ORAL CANCER
I will not get cancer since I have stopped chewing tobacco.
Once if anyone gets exposed to carcinogenic agent (tobacco, alcohol most commonly), the risk of cancer will be there for lifetime irrespective of duration of stopping the habbits. They will require constant follow up. They will need to undergo periodic screening by Head and Neck Oncosurgeon.
Oral cancer screening is costly.
During screening for oral cancer, patient will be subjected to simple examination. Only if the clinician is suspicious, the patient will be subjected to biopsy and imaging. The screening process is as LESS as it can be.
I will not be able to lead normal life after cancer surgery.
Now with advances in surgical techniques, the Tumor can be removed completely with no permanent damage to normal structures. With advanced reconstructive techniques, the patient can lead near normal life after surgery. Of course, the patient may have to make some modification in job or in dietary habbits particularly if the cancer is in advanced stage which will require big resections.
Chemotherapy cures oral cancer.
The standard of care for oral cancer is Surgery followed by radiation or chemoradiation. Chemotherapy alone cures oral cancer is FALSE.
I will not be able to eat after tongue cancer surgery.
Depending on the extent of removal of the tongue, reconstructive procedure will be performed. You will be able to eat and swallow after tongue cancer surgery. Although certain patients will require dietary modifications. The swallow therapist will help the patient through the rehabilitation process.
I will not be able to eat after my surgery. I have been told that my jawbone needs to be removed.
After the removal of jaw bone, it will be reconstructed with bone flap from your leg ( fibula). Dental implants will be placed on this bone. After complete rehabilitation process, you will be able to eat normally.
I will lose my teeth after surgery.
If the cancer has spread into the lower or upper jaw bone, then it maybe decided to remove a portion or complete jaw bone. In such instances, the teeth will have to be removed. But you will undergo reconstruction process, wherein if your complete jaw bone is removed, portion of bone from the leg will be attached to remaining jaw bone. Dental rehabilitation can be done over this bone.
What is plastic surgery? What is microvascular reconstruction?
Inevitably, to remove the cancerous portion, certain part of the normal tissue needs to be removed as margin. It could be jaw bone, tongue or skin of the cheek or anything else. After removal, there will be a defect. If this defect is not reconstructed, there will be functional compromise. So, in microvascular reconstruction, tissue from other part of the body is transferred in to the mouth. The tissue can be taken from your hand or thigh or leg or from the back. For any tissue to survive, it needs constant blood supply. Once the tissues are transferred, the blood vessels of the tissue ( hand / leg / thigh/ back....) are joined with blood vessels of the neck, so that the circulation is established for it to survive. This process is called microvascular reconstruction or plastic surgery. These are small blood vessels measuring 2 - 5mm in diameter. The blood circulation in the flap will be monitored post surgery.
When will my jawbone not be replaced?
Usually jaw bone if removed will be replaced by a bone. In certain unfortunate situations, due to tobacco use the mouth opening will be very less. In such situations, the bone will not be replaced. If more tissue is removed along with the bone, both needs to be replaced. Mouth opening is one important determinant of replacing the bone.
What is the standard of care for oral cancer?
The standard management for oral cancer is SURGERY . In early stages (Stage I and II), surgery with negative margins is sufficient. In Stage III and Stage IV ( locally advanced), the patient will need adjuvant (post surgery) Radiation or chemoradiation.
What is tracheostomy?
Tracheostomy is a surgical procedure, wherein silicone tube will be put inside the trachea ( windpipe) to help you in breathing and clearing the secretions. In complex or big resections of cancer, there tends to be lot of swelling in the mouth and pharynx after surgery. This swelling usually decreases in few days. During this period, it will be difficult to breathe through nose and mouth. Henceforth tracheostomy will be done. Since this tube bypasses the upper airway, patient will not have breathing difficulty. Once the tube is removed, patient will be able to breathe through the nose and will be able to talk.
ORAL CANCER
WHAT IS MEANT BY METASTASIS?
