Untitled - Clpdigital.org

R a d i u m 3
ORAL CANCER
The next paper will cover several phases of oral cancer and I will
only state my conviction that the knife has no place in the treatment
of cancer within the mouth. The knife adds to the danger of recurrence,
by carrying cancer cells into the tissues, and by cutting across
lymphatics and blood vessels; and there is the ever present tendency to
leave too much tissue behind in the attempt to achieve a good plastic
result. I believe the best results can be obtained by thorough electrocoagulation
of the cutnc involved area first, under a local or general
anaesthetic, followed immediately by the insertion of radium deeply
throughout the destroyed tissues. When accurately applied, the heat
generated in the tissues by electro-coagulation effectually seals the lymphatics
and blood vessels immediately surrounding the area of destruction.
The treatment must be thorough and wide, ami the dosage heavy,
disregarding subsequent bone destruction and the temporary very painful
reaction lasting from two to six weeks. When a considerable area
of the tongue or floor of the mouth is to be destroyed, a preliminary ligation
of the lingual artery should be performed.
The following are illustrative types of oral cancer difficult or impossible
to remove surgically on account of their location, but which have
been successfully eradicated by employing the combination of electrocoagulation
and radium:
Mr. CC was referred to me November i. 1920, vvith a tumor 1 cm.
in diameter lying on the right side of the fraenum of the tongue, and
involving the mucous membrane of the floor of the mouth. A small
white area was noticed at the site of the present tumor in February. 1920.
In June, firstnoticed increase in the thickness. On November 1. two
i2-5 mg. needles were buried in the tongue, and one 25 mg. tube screened
vvith lead and rubber, placed on the surface for cross-firing. This remained
in place three hours, and then treated the next day for the same
length of time. On November 22 the slough had separated and the area
had nearly healed. On this dale two needles and one tube, totaling 50
mg., screened with lead and rubber, were placed over the area for one
and one-half hours. Also the glandular area on the outside of the neck
was radiated for six hours on each side vvith the same dosage. In April,
1921, there was no sign of recurrence at the same place, but on the floor
of the mouth. J.^ cm. to the right, was a recurrence with two or three
small indurations. This area was then treated vvith electro-coagulation,
following which four needles were buried in the floor of the mouth for
four hours. There is no sign of recurrence at the present time.
Mr. GF. Age, 65. For eight months had been aware of a sore in
the mouth, which constantly increased in size, considerable tenderness,
but no pain. On examination a gray ulcer with elevated edges, size of
a 25-cent piece, involving the left soft palate, anterior pillar, and edge
of the tongue. Underneath this ulcer was deep infiltration with fixation.
Treatment: April 19. 1922, under clher anesthesia, electro-coagulation
of the entire area, paying particular attention to the base of induration
and the involvement of the tongue, following which four 12.5 mg,
needles were buried 1 cm. apart, deeply, and one 25 mg. tube covered
with gauze and rubber was sutured to the surface that had been cauterized.
This arrangement of needles and tube furnished perfect crossfiring.
The tube was removed in six hours and the needles in 12 hours.