1.What is the stage of my cancer?
Presence of a lymph node in neck is stage 3
Involvement of bone,muscles of cheek or skin or size more than 4
cms is stage 4
In stage 3 and 4 there is increased chances of Field cancer i.e even if the tumour is
removed there is residual tumour in the surrounding areas which leads to recurrence.
In simple words
if the cancer was removed 100% after an extensive surgery there would be no need for
chemotherapy and radiotherapy.
The very fact chemotherapy and radiotherapy
is advised after surgery means the surgeon knows that 100% of tumour is not removed.
The original tumour is never a problem it is always the “Field Cancer” which proves fatal.
Basically it means in stage 4 cancer the conventional surgery is of no use in controlling cancer.
The average life span is 8 months only.
Your cancer doctor will be able to elaborate more on this.
Please click on this >>>link of field cancer to know more<<<
Field cancer is the reason why all surgeries fail in stage 4
Field cancer makes it impossible to treat the patient after surgery as the face is having extensive mutilation and
mouth opening is very limited.
The recurrence though starts early cannot be seen by the surgeon or treated by another surgery
2. How does laser work.?
Laser surgery is divided into 2 parts:
Cutting & Ablation.
In cutting mode it is no different from a knife and the results are same as a knife or conventional surgery.
Most doctors are trained in cutting mode as it is an extension of their training.
Laser ablation is a different procedure with different training and study.
Laser ablation can burn the visible part of tumour without it affecting surrounding tissues significantly.
The residual cancer which is mostly microscopic is called field cancer is now acted upon by chemotherapy and radiotherapy. These obviously now have a better effect .
In our experience whatever the oncologist hopes to gain in 6 sessions of chemotherapy is obtained by a single session of laser .
The best part is that laser has no significant side effects like radiotherapy and chemotherapy.
This makes it ideal for advanced cases and cases of recurrence after surgery.
3. What is the cure rate of my cancer after Conventional Surgery?
Cure rate depends on staging of cancer .
It is high in stage 1 and 2 but not 100%
It is very low in stage 3 and for all practical purposes nil in stage 4.
IT IS HIGHLY IMPROBABALE TO ESCAPE CANCER IN STAGE 4 BY CONVENTIONAL SURGERY .
4. Why is laser not available everywhere?
Any new technology in Medicine takes a long time to get accepted
and then an equally long time for surgeons to get trained in.
For example laparascopic surgery took
25 years to become mainstream but even after that only a handful of senior surgeons could make the switch
Laser varicose veins has been accepted and awareness among patients and surgeons is
very high approaching 100% in surgeons today.
The % of surgeons doing laser varicose veins is 0.3 %.
This figure is after 10 yrs of the procedure being accepted as gold standard .
Now the problem gets more complicated in cancer.
Though the latest NCCN guidelines mention laser surgery as an alternative option.
The skill sets required are maybe 10 times more than varicose veins.
The uncertainty is equally high as is the nature of disease.
But things are improving and we hope to see this technology in all hospitals in the near future.
5. Why does my surgeon not recommend Laser?
Laser techonology has been evolving in last few years .
Many of the practising surgeons are yet to explore this evolving new technology and
would prefer old and tried and tested technology .
6. Why is my family doctor not endorsing laser?
Laser medicine as discussed earlier is very new .It is not so widespread so your doctor in all probability has not encountered a case or a surgeon practicing laser surgery
7. Why is chemotherapy and radiotherapy given after surgery?
Chemotherapy and radiotherapy work on the principle that rapidly dividing cells are more susceptible for being destroyed.
Surgery cannot remove 100% of the tumour.
Cancer cells which are remaining are now supposed to be destroyed by this chemotherapy and radiotherapy.
At least that is the plan. That it does not work is known to all patients.
This happens due to a no of factors .In our experience one of the most important reasons is the decrease of immunity after conventional surgery.
This happens because the oral intake is drastically reduced and the inner willpower of the patient in most cases becomes non existent.
8. If my tumour is taken out why does it come back again?
It is generally never the original tumour which
comes back in surgery since the original tumour is taken out.
Rough time lines for recurence are as follows
Within 2 month ----- Original tumour
2 month to 4 months ----
4 months to 6 months -----New trauma or field cancer
After 6 months --- Radiotherapy which was used for curing the disease
causes genetic mutation which is an ongoing process in many cases.
Above time lines are for the time when recurrence is first seen by investigation.
In most cases the time when patient observes the recurrence is much later than when the recurrence starts.
9. My cancer has come back after surgery what is my chance of getting cured?
After stage 4 when chemotherapy and radiotherapy have been used alone,cure chances are practically nil.
Still in stage 4 even if surgery has been performed ,chances are very low.
