
Language and How to decide which methods to use in the treatment of oral cancer?
The main treatment method accepted all over the world for oral and tongue cancer is surgery. Today, other treatment methods find their place as an adjunct to surgery. In cases where surgery cannot be performed for various reasons, other treatment methods can replace surgery.
When deciding which type of treatment will be appropriate for the patient, the ear, nose and throat and head and neck surgeon; The radiologist and nuclear medicine specialist who perform the imaging procedures, the radiotherapist who will apply the radiotherapy that may be required later, the medical oncologist who will administer chemotherapy, the anesthetist who will administer the anesthesia throughout the surgery, the internal medicine specialist who evaluates whether the patient will be able to survive the long surgery and post-operative period internally, the cardiologist, the pulmonologist and the biopsy during the surgery. It also takes into account the opinions of the pathologist who will examine the removed tissues.
In most centers where such tumors are treated, treatment decisions about patients are made by tumor councils that include the experts listed above. Sometimes the patient's condition is brought up and evaluated more than once before and during the treatment process in tumor councils.
What are the stages of tongue and oral cancer surgery?
There are three stages of oral and tongue cancer surgery. It would be appropriate to examine it in stages:
- If it is to be performed, the surgery to clean the neck lymph nodes, 'neck dissection'.
- With the 'safety margin', which includes the healthy tissues around the tumor in the mouth and on the tongue. Removal
- Reconstruction (repair of the cavity formed inside the mouth) and closing of the incisions on the skin.
The decision which of the neck lymph areas to be cleaned is made in the light of radiological examinations and with the surgeon's preference. Most often, the region where the lymph nodes to which intraoral-tongue tumors first metastasize includes 1-2-3. Sometimes zones 4 and 5 are also added to these.
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