Oral cancer is classified as one of the deadliest forms of cancer for various reasons. It derives from benign neoplasms such as leukoplakia and other precancerous lesions. “It is suggested that cancers arise by expansion of cell numbers from a single cell affected by premalignant and dysplastic lesions.” (Woolgar, 2011) It often includes most of the oral soft tissues such as the cheeks, floor of the mouth, tongue, both soft and hard palates, sinuses, and the pharynx.
Research reveals that 90% of oral cancers are under the category of squamous cell carcinoma, which is a fatal, malignant abnormality. Furthermore, oral cancers happen to be associated with oropharyngeal cancer in the majority of the diagnosed patients. The two most common factors and etiologies of oral cancers are smokeless chewing or pit tobacco, and sexual transmission. The patient will suffer from formations of painful, malignant lesions that grow rapidly with extended use of nicotinic products and persistence in oral sexual activity. The average age of the infected patients ranges from 35 to 40 years of age; the disease mainly occurs in middle aged adults.
Oral cancers develop at the posterior oral cavity, primarily at the base of the tongue and in the tonsils. The onset of the disease is usually noticed once the cancer progresses to other extra oral regions of the body, mostly into the lymph nodes of the neck. A medical biopsy is taken and sent to the laboratory for further investigation to reach a more accurate prediction on the kind of oral cancer developing. One of the main disadvantages of oral cancer is that it is not always diagnosed during its initial stages.
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The later it is diagnosed, the more potentially harmful and life threatening it becomes. It is known to occur in people of diverse regions all around the world but mainly the United States of America, Bangladesh, India, Pakistan, and Sri Lanka; over thousands of cases are reported annually in Southeast Asia.
Moreover, an estimated 53,000 Americans have been diagnosed with oral/ oropharyngeal cancer. 9,750 deaths have been reported as a result of misdiagnosis or late discovery. Oral cancer provides little to no room for health improvement and subsides with a poor oral status; hence, it is important to gain medical attention and seek treatment once any symptoms have arised. Surgical excision of the cancerous lesion and chemotherapy have proven to be exceptionally beneficial in eradicating the disease and removing any lesional remnants.
Over the course of many years, the majority of dental and medical practitioners have recommended surgical removal of cancerous tissue. Each surgical plan depends on the extent of the cancerous activity as well as the area of interest. The most commonly performed surgical practices are such as: maxillectomy, laryngectomy, neck dissection, partial or full mandible resection, Mohs microscopic surgery, tumor resection, and glossectomy. It is of extremely crucial that the surgeon removes the entire existing malignant lesion, using the appropriate tools, to prevent recurrence and further subsequent harm to the patient. The lesional margins and borders must be defined and a proper outline of the cancerous tissue must be marked to ensure adequate removal of the tissue.
The more fatal the lesion, the more rapidly it grows. Consequently, the lesional tissue borders become less defined and harder for the surgeon to see. There is a number of advantages regarding surgical removal of cancer cells. Some of them are such as: enhanced oral health, decreased pain sensations in the once infected area, and decreased tongue and oral inflammation and redness. “Localization of the disease facilitates the surgical procedure, making it easier for the surgeons to fully remove the lesion.” (Oral Cancer Foundation, 2019).
On the contrary, there are also some rather disturbing disadvantages of surgical treatment. If the patient’s condition has advanced into the facial bone structure, bone removal may be necessary for complete removal of the cancer. There are some cases where the cheek bones and infected parts of the jaw and mandible are removed. “Pain is the primary symptom of oral cancer, as it causes severe, intolerable difficulty in speech, mastication, and swallowing.” (Rivera, 2013)
Another gruesome advantage is such as bone grafting, the surgical practice of replacing or transplanting missing facial bone tissue with extra oral and facial bone tissue, the surgeon of course meticulously joining the underlying veins and arteries under microscopic vision to provide a healthy bone graft and increase the duration of the operation. The final disadvantage is facial deformity; the surgeon might have to remove some of the facial skin and lip line of the patient. Skin from the shoulders and chest are later grafted and surgically sutured in place of the removed facial skin. All in all, surgical excision is one of the oldest and most useful methods in cancer removal and it has saved many lives for so many years.
