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A Smarter Approach to Oral Cancer Surgery

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Head and neck lymph nodes. (Credit: Henry Ford Cancer Institute)

Doctors are now able to employ less invasive and aggressive methods to deal with oral cancer at an early stage, such as the sentinel lymph node biopsy method.

 

Up until quite recently, the removal of all neck lymph nodes through desiccation was a standard procedure in treating oral cancer. The undesirable effects of such an intervention are numerous: the necessity of using neck drains due to swelling and fluid retention caused by temporary blockages in the lymphatic system; shoulder and lip weakness due to nerve manipulation and exposure; larger scars; a longer recovery period and so on.

Doctors are now able to employ less invasive and aggressive methods to deal with oral cancer at an early stage. Take sentinel lymph node biopsy for example; in this case, pathologists are now able to perform biopsies at the same time as the procedure to remove the tumors. In this way, only the diseased lymph nodes have to be removed. An injection of a weak radioactive substance is given so that doctors can precisely locate the oral cancer sites by noting where the white blood cells are more concentrated. The substance is also able to trace the path most likely used by cancer cells to reach lymph vessels and nodes.

Pathologists are now able to perform biopsies at the same time as the procedure to remove the tumors. In this way, only the diseased lymph nodes have to be removed.

Although the pattern with which cancer cells can spread varies from patient to patient, there is always a first lymph node which picks up the radioactive substance showing it is draining the tumor. This is then termed as the sentinel lymph node for that particular case. From this point, surgeons are able to identity which lymph nodes are likely to be diseased.

Dr. Steven Chang (Credit: Henry Ford Cancer Institute)

According to Dr. Steven Chang, director of the head and neck oncology program and microvascular surgery division at the Henry Ford Cancer Institute in Detroit, Michigan, another advantage of the sentinel lymph node biopsy method is that it maps lymph nodes in the lower neck and opposite sides of it. This allows patients with cancer in the middle area of the head or neck to also benefit from less invasive surgery. The Henry Ford Cancer Institute has been using sentinel lymph node biopsy with great success for the last four years.

Mouth Pains Should be Checked by a Dentist

The experimental introduction of less aggressive and invasive treatments on patients suffering from malignant neoplasms started almost three decades ago, mainly in treatments against melanoma and breast cancer. But in the 90’s, the accuracy of this whole process was still very low. As only 10 to 15% of the examinations’ results turned out to be correct, the decision to not remove lymph nodes had a higher risk level than most doctors and patients were willing to accept. But the extraordinary developments in medical technology—especially in imagery—have reduced the rate of potential misdiagnosis by 85 to 90% over three decades to as low as 2.5 to 3%.

The combination of smoking and alcohol in excess is particularly dangerous, for alcohol enhances the harmful effect of the first problem.”

Neck and head malignant tumors are among the most common cancers worldwide. When dealing specifically with oral cancer, the two biggest risk factors are, in this order, smoking and excessive drinking. “The combination of smoking and alcohol in excess is particularly dangerous, for alcohol enhances the harmful effect of the first problem,” warns Dr. Chang. Paying attention to possible early symptoms is also important. “Mouth pains that last more than one or two weeks should be checked by a dentist or a doctor,” he adds.


About the Author

A native of São Paulo, Ana Luiza Daltro is a former economics and business reporter from VEJA magazine who currently writes for three e-magazines within VirtualExpo group.

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