Treatments used for mouth cancer
This page has information about treatments for mouth or oropharyngeal cancer. You can find out about
The main treatments
Mouth and oropharyngeal cancers can be treated with surgery, radiotherapy, chemotherapy, chemoradiation, biological therapy or a combination of these. Your doctors will plan your treatment according to the type of cancer you have and the stage and grade of your cancer. They will also take into account the impact your treatment will have on your speech, chewing and swallowing, and your general health and fitness.
Being cared for by a multi disciplinary team (MDT)
NHS guidelines state that everyone who has head and neck cancer should be under the care of a multi disciplinary team. This is a team of health professionals who work together to decide on the best treatment and care for each patient. The MDT includes specialist head and neck surgeons and cancer specialists, a specialist nurse, a dietician, consultant restorative dentists and speech therapists.
You can view and print the quick guides for all the pages in the Treating mouth cancer section.
For mouth or oropharyngeal cancer, you may have one type of treatment or a combination of treatments. You may have
If the cancer has spread, you may have biological therapy with chemotherapy.
Your doctor will plan your treatment according to
- The type of mouth or oropharyngeal cancer you have
- Whether the cancer has spread (the stage)
- What the cells look like under a microscope (the grade)
- The impact your treatment will have on your speech, chewing and swallowing
- Your general health and fitness
There is detailed information about surgery, radiotherapy for mouth cancer, chemotherapy for mouth cancer, chemoradiation for mouth and oropharyngeal cancer and biological therapy for mouth cancer in this section.
Surgery alone cures some tumours, but others respond better to radiotherapy, or radiotherapy with chemotherapy or biological therapy. A Cochrane review in 2010 found that adding chemotherapy to surgery or radiotherapy for oropharyngeal cancer works better than just one of these treatments on their own.
On the next page, there is information on the most common treatments for each type and stage of mouth and oropharyngeal cancer.
Surgery is a common treatment for mouth and oropharyngeal tumours. How much surgery you have depends on the size and depth of the cancer when it is found. It also depends on whether there is a risk that the cancer has spread into lymph nodes around your mouth or in your neck. You are most likely to have an operation under general anaesthetic. Surgery works very well for early stage mouth cancer.
For some very early stage cancers of the mouth and oropharynx, you may be able to have laser surgery under local or general anaesthetic, although this is not common. In laser surgery, the surgeon uses a narrow, intense beam of light to cut out the cancer. The laser beam works like a surgical knife (scalpel). But if you have an early cancer, your specialist team may recommend that you have radiotherapy instead of surgery.
For information about specific operations that you may have, you can look in the surgery for mouth and oropharyngeal cancer section.
If you have surgery, your surgeon will examine the area around your tumour during your operation. They may remove some of the lymph nodes from around your tumour to see if they contain cancer cells. They do this to help find the stage of your cancer.
If your cancer has already spread to lymph nodes in your neck, your surgeon is likely to remove all the nodes on one or both sides of your neck. They may also remove other structures. They call this a neck dissection.
Neck dissections are also sometimes done for people with no signs of cancer in the lymph nodes. Your surgeon is most likely to suggest this if you have a tumour that is larger than 4mm. The aim is to get rid of any remaining cancer cells, and lower the chance of the cancer coming back in the lymph nodes. Even if cancer cells can’t be seen in the nodes there could be a few cancer cells there that will keep on growing if the surgeon doesn’t take the lymph nodes out. Checking the nodes also helps your doctors to decide if radiotherapy will be helpful for you.
Your surgeon will need to do a neck dissection if they plan to rebuild (reconstruct) part of your mouth or throat with tissue taken from another part of the body. This surgery is called a free flap. To attach the tissue the surgeon uses microsurgery to join tiny blood vessels in the neck to tiny blood vessels in the new piece of body tissue. A neck dissection allows the surgeon to reach the blood vessels in the neck.
There is detailed information about removing lymph nodes and neck dissection in the surgery for mouth and oropharyngeal cancer section.
Radiotherapy alone is used to treat some types of mouth and oropharyngeal cancers that have not spread.
If you have surgery your doctor may recommend that you have radiotherapy afterwards. The treatment aims to kill off any cancer cells that might have been left behind. This lowers the risk of the cancer coming back.
Radiotherapy may be combined with chemotherapy for people whose cancer has spread into surrounding areas (locally advanced cancer).
You may have chemotherapy in the following situations
- If your cancer has come back after surgery and radiotherapy
- To treat a mouth and oropharyngeal cancer that is locally advanced or has spread to other parts of the body
Chemotherapy may be combined with radiotherapy and is called chemoradiation. It may be used instead of surgery for some oropharyngeal cancers that have spread into surrounding tissues or into nearby lymph nodes. For some people this may get rid of the cancer completely.
This treatment may also be used for very small mouth cancers but this is rare.
We have detailed information about chemoradiation for mouth and oropharyngeal cancers in this section.
