Oral Cavity Cancer Management, Abroad

Whole Body Oral Cavity Cancer Management cost:
{the cost covers all destination medical & logistics costs}
International Destinations: India, Jordan, Mexico, South Korea, Turkey

Oral cavity cancer is the growth of malignant cells in the lips, buccal mucosa (inner lining of the cheeks), tongue, gums, palate (floor of the mouth, roof of the mouth), a small portion of area behind the wisdom tooth (retromolar trigone) and the salivary glands. 90 % of all oral cavity cancers are usually squamous cell carcinomas. The other 10 % are verrucous carcinomas, salivary gland carcinomas, and lymphomas. Mexico, Jordan, South Korea, India and Turkey are the preferred international destinations for the treatment and management of cancers originating within the mouth.

Clinical features of oral cavity cancer

1. A lump or a non healing ulcer on the lip, the sides of the mouth, tongue or the throat.
2. Unusual bleeding or pain
3. A sore throat that does not heal
4. Hoarseness of the voice that does not improve, a change in the tone of voice
5. Difficulty in swallowing
6. Changes in the denture fittings

Risk factors responsible for the development of oral cavity cancer

1. Excessive smoking of cigarettes and chewing of tobacco are associated with a heightened risk of developing oral carcinomas.
2. Too much of alcohol consumption is another contributing factor. (It is believed that a combination of tobacco and alcohol is a more potential risk factor, than the use of either one alone).
3. Viral infections, especially HPV infection, (human papilloma virus) augments the chances of developing lip cancer.
4. Poor nutritional status increases chances of developing mouth cancers
5. Immune system being compromised is another significant risk factor
6. Exposure to sunlight and UV light increases the danger of getting lip cancer.

An assessment of oral cavity cancer

• A thorough history taking is crucial, with respect to the symptoms and habits.
• The affected area is examined in detail. The physician will also check for enlarged lymph nodes in the neck region. A detailed evaluation of the larynx, pharynx and the esophagus is a must. Also, evaluation will be done to assess the spread of the tumor through metastasis.
• X-rays of the head and neck, and the chest, as well as, a barium swallow for the gastrointestinal tract are performed to rule out metastasis.
• A CT scan, MRI or a PET scan is done to provide specific and accurate information.
• A biopsy of the suspicious tissue would be inspected to ascertain the type of cells in the cancerous growth.
• Exfoliative cytology is carried out, using a brush or a wooden stick to scrape off a few cells from the oral cavity and the cells are examined under the microscope.

Management of oral cavity cancers:

• A typical X ray, releases beams that pass through the body via an external source, which create an image of the internal organs on a film
• On the other hand, for a PET scan, a radioactive substance called a radiotracer or radiopharmaceutical is injected in the patient’s body. This material, then collects in the tissue or organ which has to be examined, are releases gamma rays (from inside the body) which are detected by special a camera called “Gamma camera”. This gives a more comprehensive understanding of the internal structure.
• Also the radiotracer or radiopharmaceutical accumulates in the organ depending upon the metabolic or chemical activity. Hence, the radioactive material is found in a greater concentration in areas where the metabolic or chemical activity is high and in lesser concentration in areas where the metabolic or chemical activity is low. This allows the physician to understand the physiological process within the body in addition to understanding the anatomy and structure.

Positron Emission Tomography- Computed Tomography: The procedure

Carcinoma of the oral cavity is treated well through a multidisciplinary approach of surgery, chemotherapy, and radiotherapy.

• The stage of the cancer ” The size of the growth, its location in the oral cavity, and metastatic spread.
• Age of the patient and the general health
• The change in the patient’s appearance, his ability to talk and swallow.

The 5 year survival rate for a person in the stage 1 and 2 of the cancer is 70 %, while for those in the stage 3, the rate is 50 %, and the rate drops to 35 % for individuals in the stage 4 of the cancer.

The surgeries performed to manage the cancers of the oral cavity are major surgeries, that could greatly change the way one looks, eats, speaks, and copes with life. The site and extent of the cancer determines the nature of the surgery, whether tissues from the tongue, larynx, the palate, lip, or jaw bones need to be excised.

Surgical interventions for oral cavity cancers

1. Primary tumor resection
The tumor growth is excised with some of the surrounding healthy tissue. This is done to ensure that there isn’t any cancerous tissue left behind, which could lead to re-growths. In cases of tumors of small sizes, the surgery is performed through the mouth. Larger tumors require a mandibulectomy (an incision through the jaw bone), or an incision made in the neck, to gain access to the growth.

2. Mandibular resection 
A madibular resection becomes necessary, in cases where there is a spread of the cancerous growth to the mandible (jaw bone). The surgery would entail either a partial resection or a complete resection of the jaw bone. A partial resection removes a thin layer of the mandible that contains the teeth, while a complete resection involves the removal of all the mandibular bone.

3. Maxillectomy 
Carcinoma of the hard palate (roof of the mouth) necessitates either a partial maxillectomy or a complete maxillectomy. A maxillectomy would leave a gap between the roof and the nose above, thus, prosthesis is needed to fill in the gap.

4. Moh’s surgery
Moh’s surgical procedure is highly beneficial in the management of lip cancers. This surgery removes layers of the cancerous tissues, in very fine slices. Each slice is assessed and examined before excising another slice. The procedure is stopped when no cancer cells are demonstrated under the microscope.