If the tumor spreads from the site of origin to another site ( it may be to lymph nodes or to any other part of the body) it is called metastasis.
WHAT IS MEANT BY CURATIVE OR PALLIATIVE INTENT OF TREATMENT?
Curative intent - The disease / tumor can be completely removed by either modality ( Surgery / Radiation / chemoradiation). Usually this terminology will be used if the cancer is detected at a stage where it has not spread to any other organ.
Palliative intent - The tumor cells have spread from the primary site of origin to other organ ( eg lungs, liver, bone) . In this scenario, the patient will not be curable. In such scenario, the term palliative is used. In these situations, the treatment will be directed to decrease the spread of tumor cells if the patient is able to tolerate chemotherapy / immunotherapy. If the patient has poor performance status, he/she will need best supportive care to maintain decent quality of life.
WHY SHOULD WE TAKE RADIOTHERAPY / CHEMOTHERAPY WHEN THE TUMOR IS REMOVED DURING SURGERY?
Whenever the surgeon operates, the goal is complete tumor resection. Completeness of tumor resection will be known in the histopathological report by margin assessment. The required margin is 5mm on histopathology. But there is always chance of microscopic tumor cells in the bed or in the surrounding site, by which the tumor can recur. The chance of recurrence is higher in Stage III and Stage IV. Henceforth, these stages will need Radiation / chemoradiation after surgery.
will doing biopsy cause rapid spread of cancer?
Biopsy is very important to confirm the diagnosis. It is mandatory procedure before initiation of any cancer treatment. Biopsy will not increase the chance of spreading cancer cells.
do i need to do PET scan ?
PET CT scan, CECT scan, CEMRI are the imaging modalities available. Usually CECT neck and chest is performed to stage the disease and for surgical planning. Certain indications for PET CT are - in recurrent / metastatic settings, big neck lymph nodes, large volume primary tumor. The purpose of doing PET scan is to assess if the the cancer has spread to any other organ. PET scan is expensive. Hence suitable scan will be decided by the surgeon based on the clinical scenario and suspicion.
how frequently should i follow up after treatment?
As per the guidelines, for the first year, follow up is at every 4 - 6 weeks. For the second year at every 8-10 weeks, third year at every 12-14 weeks. Follow up for a minimum period of 5 years is compulsory. After 5 years, yearly follow up is recommended.
THYROID CANCER
WHAT IS THYROID CANCER?
Thyroid cancer arises from the thyroid gland. The thyroid gland is present in the neck. The main function of the gland is to produce thyroid hormones, which is essential for our development. There are various types of cells in the gland from which the cancer originates.
WHAT ARE VARIOUS TYPES OF THYROID CANCER?
Broadly, they are classified as well differentiated thyroid cancers, poorly differentiated thyroid cancers, anaplastic thyroid cancer and medullary thyroid cancer. Most often we see well differentiated thyroid cancer - papillary thyroid cancer and follicular thyroid cancer. These well differentiated cancers have good prognosis.
HOW DO WE DIAGNOSE THYROID CANCER?
Thyroid cancer can be diagnosed with a simple test called FNAC ( Fine needle aspiration cytology). In this test, the contents will be aspirated using a fine needle, smeared on a glass slide and seen under microscope. The patient will also undergo imaging ( usually Ultrasonography / CT scan ) to assess the size of the nodule and neck lymph nodes.
WHAT IS IODINE SCAN?
After thyroid surgery, the patient will have to undergo iodine scan. Initially for scan, small dose of radio iodine will be given. In this scan, we will assess for any microscopic disease ( which is not seen through naked eye). If any microscopic disease is present, a higher dose of iodine will be given to destroy these cells ( Iodine therapy) .
CAN THE THYROID TUMOR BE REMOVED WITHOUT ANY SCAR?
Small sized thyroid cancer can be removed through robotic surgery . Here the scar is small and can be placed in hidden areas.
WHAT ARE THE COMPLICATIONS IN THYROID CANCER SURGERY?
