Oral Cancer Treatment: Key Questions and Considerations

Malignant tumors: Oral cancer issues?

My mother underwent an oral biopsy at the hospital a month ago, and the results indicated carcinoma in situ.
She was later transferred to another hospital for further management, where the physician deemed it unnecessary to perform another biopsy.
Instead, he recommended directly excising the affected area (the posterior maxillary gingiva) and sending the excised soft tissue for examination.
We followed the physician's advice.
The interval between the initial biopsy and the surgical excision of the soft tissue was about one month.
Recently, the pathology results came back, revealing a malignant tumor.
The physician has now suggested that surgery is necessary to perform a wider excision, including the alveolar bone.
However, prior to the surgery, a CT scan of the head and neck and a PET scan will be conducted.
Currently, the family is still considering this, as my mother is 84 years old, and we are unsure if she can undergo another surgery in such a short time.

I would like to ask if the physician has any recommendations regarding this situation.
When my mother was transferred to the other hospital, should the normal procedure not have included performing another biopsy and completing preoperative evaluations (such as a CT scan of the head and neck and a PET scan) before proceeding with surgery? Is there a possibility that there was an oversight in the physician's management process? Why is there such a significant discrepancy between the results of the initial biopsy and the pathology report of the excised soft tissue?

barry, 50~59 year old female. Ask Date: 2022/03/01

Dr. Zeng Guanghui reply Dentistry

If the initial biopsy reveals spindle cell carcinoma and a subsequent complete excision of the visible lesions still shows spindle cell carcinoma upon pathological examination, it suggests that the spindle cell carcinoma may have spread to the underlying alveolar bone.
Surgical intervention is recommended, and preoperative imaging such as CT and PET scans is primarily conducted to assess the extent of the lesion's invasion, which will help determine the scope of surgical resection.
It is advisable to consult an oral surgeon for further evaluation and discussion.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2022/03/01

More Info

When it comes to the treatment of oral cancer, particularly in cases like your mother's where there is a diagnosis of squamous cell carcinoma in situ, there are several key considerations that need to be addressed. The situation you've described raises important questions about the treatment process, the timing of procedures, and the implications of the findings from the biopsies and subsequent surgeries.

Firstly, regarding the decision not to perform a repeat biopsy after transferring to another hospital, it is generally considered standard practice to confirm the diagnosis with a fresh biopsy, especially when there is a significant time gap between the initial diagnosis and the proposed surgical intervention. This is particularly crucial in cases where the initial biopsy indicates a potentially malignant condition. The rationale behind this is to ensure that the treatment plan is based on the most current and accurate information regarding the tumor's characteristics, including its aggressiveness and extent.

The gap of approximately one month between the initial biopsy and the surgical excision could potentially allow for changes in the tumor's status. If the tumor were to progress during this time, the initial treatment plan may no longer be appropriate. Therefore, it is understandable to question whether there was a lapse in the standard care protocol during this transition.

The significant difference in findings between the initial biopsy and the subsequent pathology report of the excised tissue is concerning. This discrepancy could arise from several factors, including sampling error, where the initial biopsy did not capture the full extent of the disease, or the possibility that the tumor had progressed in the interim. It is essential to discuss these findings with the treating oncologist to understand the implications and to ensure that the treatment plan is adjusted accordingly.

As for your mother's age and the recommendation for further surgery, it is crucial to weigh the potential benefits of the surgery against the risks, especially considering her advanced age. Surgical interventions can be more complicated in elderly patients due to factors such as comorbidities, recovery capacity, and overall health status. A thorough preoperative assessment, including imaging studies like CT scans and PET scans, is essential to evaluate the extent of the disease and to plan the surgical approach effectively.

In terms of treatment options, if surgery is deemed too risky, other modalities such as radiation therapy or chemotherapy may be considered, depending on the specific characteristics of the cancer and the patient's overall health. Palliative care should also be discussed to manage symptoms and improve quality of life.

Ultimately, it is vital to have open and honest discussions with the healthcare team, including oncologists and surgical specialists, to explore all available options and to make informed decisions that align with your mother's health goals and preferences. Seeking a second opinion from a multidisciplinary team specializing in head and neck cancers may also provide additional insights and treatment alternatives.

In summary, the treatment of oral cancer involves careful consideration of diagnostic accuracy, timing of interventions, and the patient's overall health status. It is essential to ensure that all decisions are made collaboratively with the healthcare team, taking into account the patient's unique circumstances and preferences.

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