HEAD AND NECK ONCOLOGY SURGERY

Head and Neck Cancer can occur at various subsites. These subsites can be enumerated as under:

Carcinoma of oral cavity:

Morbidity and mortality in cancer had been greatly caused by the presence of Oral cavity Carcinoma. Recent improvement in treatment procedures has increased overall survival with less morbidity. Surgical resection has been recommended as the prima facie method of treatment followed by stage specific recommendation for adjuvant therapy. It is important to enquire about onset and duration. The consulting physician will also make a check about family history and the risk factors. Determination of stage is critical for planning surgery and reconstruction. Acute interventions are thus be planned too. Critical observations are required to identify any alterations of speech, an articulation, and tongue mobility that are helpful to suggest any above-board involvement of tongue muscle and hypoglossal nerves.

Use of Radiographic imaging is also required for making preparation for assessment of primary tumor extent and identifying synchronous second primary tumors. High-resolution anatomic imaging is obtained through computed tomography and use of intravenous contrast material. Thus, bone invasion assessment has become more accurate and inexpensive too.

Treatment of OCC is normally done by a multi-disciplinary team. Specialists who are some of the best Head and Neck Cancer Surgeon from the realm of trained Surgical Oncology, Radiation, Chemotherapy, Nutrition, Dentistry and Psychology form the team. Best patient care is thus ensured.

Carcinoma Maxilla:

Para-nasal sinuses and multiple nasal cavities are seen to form in such diseases. The term ‘Para-nasal’ mean near the nose. This disease affects a person in the sixth or seventh decades of life. Most of the lesion does not show any apparent symptom. It makes diagnosis a tough job till the lesion perforated through the surrounding bone. Most patients are thus diagnosed at advanced stage. In the purview of clinical findings, the patient is made to submit under an incision biopsy, and the specimen is fixed in formaldehyde.
If the Carcinoma Maxilla is detected at the 1st or 2nd stage, surgery is recommended, and that needs be followed by a radiation, if the surgery is failed to remove the cancer completely. Radiation is also suggested when there are stints of perineural invasion. The best Head & Neck Cancer Doctor also recommends chemotherapy. Such radiations offered after surgery for cancer cases called adenoid cystic carcinoma.
At stage III and IVA, the cancer is treated with absolute radiation therapy. Lymph nodes at cervices may also be required to treat with radiation at times. Chemotherapy may also be suggested along-with. Such mode of treatment may sustain some side-effects. But it offers a surety in reducing the chances of reappearance of the cancer. Complete removal of tumor may be assured with application of radiation before surgery.
Cancers reaches stage IVB because the removal of main tumor was not possible. Strong radiation therapy is suggested. Chemo therapy coupled with targeted therapy constitutes the process. Application of targeted therapy depends on the severity of situation. Combination of surgery and radiation may be attempted by cancer specialists for complete removal of cancer.
At stage IVC, the cancer is seen to spread beyond the head and neck. Treatment is aimed at palliation and improvement of quality of life i.e., targeted to slow down the spread of cancer and minimize morbidity.

Carcinoma tongue:

This is very common in our part of the country. It can manifest as chronic non healing painful ulcer. Radiation of pain to the ear is ominous sign for a rapidly progressing ulcer. Tongue has a rich lymphatic supply which makes it notorious to spread rapidly. So management has to be early and aggressive. Depending on the size of lesion and the stage of disease management is determined by a cancer specialist.
Surgery

Partial Glossectomy : For small lesion, wide local excision of tumor with a cuff of normal tissue. Primary closure is done.

Hemiglossectomy: larger tumor ,upto 50% of the tongue is sacrificed with option of reconstruction with free flaps.

Total Glossectomy: For locally advanced tumor, tumor crossing the midline .Reconstruction with pedicle of free flaps.

Lymph Node Dissection: Due to richness in lymphatic drainage, nodes have to be addressed atleast bythe supraomohyoid lymph node dissection (SOHND) or a modified neck dissection (MND) or a formal radical neck dissection.

Carcinoma Larynx:

Laryngeal cancer may have to sustain with one or a combination of therapies like surgery, radio-therapy, chemotherapy and biological therapy. The surgeon may require suggesting complete removal of the abnormal area through surgery by the best surgical oncologist. This is followed by reconstruction and artificial voice box. Like any other cancer, extent of treatment is dependent upon the stage in which the disease has been diagnosed.

Surgery

  • Total wide field Laryngectomy
  • Partial Laryngectomy (Semon’s)
  • Laryngofissure (Rarely done)
  • Larynx conservation Surgery
  • Vertical Partial Laryngectomy
  • Surgery for Supraglottic Carcinoma
  • Supracricoid partial Laryngectomy with cricohyoidpexy (CHEP)

DISCLAIMER
Oncology is an ever evolving field of medicine and is matter of research and development. The author per say does not claim the following to be guidelines of practice in oncology. These are part of patient awareness initiative by Dr. Suvadip Chakrabarti MCh (Surgical Oncology) to educate people at large of various options in Oncology. It should not be taken to be practice guidelines.