Journal of Oncology Translational Research

Palliative Management of Late Stage Tongue Cancer by Laser: Experience of twenty patients

Abstract

Dilip Pawar

Oral cancer is the most common Cancer in Indian Males. Risk factors include tobacco use, heavy alcohol use and human papillomavirus (HPV) infection. Symptoms include a sore that doesn't heal, a lump or a white or red patch on the inside of the mouth. Late stage tongue cancer is defined as any cancer in stage 4 which is unresectable. This happens either because of an increased size or early involvement of posterior part of tongue. Treatment includes surgery and radiation therapy. In some cases, chemotherapy may be required. Palliation in this condition is limited to nasogastric tube, pain management and Tracheostomy. Aspiration pneumonia is a progressive condition which keeps on increasing as the mobility of tongue decreases gradually. This becomes increasingly intolerable for patients as the tumour growth enhances. These patients have an extremely debilitating and limited life. Field cancerisation is very common in these patients leading to a very high incidence of recurrence. The conventional treatment modalities like chemotherapy and Radiotherapy are again not very effective and addition of Radiotherapy leads to an extensive side effects. There is inability to swallow solids more than liquids. Speech is badly affected, mucositis and xerostomia are common side effects. Long term effects include cricopharygeal stenosis. Most patients are at a disadvantage regarding their quality of life after palliative radiotherapy for tongue cancer. Lasers and light source technologies can be applied to a wide variety of open and laparoscopic surgeries, as well as other procedures encountered by general surgeons and other medical professionals. The ability to produce highly precise and controllable effects on tissues, and the potential to facilitate complex dissection make these devices a welcome addition to the armamentarium of the surgeon, who is skilled in their use. Each laser wavelength has a characteristic effect on tissue. The combination of the laser tissue interaction, the selection of the appropriate delivery systems and laser parameters determines the ultimate effects of laser use on the conduct and outcomes of surgery. The use of laser to ablate the tumors was used in late stage tongue cancers. Laser ablation of late stage cancers of tongue is used for debulking the tumor in a blood less manner. Laser ablation destroys the Tumour thermally over a real time basis. The use of real time imaging allows a constant monitoring of the destroyed area. There was a marked increase in quality of life. Which was apparent within a week? There was also a marked increase in the life span of patients. Conclusion: Laser ablation offers a viable alternative for palliation in late stage Tongue cancer. The Palliation achieved depends on age of patient and involvement of volume of the tongue.