MGM Cancer Institute – Chennaionline

Doctors at MGM Cancer Institute have successfully treated a 41-year-old male smoker with advanced tongue cancer (squamous cell carcinoma), a condition previously considered inoperable at several hospitals as the tumour, measuring approximately 5 × 3 cm with significant vertical extension, had spread across the entire anterior tongue, the floor of the mouth, and reached the hyoid bone, a bone in the upper neck that supports the tongue. The patient underwent a composite resection, a single, extensive surgery aimed at removing all cancer-affected tissue. This included complete removal of the front portion of the tongue (anterior total glossectomy), removal of cancer-involved tissue from the floor of the mouth, and removal of the affected portion of the jaw bone (segmental mandibulectomy). The procedure also required removal of the hyoid bone. Following complete tumour removal, doctors rebuilt the tongue and mouth using free flap reconstruction, an advanced technique in which healthy tissue from another part of the body was used to restore normal shape and function. As a final step, radiation therapy was administered to eliminate any remaining cancer cells at the microscopic level, ensuring complete cancer control. The complex medical and surgical procedures were carried out by a multidisciplinary team comprising Dr. M.A. Raja, Director and Senior consultant - Medical Oncology; Dr. Sivaram Ganesamoni, HOD and Senior Consultant, Surgical Oncology; Dr. Manikandan Venkatasubramaniyan, Senior Consultant, Surgical Oncology; Dr. A. Siva Kumar, Plastic Surgeon. Commenting on the case, Dr. Raja said, “The patient, a known smoker, presented with a persistent ulcer and abnormal growth on the tongue. Clinical examination revealed extensive involvement of the anterior tongue and floor of the mouth. A biopsy confirmed squamous cell carcinoma, a common form of oral cancer. Further evaluation with a whole-body PET scan showed that the tumour had extended deep into the tissues, reaching the hyoid bone.” He added that considering the advanced stage of the disease and the patient’s young age, the multidisciplinary tumour board recommended chemotherapy given before surgery (neoadjuvant chemotherapy) to shrink the tumour and improve surgical outcomes. “After two cycles of chemotherapy, follow-up PET scans showed a good partial response, following which the patient was reassessed and taken up for surgery,” he said. In his comments Dr. Sivaram Ganesamoni said, "This case highlights the integration of multimodality expertise in action, delivering results even in a seemingly impossible clinical scenario. Each one of the specialists involved are to be commended for the clinical excellence." Explaining the surgical procedure, Dr. Manikandan Venkatasubramaniyan said, “The surgery involved an anterior total glossectomy, which is the complete removal of the front portion of the tongue, along with resection of the entire floor of the mouth. In addition, a segmental mandibulectomy was performed to remove the affected part of the jaw bone on the right side, and the hyoid bone was also removed. To restore the large surgical defect and preserve function, the team carried out advanced reconstruction using a Free Anterolateral Thigh (ALT) flap, in which healthy tissue from the patient’s left thigh was transplanted to rebuild the removed structures. The patient is disease free and is back to his routine life.”