Thursday, July 8, 2010

Treatment of oral cancer

Surgery and radiation therapy (radiotherapy) is still the treatment of oral cancer, two of the most effective way, often better than the comprehensive application of the two alone. Chemical treatment (chemotherapy) is still an adjuvant therapy for surgery and radiotherapy before or with the application. Select suppressing radiation surgery, in addition decided to illness, but also depends on the clinical experience of doctors by the government and the hospital conditions and technical equipment. Patient should be an objective estimate of a multidisciplinary consultation methods to determine treatment. Oral cancer treatment to a large extent determined by the success of the 1st treatment is correct.

Surgical treatment can be used with the following conditions: ① no distant metastasis; able to secure borders and cervical resection of primary tumor metastases; ② disease who are poor radiation effects; ③ oral surgery caused little injury, or big but But through reconstruction or prosthesis can be a considerable degree of compensation to and obtain the patient's consent.

Oral cancer is usually very small when the initial visits in patients with distant metastasis. If the suspect had distant metastasis, especially in the primary cancer is small, should first rule out the first two primary cancer. Adenoid cystic carcinoma of the earlier occurrence of distant metastasis, but this cancer was long, the primary tumor can still surgical resection could be considered.

Estimated to be complete resection of primary tumor surgery and neck metastases, it can also cut around a certain amount of normal tissue without endangering the important organizations such as the carotid artery, carotid artery, brain, etc., you can consider surgery. Carcinoma CT may help estimate the scope of violations, but still found in the operation of its invasion of larger than originally estimated. This situation should be fully considered before surgery. Surgical field visible residual cancer even though few, will also significantly reduce surgical treatment failure or treatment. Preoperative estimate to complete resection of the carcinoid tumor but could not secure the border, after preoperative radiotherapy and / or carcinoid tumor after chemotherapy, there may also consider reducing surgery, can also be the first post-operative radiotherapy.

Following radiotherapy for poor results when: ① the source of oral epithelial carcinoma, verrucous squamous cell carcinoma, squamous cell carcinoma of central necrosis with hypoxia were not sensitive to radiotherapy or after radiotherapy, although sensitive, but still have residual cancer. ② violations or close to bone cancer, such as gum cancer, palate or tongue cancer, buccal, floor of mouth, etc. carcinoma invading the upper and lower jaw when. Bone tissue susceptible to radiation damage, barely radical dose radiation therapy often lead to bone each other so bad even further surgery. ③ already clear neck metastasis. Cervical metastasis of oral cancer is difficult to cure with radiation therapy is recommended because the surgery. Even small primary cancer can be radiation control, radiation from start to finish takes about 2 months or so to make neck surgery, this time to the development of cervical metastases may be difficult surgery, or for the primary tumor and cervical metastases the rule of joint operation to root properly. Unless the primary cancer has been late, or could be considered for primary and neck metastases after preoperative radiotherapy surgery.

Second, radiation therapy

Radiation therapy either alone or with surgery integrated application, both in the treatment of oral cancer plays an important role. Early lesions with interstitial implantation with external radiation therapy is surgery the same effect, and can maintain the beauty, the normal chewing, swallowing and voice function, to improve the quality of life in patients. On the middle and late disease, especially lymph node metastasis occurs when the poor radiotherapy alone. The ideal treatment choice is subject to radiologists and surgeons with each other, according to anatomic location, infiltration areas, cervical lymph node metastasis and the patient's general condition and other developing integrated treatment programs.

1, external radiation therapy

Applicable for various reasons can not accept the Integrated interstitial or surgical therapy, and treatment of local recurrence or disease after extensive palliative therapy.

2, preoperative radiotherapy

To control the primary tumor or neck lymph nodes subclinical lesions, surgery to reduce the spread opportunity, while the tumor size decreased, so that the original becomes inoperable tumor lesions can be surgery, thereby increasing the resection rate, a decrease of local recurrence rate.

3, postoperative radiotherapy

For residual cancer after surgery or pathological examination prompted a cutting edge or cutting edge cancer tumor tissue from the edge of less than 0.5cm cases. Wound healing after radiotherapy can be carried out.

4, interstitial radiotherapy

Radium needle interstitial implantation is widely used in clinical treatment in half a century, and the tongue, buccal cancer, mouth cancer and other end of the treatment of local control with satisfactory results. With the artificial radioactive isotope 192Ir, 125I, 198Au, and after the emergence of other equipment technology, laser acupuncture has been the treatment of interstitial 192Ir afterloading replaced.

5, oral tube light

Applied to lesions shallow, easy-to-exposure, and to maintain exposure to the location of small lesions, and carcinoma invasion is less than 0.5cm. As external irradiation before or after a dose of radiation technology, using kV X ray or electron beam irradiation to be reduced jaw tumor area increased dose, to reduce late complications.

Third, chemical treatment

Most of head and neck squamous cell carcinoma, is less sensitive to chemotherapy. In the treatment of rare head and neck cancer chemotherapy alone, often with the comprehensive application of radiation or surgical treatment to kill the sub-clinical cancer; or combined with radiotherapy to increase the radiation sensitivity; also used for advanced or recurrent head and neck cancer of palliative care. Clinical data reported for head and neck cancer chemotherapy drugs are mainly methotrexate (MTX), bleomycin (BLM), cisplatin (DDP) and 5 - fluorouracil (5-FU). Poor efficacy of a single drug, multiple drugs combined with radiation or surgical treatment with good effect. And taking it in rather hydroxyl results would be better.

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