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ENHANCE Head and Neck Rehabilitation Centre, Pune

Head & Neck Cancer

Enhance - Adding life to LIFE.

Progressive oral cancer

This information will help you understand advanced oral cancer, including risk factors, symptoms, diagnosis, and treatment.

 

About the oral cavity

The oral cavity (or simply the mouth) consists of:

  • lips;
  • cheeks;
  • teeth;
  • language;
  • gums;
  • vault of the oral cavity;
  • floor of the mouth.

Cancer can develop anywhere in the mouth. Advanced oral cancer can affect nearby tissues, muscles, and bones. In advanced stages, cancer can spread to the lymph nodes in the neck.

 

Risk factors for advanced oral cancer

Risk factors for advanced oral cancer include:

  • smoking cigarettes or other tobacco products;
  • chewing tobacco;
  • The use of alcoholic beverages.
  • aging; oral cancer usually develops in people between the ages of 65 and 74;
  • male gender; oral cancer develops in men twice as often as in women;

Symptoms of advanced oral cancer

You may experience any of the following symptoms:

  • persistent pain in the lips, mouth, or both;
  • a lump on the lips, neck, or mouth that does not go away;
  • white or red patches on the gums, tongue, or cheeks;
  • persistent bleeding, pain or numbness in the mouth;
  • persistent sore throat;
  • feeling as if something is stuck in the throat;
  • trouble chewing food or swallowing;
  • pain while chewing food or swallowing;
  • Swelling that causes dentures to fit poorly or cause discomfort
  • voice change;
  • ear pain;
  • inability to open the mouth.

Diagnosis of advanced oral cancer

To check if you have oral cancer, you need to have a biopsy (a procedure where small tissue samples are removed). During a biopsy, a healthcare provider will remove a small piece of tissue from the area where the cancer might be. This tissue is examined for abnormal or cancerous cells. It will take at least 5 business days to receive the biopsy results. The health worker will then explain the diagnosis to you.

Your healthcare provider may order other tests, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to help you find out if the cancer has spread to other areas.

Information about surgery for advanced oral cancer

Surgery is the most common treatment for advanced oral cancer. Its goal is to remove all of the cancerous tissue. Depending on the operation, you may need tissue, muscle, or bone reconstruction. In this case, together with a surgeon who specializes in the organs of the head and neck, a plastic surgeon will work.

A surgeon who specializes in the head and neck may refer you to a dentist and oral surgeon. If necessary, they will examine your teeth and make a prosthesis. A prosthesis is a device that replaces a part of the body that has been removed.

The extent of the operation depends on how the head and neck surgeon removes the cancer.

  • Some tumors are removed through an incision (surgical cut) in the jaw. An incision is made between the 2 lower front teeth. After the incision is made and the tumor is removed, the jaw is reattached using a metal plate and screws.
  • If the cancer is close to the jaw or affects only a small part of it, only that part of the bone is removed.
  • If the cancer affects most of the bone, that part of the jaw is removed entirely.
  • Sometimes tissues, muscles, bones, arteries, and veins can be taken from another part of the body to replace those that have been removed. This is called a free flap.
  • You may also need to remove lymph nodes in your neck. The tumor and lymph nodes will be sent to the Pathology Department for examination. It will take at least 1 week to get results.

Tracheostomy

Sometimes surgery to treat advanced oral cancer can cause swelling in the throat. In this case, your surgeon may perform a tracheostomy to make sure you can breathe normally. A tracheostomy is an operation to create a surgical opening in your windpipe to make breathing easier and protect your airway. Before your surgery, your healthcare provider will discuss with you whether you need a tracheostomy.

During a tracheostomy, your surgeon will make an opening in your neck and pass a tracheostomy tube through it into your trachea (windpipe). This will allow you to breathe easier. If you are having a tracheostomy, your nurse will provide you with the resource Care After a Tracheostomy .

You will also have a tracheostomy if your surgery involves certain types of reconstruction or the use of free flaps.

A nurse will take care of your tracheostomy while you are in the hospital. The resulting mucus will be removed with an aspiration tube. Keeping your airways clear will make breathing easier and reduce your risk of developing pneumonia.

The tracheostomy tube will be removed when the airway swelling has gone and you can breathe normally. If you keep your tracheostomy after you leave, your nurse will teach you how to care for it.

After operation

Communication after a tracheostomy

If you have had a tracheostomy, you may not be able to speak when you wake up for the first time after the operation, but you will be able to communicate in writing. The nurse will give you a pencil and paper. You can also answer yes or no questions by nodding or shaking your head. You may also be given a tablet to facilitate communication. Your tablet comes with an app to help you communicate your needs. The nurse will teach you how to use the tablet.

