Miracle surgery averts tongue and voice loss for a 32-year-old woman

In 2022 Shahnaz Fatima 32 noticed an uncommon white scar forming on her tongue informs her husband Mohammad Israr Over time this scar transformed into a persistent nonhealing ulcer remaining on her tongue for months Concerned about the ulcers persistence the couple opted to consult local medical professionals in their hometown Sidhartha Nagar Uttar Pradesh seeking advice and treatmentFollowing consultations with several doctors they were advised that the condition was leukoplakia However Israr found the diagnosis to be less than convincing and felt prompted to take his wife to Mumbai for a more thorough and accurate diagnosisUpon reaching Mumbai Shahnaz received a diagnosis of carcinoma at the Head and Neck Cancer Institute of India The prognosis initially included the possibility of tongue amputation which would have resulted in her losing the ability to speak However following the tongue cancer surgery conducted three months ago a portion of her tongue was successfully removed and she has since regained her ability to speakDr Kanav Kumar a surgical oncologist at the Head and Neck Cancer Institute of India along with Dr Sultan Pradhan Dr Rajan Kannan and Dr Mohsin Shaikh conducted surgery on Shahnaz ultimately saving her from losing her tongue In an exclusive interview with Midday Dr Kumar sheds light on the symptoms diagnosis and treatment of tongue carcinomaDr Mohsin Shaikh Dr Kanav Kumar Dr Sultan PradhanWhat were the symptoms that led to the diagnosis of tongue carcinomaKumar The specific characteristics of the ulcer on the tongue that led to the diagnosis of carcinoma included its nonhealing nature and painlessness Typically malignant ulcers such as carcinomas exhibit a lack of healing and are initially painlessIn this case the patient had been experiencing a nonhealing ulcer over the tongue for the past month which raised concerns regarding its nature The absence of pain initially is a common feature of cancerous ulcers as the disease progresses and involves surrounding nerves pain may develop as a later symptomThe combination of the ulcers persistence and painlessness prompted further investigation to rule out malignancy While nonmalignant ulcers can also occur for various reasons the duration of one month without signs of healing coupled with the lack of pain raised suspicion for carcinomaAdditionally considering the location on the tongue which is a common site for oral cancers heightened the concern for malignancy Consequently the patient likely underwent diagnostic tests such as a biopsy to confirm the diagnosis of carcinoma and initiate appropriate treatmentWhat was the extent of the surgery performed to remove the cancer from the tongue and ensure clear marginsKumar The tongue cancer surgery performed on Shahnaz aimed to ensure complete eradication of the tumour while preserving as much healthy tissue as possible The procedure involved excising the tumour along with a surrounding margin of approximately 1cm of normal tissue This margin was crucial to ensure that any potentially cancerous cells were completely removed minimising the risk of recurrenceTo verify the adequacy of the resection and ensure clear margins the excised tissue was immediately subjected to examination using a technique called frozen section analysis This process involves quickly freezing the tissue sample and then slicing it thinly for microscopic examination The advantage of frozen section analysis lies in its rapid turnaround time providing results within 1015 minutes while the patient is still in the operating room This immediate feedback allows the surgical team to assess whether the margins are free of tumour cells and if further resection is necessary to achieve clear marginsAlso Read How this new heart procedure saved the life of a 72yearold woman in MumbaiWere there any signs of metastasisKumar During Shahnazs surgery lymph nodes from the same side of her neck were meticulously cleared as part of the procedure This step was essential to assess whether the cancer had spread beyond the primary site in her tongue to nearby lymph nodes a common pathway for cancer metastasisFortunately the findings from the lymph node clearance were reassuring Despite the potential risk of metastasis no definitive signs of cancer spread were observed during the surgery This initial assessment was further confirmed upon final histopathological examination of the excised lymph nodesThis outcome was particularly encouraging as the presence of metastasis in the lymph nodes would have significantly impacted her prognosis and treatment plan The absence of lymph node involvement suggests that the cancer was localised to the tongue without spreading to other parts of the body indicating a more favourable prognosis for ShahnazSide effects associated with the surgical removal of tongue cancer and lymph nodesKumar The surgical removal of tongue cancer and lymph nodes while crucial for treating the disease can potentially lead to various complications and side effects One significant concern is the impact on speech and swallowing functionSince the tongue plays a vital role in articulating sounds and manipulating food during swallowing its removal or significant alteration can result in speech difficulties and swallowing problems Patients may require speech therapy and dietary modifications to manage these challenges effectivelyAdditionally the surgery can cause changes in taste sensation and mouth dryness affecting the overall quality of life Patients may experience discomfort pain and swelling in the surgical area following the procedure Moreover there is a risk of infection at the surgical site which requires vigilant monitoring and prompt treatment to prevent complicationsFurthermore the removal of lymph nodes can disrupt the normal drainage of lymph fluid leading to lymphedema a condition characterised by swelling in the affected area Lymphedema management typically involves physical therapy and compression garments to alleviate symptomsDespite these potential complications it is essential to note that advancements in surgical techniques and postoperative care have significantly reduced the incidence and severity of complications associated with tongue cancer surgeryMoreover in the case of Shahnaz the absence of cancer spreading beyond the primary site to other parts of the body as confirmed by examinations and investigations such as Xray and MRI suggests a more favourable prognosis and lower risk of systemic complicationsAre there any factors that may affect their longterm outcomeKumar Following surgery the prognosis for Shahnaz appears favourable particularly considering the absence of cancer spread beyond the primary site and the successful removal of the tumour and affected lymph nodesHowever the longterm outcome for patients with tongue cancer can be influenced by various factors including the stage of the disease the extent of surgical intervention and the presence of any underlying health conditionsIn her case the early detection of the cancer played a crucial role in minimising potential side effects and improving the prognosis Earlystage cancers typically require less extensive surgical intervention reducing the risk of complications such as speech alteration swallowing difficulties and shoulder stiffness Moreover early detection allows for more conservative treatment approaches preserving as much healthy tissue and function as possibleNevertheless factors such as the aggressiveness of the cancer the presence of any residual tumour cells and the patients overall health and response to treatment can also impact the longterm outcome Adjuvant therapies such as radiation therapy or chemotherapy may be recommended based on these factors to further reduce the risk of cancer recurrence and improve survival ratesAre there any lifestyle changes for such patients to reduce the risk of recurrence or further complicationsKumar In addition to undergoing surgery and potentially adjuvant therapies there are several lifestyle changes and precautions that patients of carcinoma need to consider First and foremost avoiding tobacco and alcohol consumption is paramount as both are significant risk factors for the development and progression of oral cancers including tongue cancerMaintaining excellent oral hygiene is also essential in preventing oral health issues and reducing the risk of complications Regular brushing and flossing can help remove plaque and bacteria from the mouth reducing the likelihood of oral infections and other dental problemsAnother important consideration is the use of wellfitting dentures Illfitting dentures can cause irritation and trauma to the oral tissues increasing the risk of complications and potentially hindering the healing process following surgeryFurthermore regular followup appointments with medical professionals are crucial for monitoring progress detecting any signs of cancer recurrence or complications early and adjusting treatment plans as neededAlso Read Indian startup develops AIbased blood test to detect 32 cancers early