5. Glossectomy 
A partial glossectomy, involves the removal of a part of the tongue, while a total glossectomy involves the removal of almost all the tongue. It is followed up with a reconstruction surgery (of a prosthetic tongue) to prevent excessive speech and swallowing difficulties. These cases require good family support and counseling.

6. Laryngectomy
Large cancerous growths in the tongue or the oro-pharynx would necessitate the removal of a part or the entire larynx (voice box). This surgery is called a laryngectomy. A partial or a complete laryngectomy could be performed, depending on the extent of spread. The larynx connects the mouth to the lungs. After a laryngectomy, a tracheostomy needs to be performed which links the end of the trachea (wind pipe) to an opening in the neck, through which one breathes.

7. Neck dissection 
To prevent metastasis through the lymphatic channels, the lymph nodes in the neck need to be dissected out. The lymph nodes surrounding the tumor growth are sent for laboratory examination for the presence of cancer cells. Once confirmed, a large number of the lymph nodes in the neck are excised out. A neck dissection is a big surgical procedure, and has considerable side effects. The surgeon will decide on either one of the following 3 modes – a partial neck dissection, a modified radical neck dissection, or a radical neck dissection.

8. Reconstruction surgery
Reconstruction surgery becomes essential in cases where a large area of the skin is removed. Management is done through skin flaps and skin grafts. Skin flaps A fold of the skin or muscle is removed from the vicinity of the wound, and rotated over, to cover it. Skin graft A skin flap is helpful in managing a large or a deep wound. Tissues from various parts of the body – bowel muscles from the arms or the abdomen could be utilized for the operation.

9. Palliative surgery
Oral carcinomas which cannot be cured would require a palliative procedure which would ease the symptoms and improve the quality of life. The following procedures are usually recommended.

• Tracheostomy (this surgical procedure makes an opening in the front of the neck to assist easy breathing, in cases of large tumors pressing on to the larynx)
• Removal of the teeth and installing dental implants
• Gastrostomy (a technique through which a tube is introduced in to the stomach to provide liquids, in cases of swallowing difficulties.

Radiation therapy

• Radiation therapy is given after the surgical procedure or just by itself, as the first line of treatment.
• The treatment could incorporate either external radiation or internal radiation.
• It is particularly useful in extensive cancers as a palliative method. It shrinks the growth and greatly relieves symptoms.
• Unfortunately, radiation therapy is fraught with certain complications like destruction of the salivary glands, a dry mouth, and dental trouble.

Chemotherapy

• Chemotherapy is preferred in patients who can not be treated with radiation therapy or through surgery.
• They help relieve pain and shrink the tumor size, but do not bring about cure.
• Chemotherapy could be systemic (i.e. taken either orally, or injected in the vein or mouth, so that it enters the blood stream) or regional (i.e. placed in to an organ or body cavity or the spinal cord)

Hyperthermia therapy

This procedure involves heating of the cancerous tissue above the body temperature to kill the tumor cells or to make them more sensitive to radiation and chemotherapy.

Care for patients of oral cancer after the treatment

• A follow up with the surgeon every 4 to 6 weeks is essential to check if there could be a recurrence or a re-growth of the tumor. Approximately 70 % of all tumors that are likely to recur, would recur within the first year, after the treatment procedure, and about 90 % are known to recur after a period of 18 months.
• Chest X-rays, liver function tests, blood investigations ought to be done from time to time to ensure that there aren’t any metastatic growths.
• CT scans and MRI need to be done periodically to check if there is a recurrence or a spread to distant organs.
• Following the surgery, chemotherapy and radiotherapy, oral functions could be adversely affected. Common complaints that are known to occur are reduced lubrication in the mouth and the throat, trouble while swallowing, and difficulty with speech. Thus, working with a speech therapist, deglutition (swallow) therapist, physiotherapist, occupation therapist and pain management therapist is an important component of the treatment plan.

Oral cancer management in Jordan

Jordan has become a huge competitor in the blossoming medical tourism industry. The facilities and equipments are all state of the art, yet the prices are rock bottom, some as low as 10 % of the fees charged in the United States of America. The Jordanian ministry of health has done everything in its power to ensure quick, cheap and effective health care facilities.

Oral cancer management in India

India has emerged as a prominent medical tourism destination, housing the best doctors and surgeons, high-standard health care providers, and optimum infrastructure, all at affordable rates.

Oral cancer management in Turkey

Turkey is known for its expertise in the field of oncology and cancer management. It offers experienced surgeons and health care personnel, quality care, and incorporates optimum safety measures to ward off complications.

Oral cancer management in Mexico

Mexico grants the most positive, approved and finest medical care facilities, and clinches all the modern and advanced surgical procedures, techniques and equipments. The various surgeries and treatments required for the effective management of cancers are carefully and cleverly handled.

Oral cancer management in South Korea

South Korea has quickly emerged as a sought after destination for medical tourism. It offers excellent medical care, the best possible management through the use of sophisticated gadgets, modern surgical procedures, and well experienced therapists.

Resources:

Cyberknife in India
Cyberknife at Anadolu Medical Center, Turkey
Chemotherapy Treatment (CHOP) Abroad
RCHOP Chemotherapy
Cyberknife Cancer Radiotherapy Overseas Radical Gastrectomy Surgery Abroad
Mastectomy Surgery Abroad
Total Pelvic Exenteration Abroad

Medical Tourism Corporation facilitates Oral Cavity Cancer treatment in Europe (Turkey) and other overseas world-class oncology treatment destinations.