The role of selective neck dissection in early oral cancer treatment (SEND study)

Update 17/10/2019: The results of the SEND study is published in the British Journal of Cancer and has been recommended in the F1000 Prime as being of special significance in its field.

First national mouth cancer surgery study now published reveals thousands of lives worldwide will be saved

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Saving Faces researchers are working on a Cancer Research UK funded study, which is the first large scale surgical clinical trial in the United Kingdom for patients with oral cancer. The trial will involve over 600 patients nationwide and aims to answer important questions in the treatment of patients with oral cancer that will benefit both patients and the NHS.

For patients with early stage oral cancer, surgery to remove the tumour is the first line and usually the only required form of treatment.  Radiotherapy or chemotherapy can sometimes be given after surgery but this is only the case if the tumour is at a more advanced stage.  Like many other forms of cancer, oral cancer can spread and the most common site that oral cancer spreads to is the lymph glands in the neck.  Even where scans and clinical assessments show that there is no evidence of cancer in the lymph glands, there is still about a 30% chance that there will be some microscopic cancer in these glands that cannot be detected.

When treating early stage oral cancer when no disease has been detected in the neck, surgeons will remove the mouth tumour and may also decide to take a pre-emptive approach and remove the lymph glands as well (at the same time) to stop the cancer spreading.  Some surgeons will routinely remove the lymph glands at this stage while others may choose to actively monitor the disease and only remove the lymph glands if disease becomes apparent.  Both approaches are standard procedures carried out by surgeons every day but depend on the individual surgeon which treatment they will offer their patient.  As with any surgery there are risks involved with both approaches and these always need to be balanced not only against the chance of curing the disease but also against the benefits and effects on the patient’s quality of life.  However, the fact is that there is no real evidence that one approach is clearly better for the patient than the other.

The SEND study aims to answer the question of which is the better approach when treating patients with this early stage oral cancer. Patients will have either one of the two treatment options, as they would if they were not in the trial and then followed up closely to monitor their progress.  There are no new or untried procedures in this trial. It simply compares two standard forms of treatment to decide which approach is better for treating patients with this disease.

Read more on the clinical trial

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