Head and Neck Oncology
Oral Cavity Cancer
Surgical resection and reconstruction for tongue, base-of-tongue, floor-of-mouth, lip, and buccal cancers.
How is oral cavity cancer recognised and treated?
Oral cavity cancer covers tumours from the lip to the hard palate, anterior 2/3 of the tongue, floor of mouth, and buccal mucosa. The most common symptom is a non-healing oral ulcer lasting more than 3 weeks; pain, chewing/swallowing difficulty, bleeding, and a neck lymph-node mass may follow. Risk factors: smoking, alcohol, betel/quid use (Asia), HPV (rising in younger patients). Diagnosis is by incisional biopsy + MRI/PET-CT staging. Treatment: T1–T2 early tumour — surgical resection (alone may suffice); T3–T4 — surgery + neck dissection + post-operative radiotherapy (chemotherapy if indicated). 5-year overall survival: early stage 80%+, advanced 40–60%.
Surgical resection principles
Resection of tumour + 1 cm healthy surrounding tissue is standard. Partial glossectomy in the tongue (removal of part of the tongue), margin-controlled resection in the floor of mouth, full-thickness resection in the buccal mucosa. Neck dissection is added when neck nodes are clinically or radiologically positive; elective neck dissection is common in T2+ tumours even when clinically negative.
Post-resection reconstruction: primary closure for small defects, local flap for medium defects, microvascular free flap for large defects (most often radial forearm or anterolateral thigh flap). The reconstruction target is preservation of speech, mastication, and swallowing as much as possible.
Frequently Asked Questions
- ENT or oral surgery evaluation is needed. A non-healing ulcer is malignant until proven otherwise; incisional biopsy clarifies.
- Yes. HPV-associated oral cancers are rising in younger non-smoking patients. Genetic predisposition and betel/quid use are also risk factors.
- After small tongue resections, most patients return to near-normal speech in weeks. After extensive resections, speech-therapist-led rehabilitation is critical.
- Yes — it largely prevents HPV-associated oral cancers. CDC and ECDC recommend HPV vaccination for young individuals (recommended ages 9–26).
- For patients planned for radiotherapy, pre-op dental evaluation is standard. Caries and suspicious teeth are extracted before radiotherapy to avoid osteoradionecrosis risk.
References
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