Compression boots

While you are in bed, you will be wearing compression boots. These boots apply gentle pressure to the calves to prevent blood clots. They will be removed when you can get out of bed and walk. If you had surgery without using a free flap, you will be able to get out of bed and walk the day after surgery. If a free flap was used during the operation, this will happen somewhat later, depending on the location of the free flap. Every day your physical activity will increase.

Nutrient Probe

If you find it too difficult to eat and drink, you may have a feeding tube placed after the operation. Depending on the operation, you may not be able to eat for up to a week after the operation. The health care provider will provide you with more information.

Anesthesia

You will experience pain after the operation. Be sure to ask your nurse for pain relief. You may initially receive it through an intravenous (IV) line. Later, you can take medicine by mouth (by mouth) or by feeding tube if you have one. As you recover, you will need less pain medication.

Drainage tubes

In case of removal of lymph nodes in the neck, drainage tubes will be installed in the neck. You can also install them in the free flap area, if one was used. Drainage tubes are usually removed when the amount of discharge decreases. Most likely, all of these tubes will be removed before you leave the hospital. If you are discharged from the hospital with tubes in place, the nurse will teach you how to care for them. For more information, read the Pre-Operation Guide About Neck Dissection Surgery .

Oral hygiene

Your nurse will teach you how to use the oral irrigation and care kit. This kit will help keep your mouth clean and speed up healing. After you leave the hospital, you will need to rinse your mouth with an irrigation kit. It is especially important to rinse your mouth after eating. After you eat, no food particles should remain in your mouth. For more information, read the resource Oral Irrigation

How to prevent spasm of masticatory muscles

Spasm of the masticatory muscles is the inability to open the mouth. During recovery after surgery, it is very important to prevent spasm of the masticatory muscles. Your nurse will teach you how to do exercises to prevent this side effect, which are described in the resource How to Prevent Chest Spasms .

Discharge after surgery

Your surgeon will tell you when you can return to work and normal activities. It depends on the surgery and the speed of recovery.

In most cases, patients can manage daily activities at home without additional assistance, but the nurse will discuss this with you before leaving the hospital. If you need help, a nurse or case manager will help arrange visits by a health visitor/home visitor or home health specialist.

Call your health care provider if you have any of these signs or symptoms of an infection:

  • temperature 101°F (38.3°C) or higher;
  • increased redness around the incisions;
  • increased discharge from incisions;
  • discharge that has an unpleasant odor;
  • increased pain that does not go away after taking a prescribed pain reliever or acetaminophen.

Follow-up

7-10 days after discharge, you will need to visit your surgeon, who specializes in head and neck organs. If a plastic surgeon was involved in the operation, you will also need to make an appointment with that specialist. Call each doctor’s office to make an appointment. Depending on the rate of healing, some of your stitches may be removed during your first follow-up visit. You will also have a complete head and neck examination.

If the lab results are ready, your head and neck surgeon will review the results with you during your first follow-up appointment. He will also give you detailed information about the cancer that was removed during the operation.

Your health care provider will discuss with you the need for additional treatment. In most cases, patients with advanced oral cancer will need to undergo radiation therapy, chemotherapy, or both after surgery to ensure that all cancer cells have been removed. If you would like to have these procedures at Enhance Head Neck Rehabilitation , you will be given an appointment. If you would like to take them elsewhere, we can help you choose a healthcare provider. Your health record will be sent to the health care provider who will treat you.

It is very important not to miss a single appointment for follow-up. These techniques will help to detect recurrence (recurrence of cancer) or new cancers at an early stage. As time goes by, visits will become less frequent.

Recovery

Cancer diagnosis and treatment can leave you stressed and depressed. Each person deals with this in their own way. Many people say that it’s good to focus on small improvements that you will see with each new day and each new week, for example:

  • swelling will gradually subside;
  • the face will begin to look more natural, and the scars will become less noticeable;
  • You will find it easier to speak and you will be able to eat many of your favorite foods. a dietitian can help you choose the best way to prepare your favorite foods until you can chew and swallow again;
  • You will have more energy to do the things you love.

Emotional health

It is normal if you feel overwhelmed during or after treatment. Programs are available to help you deal with these feelings. It is important to recognize the signs of depression, such as:

  • feelings of helplessness and sadness;
  • inability to concentrate or do normal activities;
  • mood swings;
  • changes in sleep patterns (increase or decrease in normal sleep duration);
  • increase or loss of appetite.

Call your healthcare provider if you have these symptoms and they do not go away for more than 2 weeks. To speak with our counselor, you should book an appointment with us.

Smoking and drinking

Tobacco or alcohol use increases the risk of developing oral cancer. Breaking these bad habits will help reduce the risk of recurrence or the formation of a new tumor. If you want to quit smoking, we can refer you to a Tobacco Treatment Program at our center.

If you want to stop drinking alcoholic beverages, there are programs that can help you. 

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