The doctor clicked the mouse, looked at the computer, slowly turned to the patient and his family, and announced that it was indeed oral cancer. When the doctor said how long he could live, did he kill the hope of survival? Zheng Kaiyuan, the attending physician of the Otolaryngology Department of Pingtung Hospital, admits the patient's sensibility!

The doctor clicked the mouse, looked at the computer, slowly turned to the patient and his family, and announced that it was indeed oral cancer. A 49-year-old Mr. Chen, with a worried mood and a sad face, came to the clinic to listen to the last lecture. At this point, the atmosphere is stagnant, and Mr. Wang seems to have a good idea; The wife sobbed and burst into tears. The doctor sat tight, thinking about how to explain. Then the wife's depression finally broke out, and she began to cry and complain, "I told you to quit betel nut, but you didn't listen." Then he asked the doctor anxiously, "How to treat it? What stage?" Is there any hope? How long can you live? The above situation is constantly being staged in outpatient clinics. Check the staging of oral cancer after the pathological section is confirmed.

Zheng Kaiyuan, an attending physician in the Department of Otolaryngology, Pingtung Hospital, Fuwei Department, said that once oral cancer is diagnosed, doctors will arrange a series of tests to determine the stage of cancer. The examinations include computed tomography, magnetic resonance imaging, positron emission tomography, ultrasound, nuclear medicine photography, X-ray examination, gastroscopy and hematology examination. According to the grading system of TMN primary tumor size (T), cervical lymph node metastasis (N) and distant metastasis (M) of American Joint Cancer Committee (AJCC), oral cancer can be divided into 0-4 stages. Stage zero is carcinoma in situ, and the cells are confined to oral mucosa epithelium. The primary tumor was less than or equal to 2 cm, and there was no cervical lymph node (or distant organ) metastasis. The second stage tumor was 2-4cm, and there was no cervical lymph node or distant organ metastasis. The third stage lesion was larger than 4 cm, but it did not invade other deep tissues nearby, and there was no cervical lymph node metastasis. Or regardless of the size of the lesion, a single lymph node with enlargement less than 3 cm in the ipsilateral neck can be touched. In the fourth stage, there are any of the following situations, including the tumor invading adjacent tissues, such as metastasis through the outer layer of jaw, deep muscles, maxillary sinus, skin and cervical lymph nodes, contralateral or bilateral cervical lymph nodes, unilateral cervical lymph nodes exceeding 3 cm, and distant organ metastasis.

According to different clinical stages, the treatment methods include surgery, chemotherapy and radiotherapy.

As for treatment, according to the standard of NCCN (National Comprehensive Cancer Network), in principle, oral cancer is mainly surgical resection. Radiotherapy and chemotherapy are usually used in combination with advanced postoperative patients, or as alternative therapy in some cases. The operation process can be divided into three parts: primary site resection, neck lymph node dissection and wound reconstruction. Zero-stage and first-stage oral cancers usually only need to remove the primary site, while the ipsilateral or bilateral cervical lymph nodes need to be removed for second-stage and above oral cancers. Stage III and Stage IV oral cancer may need to be reconstructed with free flaps of arms, legs and calves due to the large resection range of the primary site. Radiation therapy is effective for small localized tumors in the first and second stages and can be used as alternative therapy. For patients with stage 3 and 4, surgery or chemotherapy must be combined. If there are risk factors after operation, such as tumor cell residue at the edge of surgical incision, lymph node metastasis, lymph node extramembranous invasion, peripheral nerve or lymphatic invasion, etc., postoperative radiotherapy is needed, and oral cancer can not be cured by chemical drugs alone. Therefore, the treatment of oral cancer is a multidisciplinary and multi-team cooperation. Including otolaryngology, dentistry, plastic surgery, radiation oncology, hematology oncology, rehabilitation, dietitian, cancer personal manager, practical nurse team, social worker team, etc. , which is the so-called customized integrated holistic nursing.

The earlier the survival rate of oral cancer, the better.

Most people are concerned about the prognosis. According to the statistical analysis of the national medical service system, the five-year survival rate of oral cancer in China from 1996 to 100 is: 83.2% in stage zero, 76.9% in stage one, 67.7% in stage two, 54.9% in stage three and 33.3% in stage four, which still ranks fourth among the top ten male cancers. Early detection, early treatment effect is obviously better than late.

Although doctors know such statistics, it is cruel for doctors to answer how long they can live. After all, doctors are not God. How can they decide life and death? Dr. Zheng has always believed that statistics are only for reference, and it is a miracle that every patient can survive. Although death is terrible, despair is even more terrible. When the doctor said how long he could live, did he kill the hope of survival? When a doctor bathes a baby, he always naively answers "a long time" when asked how long it will take to finish the bath. I hope he can answer the patient casually: "I can live for a long time"!

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