Overview
I. Functional Anatomy & Pathology The oral cavity is a vital anatomical region responsible for speech, deglutition (swallowing), and facial aesthetics. It comprises the lips, tongue, floor of mouth (FOM), gingiva (gums), mandible (jaw), buccal mucosa (cheeks), hard palate, and the retromolar trigone (RMT). The vast majority of malignancies in this region are histologically identified as Squamous Cell Carcinoma (SCC).Clinical Evaluation & "Red Flags"
A meticulous physical examination is the first step in staging. Clinicians look for specific indicators of advanced invasion:
• Tongue Mobility & Speech
• Dental Integrity
• Trismus (Lockjaw)
• Neuropathy
III. Advanced Diagnostic Imaging To map the disease accurately, a multi-modal imaging approach is utilized:
• Contrast-Enhanced CT of Head, Neck and Thorax
• MRI if in doubt of extent of soft tissue invasion
• FDG-PET/CT for advanced disease
Multidisciplinary Treatment Strategy
In alignment with NCCN, ASCO (American Society of Clinical Oncology), ESMO (European Society for Medical Oncology) Guidelines. The management of oral cancer is best executed by a Multidisciplinary Team (MDT). This includes head and neck surgeon, reconstructive plastic surgeons, radiation and medical oncologists, and specialized dental and rehabilitation teams, Pathologist, Radiologist.Treatment Approach
Surgical Principles Surgery is the primary treatment modality for both early and advanced stages. The objective is a R0 resection (complete removal with clear margins).
• Approach Selection: Anterior lesions (trans-orally) posterior (pull-through" technique or a lip-split mandibulotomy) for adequate exposure.
• Modern Innovation: Transoral Robotic Surgery (TORS) is increasingly used for posterior sites i.e base of tongue/tonsils Reconstruction & Rehabilitation
• Radial Forearm Free Flap (RFFF)
• Anterolateral Thigh (ALT) Flap V. Adjuvant Therapy (Post-Surgery) According to NCCN and American guidelines, the need for further treatment is dictated by the final pathology report:
• Radiotherapy (RT): Recommended for advanced-stage tumors or specific adverse features (e.g., PNI, LVI).
• Chemoradiotherapy (CRT): Mandated when positive surgical margins or extranodal extension (ENE) are identified.
• Technology: Intensity-Modulated Radiation Therapy (IMRT) is now the standard of care, significantly reducing long-term side effects like chronic dry mouth (xerostomia) and tissue fibrosis.