10. Can laser be used alone?
Laser can be used alone in stage 1 and 2 but in stage 3 and 4 it has to be used with chemotherapy and radiotherapy(but in 80% less dose).This is due to the fact that no single treatment can remove cancer by 100%.. chemotherapy and radiotherapy are needed to cover the remaining cancer.
Typically surgery removes 98% of tumour with mutilation and laser will remove approx 95% but without mutilation .
This makes him in a fit state to carry out his daily activities and fight his disease.
That is why laser is much superior.
Please see video on home page for the patient reactions after laser and surgery.
11. Can I repeat laser for control of my cancer?
In many cases of recurrence where Radiotherapy and chemotherapy have been used up. Laser can be used to control the spread.
It can offer a real relief from many symptoms of cancer and this is called Palliation.
We may repeat the procedure monthly to keep the cancer under control.
It must be remembered that rarely if ever patients of oral cancer die of distant spread of their disease. They generally die of local complications like inability to eat,drink,breathe or erosion into a blood vessel causing uncontrollable bleeding or spread into the brain
12. What is the chances of cure in late stages with laser?
Late stage or stage 4 is divided into 2 parts
2.extensive spread i.e spread to base of skull and liver/Lungs.
spread the chances are bright but in extensive spread only
thing a patient can hope to achieve is a good remission for
a couple of months.
Laser in this stage can give a very good relief from pain and local swelling.
It is important to know that most patients of head and neck carcinomas have a local spread.This is because the
in Mouth cancer the extensive spread comes very late.
Therefore a good local control is immensly beneficial to the patient.(pl look up testimonials )
13. How will my life change after Conventional surgery?
Bulk of surgery in oral cancer involves a surgery called Commando operation in which a piece of jaw bone is removed along with draining lymph nodes in neck.
The common complaints of patients after this surgery is inability to sleep
Inability to eat normally , inability to drink normally
Speech becomes garbled.
Patients basically retreat into a shell and depression is the most common problem.
They become what we call ORAL CRIPPLES.
Work and social activities are severely affected.
Eating is by putting everything in a mixer and trying to swallow something which tastes like sawdust.
The cosmetic appearance is so bad the patient becomes a total recluse.
Basically every patient agrees it is not a life worth living.
After all this suffering cancer comes back within 4 months.
We firmly believe that if a doctor cannot make your life longer and better then he has no right to make it worse.
14. What is the Quality of life after Laser surgery?
Laser destroys the tumour without any surgery..The pain and swelling vanish within 1 month in most cases.
The patient is able to join work around 2 weeks in most cases.
He is typically advised a high protein diet to fight the remaining disease with chemotherapy and radiotherapy.
He is advised to proceed with exercise and yoga to increase the immunity.
In our experience in most cases the original tumour vanishes within 2 months.
15. Have you cured anyone after laser surgery in late stages?
Cure rate is difficult to say at present but we divide the recovery into
0-3 months Short term remission
medium term remission
More than 8 months long term remission
Our results are as follows
Short term remission 98%
Medium term remission 80%
Long term remission
This is seen in locally advanced cases This is close to 80%
But The most important thing is that Quality of Life is close to normal after Laser.
In contrast after Conventional surgery in stage 4 oral cancer, long term remission rate is less than 10% approaching nil at 14 months
16. Is there any international work done in Laser surgery?
All major institutions are working on this technology . Please look up the international links section on this subject
17. Are there any side effects of laser?
Typically there are no significant side effects of laser. A well performed laser procedure will give a pain and swelling for some days. This is controlled by medicines.
18. Can I use laser even though I had earlier been operated for cancer or undergone radiotherapy and chemotherapy.?
Yes absolutely since laser has a a very predictable outcome for the affected part.
Although the best results are obtained when there has been no chemotherapy and radiotherapy used previously.
19.What should I ask my surgeon if he recommends surgery ?
In our opinion a fair and honest opinion is every patient’s right.
Too many times we encounter patients who have either been not informed or ill informed about the consequences of surgery chemotherapy and radiotherapy
We recommend the following questions and the answers noted down to make the right decision
Questions for cancer surgeon
1. What is my stage of cancer and on what basis
2. What cancer surgery are you recommending.
3. Internationally is there any alternative to this surgery.
4. What will happen to me regarding
D. Saliva Control.
5. What is the minimum guarantee of no recurrence of this case ?
1 yr? 6 months? 3 months? 2 months?
6. What happens to me after I get recurrence ?Can I be cured with chemotherapy radiotherapy after recurrence.?
After recurrence what is the maximum time for me.?
7. Can you show me any pt which has been satisfied after this stage of cancer.?
8. Honestly are you going for cure or palliation.?