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The care of patients with oral cancer is a collaborative, multidisciplinary process. In a highly supportive and patient-focused environment, the Cancer Care Center organizes services around each patient, bringing together the expertise of diverse physician specialists to manage care from the first consultation through treatment and follow-up visits. BMC is the primary teaching affiliate of the Boston University School of Medicine, combining state-of-the-art expertise with the technological advances of a major teaching hospital that is at the forefront of clinical practice, surgical expertise, and research in oncology. The Cancer Care Center’s goal is to provide treatment that is effective and innovative in curing and controlling cancer, while managing its impact on quality of life.
What is oral cancer?
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.
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What are the symptoms of oral cancer?
It is important to be screened annually for oral cancer; this is usually done by a dentist. Patients who notice any changes in their mouth or throat between examinations should contact their dentist or physician. Any of the following are reasons to contact a 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
What causes oral cancer?
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.
Treatments & Services
At BMC, a patient’s 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 an integrated, individualized treatment plan.
With their depth and range of expertise, the Center’s specialists apply a wide array of state-of-the-art techniques to cure patients by removing and killing cancerous tissue. The treatment 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. BMC’s surgeons use the most advanced techniques, some offered nowhere 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 the 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.
Diagnostics and Tests
From a patient’s first visit to BMC, he or she receives 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.
The surgeon will most likely order some testing to confirm the diagnosis of oral cancer. For a suspected or confirmed diagnosis of oral cancer, physicians will use a variety of diagnostic procedures to stage the disease and to determine its severity and spread.
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 the patient’s 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.
Computed Tomography (CT) Scan
CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut.
Magnetic Resonance Imaging (MRI)
This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple planes. Some people may need an IV put in place so caregivers can inject a contrast solution into their veins. This depends on the exam the doctor has ordered. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT.
Positron Emission Tomography (PET) scan
A PET scan is used to detect cellular reactions to sugar. Abnormal cells tend to react and "light up" on the scan, thus helping physicians diagnose a variety of conditions. For the PET scan, a harmless chemical, called a radiotracer, is injected into your blood stream.
Fine Needle Aspiration (FNA) Biopsy
FNA uses a thin, hollow needle (thinner than the needles used to draw blood) to draw out fluid or tissue from a lump. Depending on the size and location of the lump, the needle is sometimes directed into the lump simply by feeling it. Other times it may be guided into the lump with the assistance of an ultrasound.
BMC aims to provide New England with a state-of-the-art tertiary care center for oral and oral pharyngeal cancers. The 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.