At the end of the year 2015, WHO (World Health Organization) and ECFC (European Committee for the Fight against Cancer) placed cancer on the second position in a classification of the main death causes throughout the world, the first position being taken by the cardio-vascular diseases. Oral cancer is one of the most frequent, among the cancers of the entire human body, and belongs to the 10 most common death causes in the world.
In men oral cancer represents
- 4% of all cancers of the human body
- 2% of the deaths due to cancer
In women oral cancers represents
- 2% of all cancers of the human body
- 1% of the deaths due to cancer
Since 1994, when I started my training in Oral and Maxillofacial Surgery, I had the chance to examine a few thousands of head and neck cancer patients and conduct more than 1500 oncology surgeries. In all this time I learned to respect this terrible disease and that helped me a lot in my fight to cure as many cancer patients as possible. All the head and neck structures are vulnerable to cancer occurrence. It can affect the skin, oral mucosa, bones and lymph nodes. There are certain types of cancer that can be cured, either by surgery, or by the means of radio- and/or chemotherapy, whilst others, even properly treated, give the patients the chance to live a few more years only. The life expectancy in head and neck cancers was established at 5 years post treatment. After 5 years, the patients will normally be considered completely cured of cancer. That does not necessarily mean that a new cancer cannot occur in those patients, at any time after 5 years.
Most skin cancers are caused by exposure to the sun. This may be long term exposure, or short periods of intense sun exposure and burning. The ultraviolet light in sunlight damages the DNA in the skin cells. This damage can happen years before a cancer develops. The sun’s rays contain 3 types of ultraviolet light.
• UVA makes up most of our natural sun light. It goes deeper into the skin and causes skin ageing. It is now also linked to skin cancer
• UVB is most likely to burn the skin and is the main cause of non-melanoma skin cancer
• UVC is filtered out by the atmosphere of the earth (ozone layer)
Age and previous history of cancer, past radiation exposure, weakened immune system, the Human Papilloma Virus (HPV) and the contact with some specific chemical agents can also be involved in the development of a skin cancer.
Skin cancers are relatively frequent and can be generally classified in two groups:
Melanomas are extremely aggressive and life threatening forms of cancer and they require combined efforts from oncologists, surgeons and immunotherapy specialists, in order to cure the disease. In the past there was a rule, which governed the surgical approach of melanomas that any removal of such a malignancy should be done with at least 5cm safety margins. Today, although the 5cm margins are no longer required, the quality of the tumor resection is vital for a good prognosis. Still, patients with head and neck melanomas can easily develop regional lymph nodes metastasis, as well as remote metastasis, especially in liver. Interferon therapy is quite often necessary.
The second group can be divided in BCC (basal cell carcinomas) and SCC (squamous cell carcinomas). The BCCs, which form a group of slow growing tumors, with no spread in the lymph nodes and a very low tendency to metastasize, require, in most of the cases, only surgical treatment, having the highest cure rate of all head and neck cancers. If the disease is detected in its early stages, then the successful rate of the surgical treatment is very high. Whenever we have a case suspected of BCC, we can perform an excisional biopsy, which means that the lesion is completely and largely removed, just like in the case of a confirmed BCC. The resection margins should be of at least 5mm. We close the defect primarily, whenever it is possible and has good aesthetic outcome, and we use local flaps or skin grafts in all other situations. Patients with BCCs will be seen regularly, for 5 years, as follows:
1st year – every month
2nd year – every three months
3 – 5 years – twice a year
After 5 years, they will be discharged to their GP (general practitioner/family doctor).
The SCCs form a much more aggressive group of cancers. They are life threatening, grow more rapidly, spread to the lymph nodes and give metastasis. Once such a tumor is diagnosed, the wide surgical removal is mandatory. We prefer the 1cm safety margins in all cases of SCC. Prior to any surgery, we send the patients to have a CT Scan done, in order to assess the real extension of the tumor and the presence or absence of the lymph nodes involvement. If there is any evidence of lymph node involvement, then the tumor removal should be followed by a neck dissection. In most of the cases, postoperative radiotherapy is required. The follow up is the same as for the BCCs, for 5 years.