Oral & Maxillofacial Surgery
Oral Cancer Patient Care at Boston Medical Center
- Introduction to oral cancer patient care at BMC
- What is oral cancer?
- What are the symptoms of oral cancer?
- What causes oral cancer?
- How is oral cancer diagnosed?
- How is oral cancer treated?
- Our Team
- Cancer Survivorship Program
At Boston Medical Center (BMC), the care of patients with oral cancer is a collaborative, multidisciplinary process. Organizing our services around each patient, we bring together the expertise of diverse specialists and manage your care from your first consultation and diagnosis through treatment and follow-up visits. We guide you throughout the entire process and provide all these services in one location.
At BMC, diagnosis and treatment of patients with oral cancer combines the resources of a multidisciplinary clinical center dedicated to personal, patient-focused care with the state-of-the-art expertise and technological advances of a major teaching hospital. As the primary teaching affiliate of the Boston University School of Medicine, BMC is at the forefront of clinical practice, surgical expertise and research in oral cancer.
Refer a patient by calling 617.414.4838.
Oral cancer starts in the mouth, also called the oral cavity. The oral cavity includes the lips, the inside lining of the lips and cheeks, the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth, and the roof of the mouth. There are several types of cancer that can start in the mouth including: squamous cell carcinoma, slow-growing verrucous carcinoma, salivary gland carcinoma, and lymphomas of the tonsils and base of tongue. Oral cancers are part of a group of cancers commonly referred to as head and neck cancers, and of all head and neck cancers they comprise about 85% of that category.
Resources for more information:
- American Cancer Society’s Guide to Oral Cavity and Oropharyngeal Cancer at (http://www.cancer.org/Cancer/OralCavityandOropharyngealCancer/DetailedGuide)
- Oral Cancer Foundation at (http://oralcancerfoundation.org/)
It is important that you are screened annually for oral cancer; this is usually done by your dentist. If you notice any changes in your mouth or throat between examinations you should contact your dentist or physician. If you notice any of the following you should contact your physician or dentist immediately:
- Difficulty chewing or swallowing.
- A white or red patch anywhere in the mouth.
- A sore or lesion within the mouth that does not heal within two weeks.
- Trouble moving the tongue or jaw.
- Numbness in or around the mouth or jaw.
- Chronic hoarseness.
- Change in how dentures fit.
Oral and pharyngeal cancer continues to pose a significant public health problem. Traditionally, head and neck cancer was considered a disease of older men who abused tobacco and alcohol. Recent studies have implicated the Human Papilloma Virus (HPV) as an inciting factor in some people with oropharyngeal cancer, particularly those people under 45 years of age.
A small percentage of people do get oral cancers from no currently identified cause. It is currently believed that these are likely related to some genetic predisposition
From your first visit to BMC, you will receive highly coordinated, multidisciplinary care that is managed by a BMC Oral and Maxillofacial surgeon, a doctor who specializes in treating tumors and cancers of the oral cavity and the head and neck area.
Your surgeon will most likely order some testing to confirm the diagnosis of oral cancer. These tests may include: Computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). The surgeon may also order a combined PET CT test. All of these tests are important to help the surgeon come up with a diagnosis and a way to stage your cancer. Staging assesses the degree of local infiltration, involvement of regional lymph nodes and the presence of distant metastases or second primary tumors.
The surgeon may also perform a fine needle aspiration (FNA) to make a tissue diagnosis.
A CT scan could be described as a series of x-rays, each one a view of a 3mm section of the area being scanned, which are then manipulated by a computer, allowing doctors a dynamic view of the affected soft tissue areas of the body with much greater detail than a simple x-ray.
An MRI is a non-invasive diagnostic imaging that doesn't use ionizing radiation. It is painless and a harmless way of looking inside the body without using X-rays. Instead it uses a large magnet and computer to scan your body. This provides your doctor with information not available from other scans.
A PET scan is an imaging test that can help show how your tissues and organs are functioning. A small amount of radioactive material is used to show this activity. The radioactive material is usually injected into a vein and swallowed. More radioactive material accumulates in areas that have higher levels of chemical activity. This often corresponds to areas of disease and shows up as brighter spots on the PET scan. A PET scan is a useful tool in evaluating cancer.
A biopsy is necessary to identify the type of cancer. A small amount of tissue is cut from the growth and sent to the laboratory to be examined under a microscope. It can very often be tender afterwards, and several small stitches may be used to help the area to heal.
Fine Needle Aspiration
This is a simple test that involves sticking a needle into the cancer (especially if it is a lump in the neck), and cells are aspirated into a syringe. These are then sent to the laboratory for examination under a microscope.
If you have a suspected or confirmed diagnosis of oral cancer, your physicians will use a variety of diagnostic procedures to stage the disease and to determine its severity and spread.
At BMC, your cancer care is integrated at all levels including diagnosis, treatment and supplementary therapy. Specialists from medical oncology, radiation oncology, otolaryngology, dentistry, speech/language pathology and other medical disciplines combine their expertise to provide you with an integrated, individualized treatment plan.
With their depth and range of expertise, our specialists apply a wide array of state-of-the-art techniques to cure patients by removing and killing cancerous tissue. Your plan may include surgery, radiation, chemotherapy or a combination of these treatments.
Surgery remains the primary method of treatment for cancers of the oral cavity. Our surgeons also use the most advanced techniques; some offered no where else in the region. Surgery includes removal of the cancerous tissue, lymph node sampling and complex reconstruction.
Reconstruction of the lips, tongue and floor of mouth is frequently performed with microvascular free tissue transfer. This technique optimizes quality of life by restoring function in the shortest time frame by “transplanting” the patient’s own tissues. These reconstructive surgeries are complex and labor intensive and require the use of an operating microscope to connect blood vessels in transposed tissues.
BMC aims to provide New England with a state-of-the-art tertiary care center for oral and oral pharyngeal cancers. Our patient-centered, multidisciplinary approach assures each patient benefits from the collaborative expertise of physicians uniquely focused on their individual needs.
BMC’s Director of Maxillofacial Oncology Andrew Salama, DDS, MD, is a dually-qualified oral and maxillofacial surgeon who brings a unique dentally-minded perspective to his patient care. Dr. Salama is leading his team to provide the latest technologies and practices in oral and pharyngeal cancer treatment. His current clinical research involves evaluating tongue motion and speech following reconstructive surgery and developing novel chemo-preventive medications for oral cancer. Meet our team.
A diagnosis of cancer can be a life-altering experience. The BMC Cancer Support Services Program provides a comprehensive set of services to help patients focus their energy on combating and coping with their disease. Designed to improve long-term outcomes and survivorship, these services address a range of medical, social, economic and emotional needs.
At BMC, we understand that cancer affects patients and families in many ways. We are here to support you during all aspects of care—from diagnosis through treatment and recovery. We offer a comprehensive array of support groups, workshops, lectures and activities designed with you in mind.
The Head and Neck Cancer Support Group meets monthly in the Moakley building. The schedule and location can be found on our Cancer Support Newsletter.