Oral Cancer (3)

06 Feb 2014

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Dr. Samuel

These specialists include oral and maxillofacial surgeons. Otolaryngologists (ear, nose, and throat surgeons ENT), medical oncologists radiation oncologist, plastic surgeons.

The list of other health professionals that may work in the team may include your general dental practitioner, speech pathologist, nutritionist, mental health counsellor and physiotherapist. Most of these health professionals and specialists are mostly found in tertiary institutions – teaching hospitals, federal medical centre, some general hospitals and indeed a few private health care institutions.

The treatment of oral cancer when diagnosed needs to be structured; currently, the National Health Insurance Scheme does not cover radiotherapy, chemotherapy whilst in several countries worldwide there is a cap on cancer treatment services covered. The treatment is relatively expensive, where possible a second opinion may be sought only to compare treatment modalities. This may not be practically possible in the country at the moment due to the paucity and scarcity of specialist facilities and professionals.

The treatment plan is carefully discussed with the individual and often determined by location of the cancer, initial lesion (mouth) or oropharynx (further down the throat) the size of the tumor, whether tumor had spread. All these will help determine mode of treatment, prognosis complications and best expected results of treatment.

Whilst discussing with the doctors naturally all the questions may not need be asked or answered at once as each treatment mode is often adapted and personalised to suit individual needs and values. The risks, side effects, expected end results, complications, realistic benefits, duration of treatment costs, alternative treatment cessation of habits etc, would often be discussed at the treatment planning stages.

There may be added benefit of taking part in new treatment as part of a clinical trial or research, this sometimes lesions the cost and avails individuals the possibility of participating new treatment regimen.

The options of treatment include surgery – where the tumor is removed alone or in addition with lymph nodes (glands in the neck to which cancer cells can spread).

Surgery may be combined with radiation therapy – Radiotherapy. This is often used for small tumors or whilst patient is too ill to have surgery. It could also be used before surgery to kill local cancer cells or even shrink the size of cancer growth.

Radiation involves high energy rays. Isotopes of some elements to kill cancer cells these radiation is dangerous to normal cells too hence other parts of the body including the gonads are protected during the procedure.
There are two types of radiation therapy mainly used:

  • External Radiation: - This is produced from a machine. The individual attends the hospital once or twice a day, five days a week for several weeks at a time until remission is achieved.

  •  Implant – (Internal) Radiation: - The radioactive material is implanted like seeds/ needles or thin plastic tubes out directly in the cancerous growth/ tissue. The patient is admitted in hospitals several days, whilst the implant is in place. The implants are later removed before the patient is discharged there are instances where both methods of delivering radiation are combined.

  • Another method of treating oral/ head and neck cancers is through chemotherapy in this instance anticancer drugs are used to kill the cancer cells via systemic therapy that is the drugs are delivered into the blood stream directly usually given by injection.

The anticancer drugs given can affect all the cells of the body. The advantage is that it could be given out patient. That is hospital stay may not be required, cost are cut. It can be given at home

Cancer treatment damages health cells and tissue as well. For this reason they produce ride effects that are not desirable. The side effects produced depends on the location of the tumor and the type and extent of treatment.
If is worth noting that side effects may not be the same for each person, could even change from one treatment session to the next.

Surgery may result in slow wound lealing, the time it takes to heal varies from one individual to the other. Pain is an uncomfortable side effect, most people undergoing cancer treatment are given strong pain killers and sedatives. Weakness and firedness as common with most trauma and surgery occurs. Should surgery involve the removal of lymph nodes swelling and infections result which may take longer than usual to resolve.

Side effects of surgical treatment will depend on the amount of tissue removed, the extent, it other structures like bone, tongue, glands are removed.

It may affect the ability to speak, chew, and smile. The puthooh may change hence subsequent reconstructive surgery to build the bones or tissue of the mouth may be needed.

Almost all patients who have radiation therapy to the head and neck area develop oral side effects.

It is important to get the mouth in good condition before radiation therapy or any other cancer treatment.

The side effect developed from radiation treatment for oral cancer is does -  dependent meaning the side effects developed depends on the amount of radiation given the effects of radiation therapy may end after the end of the radiotherapy treatment or some of the side effects may linger much longer after treatment and may indeed never go away.

