Treatment & Prognosis
Treatment, Prognosis & Complications of Oral Squamous Cell Cancer
Treatment: The treatment of oral cancer depends on its stage at discovery. If metastasis to neck (cervical) lymph nodes has occurred, wide excision of the primary tumor with total excision of all lymph nodes on the affected side (radical neck dissection) will likely be performed.
Depending on the circumstances, radiation treatment may be used alone or in conjunction with surgery. The use of chemotherapeutic agents is usually reserved for management of metastases.
Prognosis: The prognosis of oral cancer depends on the size of the primary tumor (T), whether lymph nodes are involved (N), and whether distant metastasis (M) has occurred. Staging of this disease is accomplished by a combination of the TNM parameters.
Complications: First, the lesion may recur if not completely removed. Second, radical surgery creates deformities that may seriously affect the patient’s quality of life; these deformities often require extensive surgical and/or prosthetic reconstruction.
There are a number of complications that may be associated with radiation therapy. The first and most serious is osteoradionecrosis, a condition characterized by death of bone (necrosis) that has been altered by passage of the x-ray beam. Because osteoradionecrosis is associated with post-radiation tooth-derived infection, it is often recommended that teeth in the anticipated x-ray path be extracted prior to radiotherapy. If osteoradionecrosis occurs, the condition may cause the loss of large chunks of mandible.
Another complication is that the x-ray beam will damage salivary glands should it pass through them. As a consequence, saliva flow may decrease producing a dry mouth (xerostomia) and resultant dental caries (“radiation caries”). Xerostomia also causes painful mucous membrane (mucositis) and fungal infestation (candidiasis).
Prior to radiation treatment patients should receive a thorough dental examination and have diseased teeth removed. The immediate and life long use of topical fluorides will inhibit radiation caries.