The main complications in thyroid surgery is related to handling to normal surrounding structures. The main important structures surrounding the gland are the nerves related to voice, trachea ( breathing tube), esophagus ( food pipe), parathyroid glands ( to regulate calcium levels). Unless we are handling a very huge tumor or a aggressive tumor, we will not expect any major complications.
If the tumor is adherent to nerve, there might be possibility of voice change due to handling and dissection. The recovery of voice depends on the nerve status ( whether cut or restricted to just dissecting around).
DO WE NEED TO REMOVE PARATHYROID GLANDS DURING THYROIDECTOMY?
NO. There is no need to remove parathyroid gland during thyroid surgery. But few patients tend to develop low calcium levels in view of handling parathyroid gland. This is transient and will recover within few weeks.
NOSE AND SINUS CANCER
I have been diagnosed with sinus cancer. My face will be disfigured after surgery.
Presently sinus cancer can be treated with endoscopic surgery most of the times. In endoscopic procedure, no facial incisions are made. Only in certain advanced stages, aesthetic facial incisions will be considered.
Will I be able to breathe through my nose after endoscopy surgery?
After nose surgery, your nose will be packed ( dressing material ) for mostly 48hrs. After 48 hrs, the pack will be removed. you will have a sensation of nose block for first couple of days post surgery. But you will be started on medications ( decongestants and nasal spray) which will help in clearing the nasal cavity and keeping it patent.
What is CSF leak?
Cerebrospinal fluid (CSF) is a fluid in the cranial cavity. It surrounds the brain. CSF is contained within a barrier called Dura. During endoscopic surgery, because of the tumour extent and for complete resection of the tumour, portion of dura may have to be removed. At this point of time, the CSF will leak into the nasal cavity. The surgeon will close this dural defect with the tissue available from the nose or from the thigh. Henceforth the nasal cavity will be separated from the cranial cavity and the leak will be sealed.
What is navigation guided surgery?
During navigation guided surgery, the surgeon will use the CT scan and MRI scan to localise critical structures. This process will help in accurate complete resection of the tumour and also preserve the surrounding normal critical structures.
SALIVARY GLAND CANCER
WHAT ARE SALIVARY GLANDS?
Salivary glands are those that produce mucus and saliva. The saliva is secreted into oral cavity. Saliva is essential to maintain normal microbiome in oral cavity. Also saliva is essential for preparing the food bolus.
how many salivary glands do we have?
The salivary glands are classified as major and minor. The major salivary glands are the Parotid gland and Submandibular gland. The minor salivary glands are few hundreds in number. They are present in the submucosal layer of oral cavity, pharynx and sinonasal mucosa.
can we get tumor from the salivary gland?
Yes, tumors can develop from the salivary glands. These can be classified into benign and malignant tumours. The malignant lesions can be classified into low , intermediate and high grade lesions.
What is the modality of treatment for salivary gland tumors?
The Salivary gland tumors are usually radioresistant tumors. Surgery remains the main modality of care. Radiation and chemotherapy are used as adjuvant treatment.
what is the risk of facial nerve injury during parotidectomy?
During Parotidectomy, the facial nerve needs to be identified and separated for tumor removal. This involves minimal handling depending on the extent of tumor. There is chance that the function of nerve will be compromised if the nerve gets damaged during surgery. To avoid damage to the nerve, every surgeon should take care to carefully identify the nerve including branching patterns, to avoid handling / undue stretching of the nerve, avoid using thermal instruments in close vicinity of the nerve.
what is facial nerve monitoring during parotidectomy?
During Parotidectomy, the facial nerve needs to be identified and separated for tumor removal. To avoid overhandling, stretching of the nerve, the surgeon may opt to use facial nerve monitor. The electrodes are placed into the muscles that branches of the nerve innervate. The completion of the circuit is checked prior to start of surgery. Once the nerve is identified, it can be stimulated using stimulator and confirmed. The monitoring process gives constant feedback about the activity of the nerve.
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