Some of the effects of radiation therapy include, Dry mouth (Xerostornia) which makes it difficult to speak or talk or swallow.
Dry mouth can increase the incidence of tooth decay (dental caries). To counteract the effects it may become necessary to drink copious amounts of water. There are saliva substitutes, (sprays) which act to moisten and lubricate the mouth. These are artificial saliva should there be increased dental caries (tooth decay) use of fluoride gels or fluoride rinse.

There are other side effects like sore throat, alcers, inflamed tissues – special rinsed and pain relief to numb the tissues become necessary.

The gums may become sore and readily bleed use of soft toothbrushes and avoiding using toothpicks. Infections readily develop as a result of dry mouth which damages the lining of the mouth. Sequel to radiation therapy tissues of the mouth may heal poorly after dental treatment; it is advisable all dental treatment be done before radiation therapy begins.

Radiation therapy affects the muscles of the mouth, head and neck. The jaws become stiff, physiotherapy can reduce this jaw stiffness. Exercising the mouth – opening and closing as far as possible without causing pain – roughly dtiut 2-wenty (20) to thirty (30) times in a sequence about three (3) times a day.

Situation where previous denture (artificial tooth) wearers may need to avoid the use of dentures due to discomfort caused by the dryness of mouth soreness after radiation therapy, denture use may be  avoided for up to a year, the denture may also be refit or made.

Loss of sense of smaller taste may also result as food may taste different or smell different voice change from radiation directed at the larynx or voice – box, the larynx swells up and there is a teching of a lump in the throat.

There is an organ in the neck called thyroid gland. This gland makes hormones called thyroid hormones. Smells sometimes in people with iodine defivency called GOITRE.

Radiation treatment can affect the thyroid. The hormones made by the thyroid may be affected by radiotherapy to the gland. Insufficiency of this thyroid hormone may make the individual tired, feel cold have dry skin and hair. The levels of the thyroid hormone can be checked with blood tests and assay should the level below, doctors may recommend hormonal pills to maintain levels compatible with normal function Dry shin and General body fatigue occur amongst the other side effects.

Chemotherapy and radiation therapy can cause more or less similar side effects viz painful mouth/ gum, dry mouth, infection, loss or change of faste sensation, bleeding mouth, pain. Just like radiotherapy side effects are dependent on the dose and amount of radiation, side effects from chemotherapy depends on the amount of anticancer (chemotherapy) drugs the body receives.

Anti-cancer drugs also affect cells of the body that divide rapidly that is a high flurn over... in addition, they affect the blood cells (red blood cells, white blood cells etc.) these are cells that carry nutrients and oxygen round other tissues in the body they fight infections. Chemotherapy therefore, can result in increased infections in the body.

Chemotherapy affects the cells in the hair root which invariably leads to loss of hair Alopecia. The hair grows back after chemotherapy though the colour and consistency of the hair will not be the same.

Chemotherapy causes a loss of apetite nausea and vomiting, dianhea, mouth and lip sores because they affect cells of the gastro intestinal tracts.

It is imperative that nutrition is adequate during cancer treatment to forestall many of the side effects and prevent weight loss, regain strength and rebuild health tissues. This may be difficult due to the discomfort from oral cancer treatment.

Use of thick soups, milkshalies, puddings and a high protein, semi – liquid diet may suffice. Tissues and dieticians often provide a good guide. Use of a feeding tube may sometimes be required or even by direct incision a flexible tube is passed into the stomach. This tube is temporary and removed once health is regained.

Avoiding sharp crunchy foods like cheps, hot spicy foods, high acid foods, juices like citrus, sugary foods that can cause dental decays (caries) Alcohol drinks are some of the precautions that are advised during cancer treatment.

The treatment of oral cancer in individuals may necessitate reconstructive/ plastic surgery. Dental implants bone grafts etc. Due to advances in oral cancer treatment, Reconstruction surgery may actually be done concurrently with treatment.
Rehabilitation using physiotherapy supportive groups, counseling helps people who have undergone oral cancer treatment return to narmal activities as son as possible, regular checking up, follow, up speech therapy etc.

This piece has been written as a compact guide, better and comprehensive advice available from your dentist.
With promises of improved care through research and clinical trial, cancer needs no longer needs to be the hushed word or disease of misery or some.

Tags: Health, ORAL CANCER

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