Sentinel Lymph Node Biopsy changes the game in treatment of Oral Cancer.
A patient with a persistent ulcer inside his cheek that failed to heal for nearly three months was diagnosed with early-stage oral cancer at KIMS Hospitals, Thane. A Sentinel Lymph Node Biopsy (SLNB) helped doctors assess whether the cancer had spread to the lymph nodes and determine that he could avoid elective neck dissection and postoperative radiation therapy.
The patient presented with a painful, non-healing ulcer in the left cheek. Following clinical evaluation, imaging and biopsy, he was diagnosed with Stage I (cT1N0M0) Squamous Cell Carcinoma of the left buccal mucosa, a form of oral cancer affecting the inner lining of the cheek. While there was no clinical or radiological evidence of lymph node involvement, doctors recognised that microscopic deposits of cancer can sometimes remain undetected in patients with early-stage oral cancer.
Rather than proceeding with a preventive neck dissection, the team led by Dr. Hitesh Singhavi, Consultant Head & Neck Oncosurgeon, KIMS Hospitals, Thane, opted for Sentinel Lymph Node Biopsy as per NCCN guidelines. The procedure helps identify and examine the first lymph node or nodes most likely to receive cancer cells from the primary tumour.
“In early oral cancer, one of the important treatment decisions is determining whether the disease has spread to the neck lymph nodes, even when scans and clinical examination appear normal. Sentinel Lymph Node Biopsy allows us to investigate this possibility with greater precision and avoid a major neck dissection in carefully selected patients. In this case, the sentinel node was free of cancer, allowing us to achieve effective cancer treatment while avoiding an additional surgical procedure and its potential impact on quality of life,” said Dr. Hitesh Singhavi, Consultant Head & Neck Oncosurgeon, KIMS Hospitals, Thane.
“The management of early oral cancer is increasingly moving towards a more individualised approach, where the extent of treatment is guided by the risk profile of the disease. The objective is to ensure adequate cancer treatment while avoiding interventions that may not be necessary. This requires careful assessment and treatment planning at every stage,” said Dr. Anil Heroor, Director – Oncological Sciences, KIMS Hospitals, Thane.
Saurabh Gupta, Regional Director, KIMS Hospitals, said, At KIMS Hospitals, the focus is on evaluating each patient’s condition carefully and determining the most appropriate course of treatment. This case reflects how a coordinated approach, involving clinical assessment and appropriate diagnostic evaluation, can help guide treatment decisions based on the individual needs of the patient."
Before surgery, the patient's lymphatic drainage was mapped to identify the sentinel lymph node. The node was subsequently removed and subjected to detailed pathological examination along with the primary tumour. The biopsy showed no evidence of cancer in the sentinel lymph node. The final histopathology also demonstrated favourable findings, and the patient did not require postoperative radiotherapy.
As a result, the patient was able to avoid both elective neck dissection and radiation therapy. These treatments can potentially affect functions such as swallowing, speech and shoulder movement and may add to the physical burden of treatment. The patient recovered uneventfully, experienced minimalist scar on Neck, postoperative discomfort and resumed his routine activities soon after surgery. He continues to remain disease-free under regular follow-up.
The case also highlights the importance of early evaluation of persistent oral symptoms. A mouth ulcer that does not heal within two to three weeks, particularly when associated with pain, bleeding, a lump or changes in the surrounding tissue, should be evaluated by a qualified healthcare professional.
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