The cancer of the mouth usually presents as a growth or an ulcer typically affecting the
tongue or floor of the mouth, the jaw or part of the cheek. Once a mouth cancer has been
diagnosed, the primary form of treatment is surgery. Radiotherapy can also be used and
is often used after surgery once we've checked on all the margins and if we're giving radiotherapy,
we can also add in chemotherapy which makes the whole treatment much more comprehensive.
Surgery is almost always the first choice when treating a cancer of the mouth. It's
my opportunity to examine the cancer in three dimensions and also to take out the tissue,
plus a margin of normal tissue. So, if there's a cancer of the tongue presenting as an ulcer
or growth, then I can accurately take a centimetre of tissue all the way around the tumour and
preserving the rest of the tissue for function and rehabilitation later on.
The type of surgery is guided by the site and the size and the extent of the disease
when it presents. This is accurately looked at on scans and we can even use models and
we have a team discussion to actually plan the surgery. Surgical resection is guided
by the extent of the tumour. What I would like to achieve is a good clear margin. So,
if this is on the tongue, we can take a portion of the tongue out with a margin of a centimetre
and preserve as much function as possible. If the cancer involves the jaw, then a significant
portion of the jaw needs to be removed so that the bone can be looked at very carefully
as for extent of disease. Once the cancer resection has been performed, I would also
need to address the neck. Here, there are hundreds of lymph nodes which may be involved
in the cancer fighting process. The procedure is a function-preserving neck dissection.
This would involve making an incision in the neck and lifting the layers of tissues away
so that we can then explore and dissect the lymph gland tissue away from all the structures
in the neck. This is a meticulously performed procedure; preserving the nerves to the face
and nerves to the shoulder as well as the major blood vessels. The lymph nodes may be
taken at the same time as the cancer operation. We call that unblock and the whole tissue
can be then delivered to the pathologist intact for them to examine and perform their tests
to see how extensive the cancer is.
As you can imagine, the defect following cancer of the mouth, face or jaw can be quite significant
and I would usually rebuild this at the same time. The surgery can be planned meticulously
offline before we actually get to the operating theatre and consistently, I'm using scans
and models and surgical stents to guide me to rebuild the face as it was before. The
tissue that we use to reconstruct the mouth, jaw or face can come from other parts of the
body. A most common site is the forearm where the soft pliable skin of the radio forearm
can be used to reconstruct the tongue and the floor of the mouth and it folds in very
nicely filling the defect. This allows the tongue that is preserved to function well
and once this all heals; the speech and swallow functions are actually quite good. If I need
to reconstruct the jaw or part of the face, then I would need to have bone as well as
soft tissue in order to be able to fill these defects. For those, I would approach either
the leg or the hip. We can also use bone from the shoulder blade as well. The bone can be
osteotomized or cut in specific way to actually bend around the three-dimensional contours
of the face. The tissue is taken with its own blood supply and this is called a microvascular
free flap. The blood vessels into and the vessels flowing out of are joined into blood
vessels in the neck. This micro surgery is performed under great magnification and we
usually have a very high success rate for the flaps to function well immediately after
they've been put in.
Well, mouth cancer treatment has really come a long way. With dedicated team, careful planning
and meticulous surgery, combine that with advances in general anaesthesia and in critical
care, we've really minimised the risks for such major surgery.