The second most widely performed treatment is chemotherapy. Mouth infections may cause pain and discomfort to the patient, and unfortunately their chances of developing secondary infections become high. Chemotherapy is known to be used with almost all cases and forms of cancer, and it is one of the most sufficient ways to get rid of cancer. Additionally, chemotherapy requires use of drugs which can be injected intravenously or orally; it may be in a tablet or liquid form and may also be taken at home although regular patient visits are mandatory.
The action and main objective of the injected drugs is to impair the mitosis and abnormal, rapid cellular division of the cancerous cells. Chemotherapy can fully cure a patient if it is done at early cancerous stages and can leave tolerable side effects for the patient once the treatment sessions are complete and the patient is cancer-free. “Once chemotherapy is successful, the recurrence probability of the cancer automatically decreases.”(Nurgali, 2006)
Among the diverse advantages of chemotherapy beside full recovery to health are such as: reduced probability of recurrent cancer, and stoppage of pain sensations. There are also many disheartening disadvantages such as alopecia (hair loss), nausea, vomiting, fatigue, temporary or permanent hearing impairment, low white blood cell count, and mucositis. “Nausea and vomiting are amongst the most feared side-effects for patients embarking on cancer chemotherapy.”(Nugali, 2006) In summary, chemotherapy is a competent treatment for cancer and it is still well known to this day.
Medically speaking, research claims that surgical treatment has proven to be the favorable treatment among all forms of treatment for oral cancer. It is shown to be the most effective because of a number of reasons. The first reason is because surgical extraction requires a single to visit in which the entire lesion is removed under a single operation, unlike chemotherapy, which requires frequent visits. “Surgery is the main and fastest treatment for oral cancer.” (Swinson, 2003).
It is always preferable for lesions and cancerous tissue to be removed with the aid of the human eye, to make sure as much of the cancerous tissue is removed to ensure potential patient safety and full health recovery. The second reason as to why surgical removal is favored is because it provides no pain for the patient since the patient is injected with anesthesia before undergoing the operation.
There may be some minor postoperative discomfort, but it is not as discomforting as the adverse side effects resulting from chemotherapy treatment. “In cases where treatment causes symptoms such as mouth sores, your chemotherapy nurse may encourage you to suck on an ice pop or ice chips while the drug is infused. These sores can be uncomfortable on their own, but can also predispose to secondary infections such as oral thrush.” (Eldridge, 2016) The presence of these post- treatment infections may further complicate the patient’s health and the need for following another treatment plan may be required.
The third and final reason regarding why surgical removal is recommended is because it helps restore oral hygiene and oral health contrary to chemotherapy, which may induce cold sores and secondary oral infections later on after chemotherapy treatment. Surgical excision of the lesion involves removal of all cancerous, rotting, malignant lesions which may have caused severe pain to the patient in performing some of the slightest daily tasks such as brushing teeth, flossing, and using mouthwash. “After surgery, your local surgeon may recommend reconstructive surgery to rebuild your mouth to help you regain the ability to talk and eat.”(Davis, 1998)
Surgical removal is by far, the fastest and most painless treatment for all kinds of cancers and it has improved tremendously with the use of 3-dimensional mapping and other advanced technological resources that, generally, have bypassed chemotherapy treatment.
In conclusion, the most suitable methods used for curing a patient from cancer is by the use of surgical technology and chemotherapy treatment. Although both are advanced, the top choice of treatment will always be surgical removal because of its shorter duration in treatment, more precise and positive results, and finally because of its minimal postoperative complications. Hopefully in the upcoming years surgery will become the dominant solution for cancers as the knowledge in the medical field evolves and as more practitioners become skilled in their surgical performances.
