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Treatment decisions

Find out about how your doctor decides which treatment you need, the types of treatment you might have and treatment by stage.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • where your cancer is
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

Treatment overview

You might have one type of treatment or a combination of treatments. The main treatments are:

  • surgery
  • radiotherapy
  • chemotherapy
  • chemotherapy with radiotherapy (chemoradiotherapy)
  • biological therapy

Surgery 

Surgery is a common treatment for early stage mouth and oropharyngeal cancer. How much surgery you have depends on the size and location of your cancer. You are most likely to have an operation under general anaesthetic. 

Radiotherapy 

You can have radiotherapy alone or together with chemotherapy. Radiotherapy alone is a treatment for some types of mouth and oropharyngeal cancer that have not spread.

You may also have radiotherapy after surgery. This is to kill any cancer cells that might have been left behind. It lowers the risk of the cancer coming back. 

Chemotherapy 

You may have chemotherapy if your cancer has come back. Or if your cancer has spread into surrounding tissues or to other parts of the body. Sometimes you can have it before other treatments (such as radiotherapy) to make the cancer smaller. 

Chemoradiotherapy 

This is chemotherapy and radiotherapy together. You may have chemoradiotherapy instead of surgery if your cancer has spread into surrounding tissues or into nearby lymph nodes. For some people, this may get rid of the cancer completely.  

Biological therapy 

These are treatments that stop or slow the growth of cancer or kill cancer cells. You might have a biological therapy called cetuximab (also known as Erbitux) together with radiotherapy. 

Or you may have cetuximab with chemotherapy or radiotherapy as part of a clinical trial.  

Treatment by stage

Your treatment depends on the stage of your cancer.

Stage 0 (carcinoma in situ) 

The cancer cells are all contained within the lining of the mouth or oropharynx. If left untreated, there is a high chance of the cells developing into a cancer. 

Your doctor may completely remove the cancer cells during a biopsy, if the affected area is very small. Or you may need to have minor surgery. Your doctor removes the cancer cells by taking a thin layer of tissue from the affected area.

Your doctor will monitor you closely after treatment. If the cancer cells come back, you may have radiotherapy.

If you smoke and continue to do so, it is much more likely that you will develop cancerous cells again in the future.    

Stage 1 and 2

Your treatment depends on which part of your mouth or oropharynx your cancer is in. You might have: 

  • surgery
  • radiotherapy
  • surgery followed by radiotherapy
  • chemoradiotherapy

When deciding on your treatment plan, your doctor considers the likely side effects of treatment in that area of your mouth or oropharynx. 

Stage 3 and 4

You might have surgery to remove the cancer. This usually includes removing some of the lymph nodes in the neck during an operation called a neck dissection. This is because there is a high risk that the cancer has spread to the lymph nodes. 

You may also have radiotherapy to your neck after surgery. This is to kill off any remaining cancer cells. 

When the cancer is too big or cannot be removed by surgery, you might have radiotherapy. You can have internal radiotherapy or external radiotherapy depending on the part of the mouth and oropharynx involved. You may have radiotherapy alongside chemotherapy or biological therapy.

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Last reviewed: 
14 Oct 2014
  • Head and Neck Cancer: Multidisciplinary Management Guidelines

    British Association of Otorhinolaryngology, 2011

  • Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy

    Furness S and others, 2011

    Cochrane Database Systematic Review, Volume 4

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