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Management of oral cancer

Management of oral cancer. Lip cancer: treated mainly surgically Intraoral cancers < 4 cm in diameter: treated equally effectively by surgery or radiotherapy. T1 tumours: generally managed surgically T2 tumours: generally managed surgically.

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Management of oral cancer

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  1. Management of oral cancer • Lip cancer: treated mainly surgically • Intraoral cancers < 4 cm in diameter: treated equally effectively by surgery or radiotherapy

  2. T1 tumours: • generally managed surgically • T2 tumours: • generally managed surgically. • However, tumours of the lateral margin of tongue may be treated by radiotherapy using external beam (40 Gy) plus radioactive iridium implants (25–30 Gy). • For many patients, the treatment must include treatment of the lymph nodes in the neck and thus often the treatment of choice is surgery (tumour excision with radical neck dissection), together with radiotherapy • T3 tumours: • generally treated by surgery followed by radiotherapy if there is extracapsular spread or multiple lymph node involvement. • For many patients, the treatment must include treatment of the lymph nodes in the neck and thus often the treatment of choice is surgery (tumour excision with radical neck dissection),together with radiotherapy • T4 tumours: • may be treated with chemo-radiotherapy. • Drugs used include cisplatin, fluorouracil (5-Fu) taxanes and methotrexate. • TPF is a common regimen (taxane platinum, 5-Fu)

  3. Neck treatment • N1: Supraomohyoid head and neck dissection • N2a-b or N3: modified radial neck dissection • N2c: radial neck dissection/ modified radial neck dissection

  4. Idiopathic: leukoplakia • Leukoplakia was defined by the World Health Organization as ‘clinical white patches that cannot be wiped off the mucosa and cannot be classified clinically or microscopically as another specific disease entity (such as lichen planus)’. • A subsequent International Seminar defined leukoplakiamore precisely as ‘a whitish patch or plaque that cannot be characterized clinically or pathologically as any other disease and which is not associated with any physical or chemical causative agent except the use of tobacco’.

  5. Epidemiology • INCIDENCE • Occurs in about 0.1% of the population. • AGE • Occurs predominantly in the middle-aged and older patient. • GENDER • Occurs more in men than women. • GEOGRAPHIC • It has no known special geographic incidence.

  6. Clinical features • Leukoplakia: homogeneous (most common) • Flat • Corrugated • Pumice-like • Wrinkled • Leukoplakia: non-homogeneous • Verrucous • Proliferative and verrucous • Nodular • Erythroleukoplakia(speckled)

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