Tuesday, May 7, 2013

HEAD NECK 12 Tongue Cancer


5.3 TONGUE
 
Carcinoma originates at the tip or along the free borders:   Area
of hyperkeratosis develops first.
 
Later  this  develops  into an ulcerated  lesion  with  exophytic
undermined border.
 
Palpation  detects  hardness  and  indicates  that  invasion  has
occurred beyond the ulcer.
 
Spread   cancer  of  the  tip  of  the  tongue  metastasises   to
ipsilateral sub mandibular nodes and later the nodes at the  angle
of  the mandible are involved. 
 Forty percent have nodes  at  the time of presentation.
 
CLINICAL
 
The patient presents with :
-  Pain
-  Salivation
-  Fixation of Tongue
-  Dysphagias
-  Difficulty in speech
-  Foetor
 
Diagnosis
 
Multiple biopsies establish the diagnosis and the extent in large
tumours.
 
TREATMENT
 
T1NoMo lesions can be treated by radiotherapy or surgery as small
lesion  is  removed  with 1.5 cm margin  of  healthy  tissue  all
around.  Lesion of upto 1cm can be treated by interstitial radion
with Iridium192 wire. 
 
Combined  operation  including  wide resection of  a  small  oral
lesion  if  they  have nodes at the time  of  presentation,  they
require radial neck dissection.
 
Treat  all  larger lesions with preoperative  radiation  therapy,
following  this with a radical neck dissection and in  continuity
excision of any residual cancer.

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