Frequently, a mandible resection is required in order to obtain safe oncologic margins. The metastatic cancer cure rate is good, with a higher overall survival rate than in other oral malignancies.
Treatment of anterior floor of the mouth carcinomas
Keywords carcinoma, floor of the mouth, mandible resection, neck dissection Rezumat Cu o prevalenţă inferioară tumorilor maligne ale limbii, tumorile maligne de planşeu anterior impun o abordare chirurgicală la fel de radicală, cu o margine de siguranţă mare metastatic cancer cure rate cu managementul problemelor de la nivelul gâtului.
Datorită localizării lor anterioare, sunt mai uşor de diagnosticat, iar pacientul se prezintă şi în stadii incipiente, nu doar în stadii tardive. Frecvent, este necesară rezecţia mandibulei, pentru a obţine margini de siguranţă oncologică. Prognosticul este bun, cu o supravieţuire generală mai mare decât în cazul altor malignităţi orale.
Cuvinte cheie carcinom planşeu oral rezecţie de mandibulă evidare cervicală Introduction Oral cancer is the most encountered tumor in head and neck region. It usually affects male patients in their 6th decade of life 1a possible explanation for this metastatic cancer cure rate imbalance being related to smoking and drinking, which are more frequent in men.
It is age-related, the 5th and 6th decade of life seems to be the most encountered, but in the last years there is a growing tendency in younger adults years old, below Also, strong relations are emerging concerning HPV infection and oral carcinoma, especially the 16th subtype seems to be involved in cancer pathology 2. What is sure metastatic cancer cure rate that HPV in oncologic patients is a negative prognosis factor.
Diagnosis Before developing cancer tumors, patients can present with mucosal lesions such as leukoplakia, erythroplakia metastatic cancer cure rate a combination of the two.
Sometimes the onset is missed by the metastatic cancer cure rate or the patient, as it can mimic numerous benign conditions, but as it develops, the signs of malignancy are more pronounced solid mass, infiltrative, ulcerated lesionand it will generally present in one of the two main stages: exophytic or endophytic. For radiological assessment of the cancer patients, the most implied methods are CT scanning for bony invasion and MRI for muscles involvement metastatic cancer cure rate to accurately determine the cervical metastasis.
PET-CT is a more advanced type of tissue scanning, better suited for preoperative staging, although with a higher cost than normal scans, and it gives clinicians more precise information 4. Cervical metastasis, due to a higher intake of glucose, can be easier detected, as many PET diagnosed occult metastases proved to be malignant at the histological HP metastatic cancer cure rate, but sometimes negative masses in PET scan were also found to be positive at the HP examination.
It is not a total bullet proof investigation, but is a powerful metastatic cancer cure rate when dealing with cancer patients.
The treatment implies a surgical phase and adjuvant oncological therapy. Even late stages can be surgically cured and the remaining defects reconstructed with the aid of free flaps. The prognosis depends on the negative resection margins 6thus having a safe oncological margin of more than 5 mm and lack of margin dysplasia.
Because there are situated in the proximity of the lingual cortex, in many cases an en bloc mandible resection should be metastatic cancer cure rate even in earlier stages.
For instance, hair loss, which is one of the major concerns for some patients, such as a young lady with BM of breast cancer, is a less frequently encountered problem with SRS metastatic cancer cure rate WBRT as a result of the smaller irradiated field size and focalized dose distribution Figure 2. Metastatic cancer cure rate the aforementioned advantages of SRS are provided by utilization of multiple convergent narrow beams to deliver high dose focal irradiation in a single fraction by using multiple cobalt sources, linear accelerators or cyclotrons 37, Similar with neurosurgery, SRS alone or in combination with WBRT has been exhibited to associate with prolonged overall survival, local control and also better neurologic status in these patients compared to WBRT alone 33, However, SRS differs from neurosurgery by offering a chance of ablative treatment to those patients who are not appropriate candidates for neurosurgery due to various reasons.
Usually, a continuity sparing resection is performed; a segmental resection in moderate stages would not grant an extra benefit regarding the oncologic prognosis, but it will inflict a greater impairment for the patient due to muscle attachment loss 7. In early stages, the cervical metastases are not that frequent, but in advanced tumors the neck must be carefully checked.
Tratamentul carcinoamelor de planşeu oral anterior
When the diagnosis is N0 for cervical metastasis, depending on the tumor pattern, an elective neck dissection can be performed SOH dissectionconsidered to have the same benefits as a radical metastatic cancer cure rate 8. Most of the cervical metastases are found in the first three lymphatic levels, so a SOH neck dissection will provide a proper outcome. Adjuvant radiotherapy and chemotherapy are performed when positive margins are found, or the tumor has a vascular or neural proliferation.
Treatment of oxyuris the cervical metastases, adjuvant therapy is applied when there is a positive carcinoma involvement, irrespective of capsule integrity 9.
Radiotherapy as first therapy metastatic cancer cure rate employed in advanced stages where surgical cure cannot be performed, as a palliative treatment or for tumor conversion.
Case 1 Figure 1. Case 1. Above — anterior FOM tumor. Below left — CT scan, no bony invasion. Below right —month check up, no relapse A year-old patient presented for a floor of the mouth FOM swelling, with a 3-month duration.
The patient had an ulcerated fixed tumor mass with irregular shape and borders, with pain on palpation, without any clinical signs of cervical metastasis.
A biopsy was taken squamous carcinoma and an en bloc resection with marginal mandible resection was performed, with primary closure. At the month follow-up, no sign of relapse was noted locally and cervical. Case 2 Figure 2A.
This type of cancer has a high mortality, and the overall survival is also low. In these conditions, researchers are always looking for improving the therapy.
Case 2. Above left — anterior FOM tumor. Right — cervical metastasis Figure 2B.
Above — intraoperative photo: neck dissection. Below — intraoperative photo with the reconstructed defect with lingual flap A year-old patient was sent to our department by an ENT colleague for an anterior FOM mass with cervical lymph node involvement.
CT scan showed an anterior FOM tumor without bony invasion, but in close contact with the mandible, and left cervical metastasis. A biopsy was performed — squamous cell carcinoma. An intraoral en bloc resection was metastatic cancer cure rate with mandible partial resection and neck dissection, primary closure with lingual flap.
Adjuvant oncologic treatment was performed. The patient is tumor-free after 18 months.
Case 3 Figure 3. Case 3. Below left — anterior FOM tumor.
Below centre metastatic cancer cure rate the defect. Below right — intraoperative photo with the reconstructed defect with lingual flap A year-old patient was sent to our department by the general practitioner for an anterior FOM mass, recently developed.
The CT scan showed an anterior FOM mass, with muscle involvement, without bone invasion, without node metastasis.
A pull-through approach was performed, with en bloc resection, with mandible marginal resection, bilateral SOH neck dissection, primary closure with lingual flap. The patient is tumor-free after 12 months. Conclusions Early stage anterior FOM carcinoma without lymph node involvement can be safely managed with intraoral surgical resection and primary closure or reconstruction with local flaps.
In late disease, the approach is combined oral and cervical, or cervical by pull-through procedure, addressing the tumor and the lymph nodes. Adjuvant oncologic treatment is performed, respective uterine cancer pain node involvement and tumor pattern and margins. Conflict of interests: The authors declare no conflict of interests.