Study resolves longstanding dilemma in mouth cancer treatment

Mouth cancer patients who have their neck glands removed at the same time as having the cancer removed from their mouth have a lower risk of death and tumour recurrence according to a study involving UCLH – a finding that could mean over 21,000 more patients can be cured of mouth cancer worldwide every year.

The UK-wide study – which at UCLH was led by Mr Nicholas Kalavrezos – resolves a longstanding medical dilemma. Oral cancers can easily spread to lymph glands in the neck, but guidelines are currently unclear on whether patients with early stage oral cancer without overt neck disease benefit from upfront elective neck dissection – where the lymph glands are removed – particularly those with the smallest tumours.

The question has been whether early neck surgery unnecessarily increases side effects experienced by the patient – or whether a more precautionary approach is safer overall.

But researchers said guidelines can now be updated after the SEND (Selective Neck Dissection) study – written up in the British Journal of Cancer – found that survival and recurrence rates improved after neck surgery even where scans showed no sign of cancer deposits in the neck glands.

The study involved 68 oral and maxillofacial surgeons treating 614 patients at 27 hospitals across the UK.

Co-author of the paper Professor Iain Hutchison from Barts Health NHS Trust said: “We now have clarity over an issue which has vexed surgeons for over 20 years about how best to treat patients with small cancers who may have undetectable tiny cancer deposits in their neck glands.”

Mr Kalavrezos said: “Due to the size and scope of this study, the findings are applicable worldwide and should directly improve clinical practice.”

The SEND study was funded by Cancer Research UK, and mouth cancer patient Elliott Bernerd with Saving Faces.

November is mouth cancer awareness month.