Head & Neck Cancer surgery

Benign and Malignant Tumours of the Head & Neck

The oral cavity contains numerous structures that may be affected by both benign and malignant tumours.

A key distinction: benign tumour cells do not usually invade surrounding tissues or spread to other parts of the body.

Malignant tumours, by contrast, are composed of cancerous cells that can invade and damage nearby tissues and organs.

Cancer develops when cells begin to function abnormally and divide uncontrollably. Malignant cells can also break away from the original tumour and enter the bloodstream or lymphatic system, spreading to distant organs in a process known as metastasis.

This is the mechanism of spread of the original (primary) tumor to other organs. This phenomenon is called metastasis.

Oral cancer spreads initially to the lymph nodes of the neck and subsequently to other organs. While oral cavity tumours most commonly affect people over 45, they can develop at any age.

Symptoms to Be Aware Of

Here is a list of the most common symptoms:

• A lump or mass on the lips, inside the mouth or in the throat
• A white or red patch on the gums, tongue or inner lining of the mouth
• Unexplained bleeding or numbness inside the mouth
• Swelling of the jaw that prevents a denture from fitting properly or causes persistent discomfort
• A lump on the side of the neck or beneath the jaw

Diagnosis

If an abnormal area is found in the oral cavity, a biopsy is the only reliable way to determine whether cancer is present.

Patients are referred to an oral and maxillofacial surgeon, who will perform a minor procedure to remove a small sample of the abnormal tissue, which is then examined under a microscope by a pathologist to identify the presence of tumour cells.

The vast majority of malignant oral tumours are squamous cell carcinomas. Staging investigations combine clinical examination with imaging, including conventional radiography, MRI and CT scanning.

The surgeon will also palpate the neck lymph nodes to detect any swelling or abnormality and may request additional tests to identify distant metastases or a second primary tumour.

Treatment

Following diagnosis and staging, the oral and maxillofacial surgeon will devise a treatment plan tailored to the patient’s condition, in accordance with international clinical protocols.

Take into account the location, size, type, extent and stage of the tumour, as well as the patient’s age and general health.

If metastatic spread is confirmed, the surgeon may also remove the cervical lymph nodes in conjunction with resection of the primary tumour.

Risk Factors

Oral cancer is most common between the ages of 40 and 70. In recent decades, cases among younger patients have increased, especially those located on the tongue.

Oral carcinoma is associated with a range of risk factors, including environmental carcinogens, viral agents, poor diet, chronic trauma, inadequate oral hygiene, and genetic and systemic factors.

The risk of oral carcinoma is 6 to 28 times higher in smokers. This risk increases further when combined with alcohol consumption. The main cancer-causing agents are polycyclic aromatic hydrocarbons and aromatic amines, by-products of tobacco smoke, with or without alcohol misuse.

Pre-cancerous lesions — including leukoplakia, erythroplakia and oral lichen planus — play a central role in the development of oral cancer and should be identified and monitored early.

For this reason, all individuals aged 40 or older are advised to undergo at least one annual check-up at an oral and maxillofacial surgery clinic as part of an oral cancer prevention programme.