Biological therapies are treatments made from naturally occurring body substances or that affect how cancer cells divide and grow. A biological therapy called cetuximab (also known as Erbitux) is used for some mouth and oropharyngeal cancers. It may be used alongside radiotherapy for locally advanced squamous mouth or oropharyngeal cancer. It is also used in clinical trials in combination with platinum based chemotherapy or radiotherapy.
There is information about biological therapies for mouth and oropharyngeal cancer in this section.
If your cancer has already spread to another part of your body, using surgery just to remove the tumour in your mouth or oropharynx will not cure it. But surgery may still help to control your symptoms and disease. For example, if your tumour is large and beginning to block your airway, your doctor may recommend surgery to remove all or part of the tumour to make your breathing easier. They may also suggest the following treatments.
- Surgery combined with radiotherapy
- Chemotherapy alone or with radiotherapy (chemoradiation) or biological therapy
Treatments that are still in development may be an option for you. This will mean taking part in a clinical trial. There is information about new treatments in the section about mouth and oropharyngeal cancer research.
If your cancer has spread your doctor is likely to refer you to a palliative care team. Palliative care is treatment aimed at improving your symptoms and making life easier for you. Some people feel very upset when their doctor suggests this. They assume that it must mean that their doctors can’t do any more for them, but this isn’t the case.
Palliative care involves helping to
- Control any symptoms such as pain, sickness or breathing problems
- Support you with your diet and physical care
- Rehabilitate you – you may just need some time to get your strength back before going home from hospital
Palliative care also includes looking after people in the terminal stages of their illness.
NHS guidelines state that everyone who has head and neck cancer should be under the care of a multi disciplinary team (MDT). An MDT is a team of health professionals who work together to decide on the best treatment and care for each patient. Even if you have only seen one specialist, the team will still have got together with your test results and case notes to discuss the best treatment options for you.
The MDT includes a variety of doctors and other health professionals who specialise in different aspects of treatment, such as
- Head and neck surgeons
- Medical oncologists – specialists in treatment with cancer drugs
- Clinical oncologists – specialists in radiotherapy treatment
- Restorative dentistry consultant
- Head and neck clinical nurse specialist
- Other health professionals
Head and neck surgeons may include ear, nose and throat surgeons (ENT), oral and maxillofacial surgeons, and plastic surgeons. They are described below.
ENT doctors are specialists trained in treating conditions of the ear, nose, throat and neck. They are always qualified surgeons and are also called otolaryngologists.
Oral and maxillofacial surgeons are highly qualified, and are trained both as doctors and dentists. They specialise in the surgical treatment of a wide variety of conditions affecting the mouth, jaw, face and neck, including reconstructive surgery and facial plastic surgery. These surgeons remove the cancer and also rebuild tissue lost due to the cancer or operation.
Sometimes a plastic surgeon will carry out reconstruction. Plastic surgery means the moulding of the surface and sometimes deep structures of the human body. It can include rebuilding an area where a cancer has been removed. Plastic surgery is common after surgery to remove a cancer of the head or neck.
A medical oncologist is a doctor who specialises in treating cancer with cancer drugs such as chemotherapy or biological therapies.
A clinical oncologist treats cancer with radiotherapy. They work closely with a team of people to plan and give the treatment.
A restorative dentist is a specialist in replacing lost tissues and teeth. They are also called prosthodontists. They assess your teeth before you have treatment. They may recommend that you have some teeth removed, for example if they are decaying or loose, so that they don't cause problems later on. The restorative dentist will also advise you on how to look after your mouth and teeth during and after your treatment, and they may send you to a dental hygienist for more help. It is important to keep your teeth and mouth clean to reduce the risk of infection.
The dentist will help to plan your recovery with your surgeon, so that you can speak and eat as well as possible afterwards. They may suggest using special false teeth, or a replacement part (prosthesis) for missing teeth or any structure in the mouth. For example, some people with mouth cancer need to have surgery to remove part of their jawbone. The consultant rebuilds the missing piece with a piece of bone from another part of the body. A restorative dentist can fit a prosthesis with teeth to attach to the new jaw bone using dental implants. A prosthesis will also help to make your facial appearance as normal as possible after major surgery.
A head and neck clinical nurse specialist is a qualified nurse who has specialist knowledge of head and neck cancers. One of their roles is to help to organise care between doctors and the other health professionals you need to see. They will also help to support you through your treatment and make sure you have the information you need to understand the treatment.
You may also need help and support from other health specialists, for example a dietician or speech therapist. There is also usually a social worker who can advise you about any benefits and grants you may qualify for.
Your specialist may advise that surgery is the best treatment for you because of the stage or position of your cancer. In other circumstances, they may suggest radiotherapy (with or without chemotherapy) as your main treatment.
In some situations you may have a choice between types of treatment. In controlling your cancer, radiotherapy can work as well as surgery for early stage cancer of the mouth or oropharynx. Making the choice can be difficult but your doctor and specialist head and neck cancer nurse will be able to help you decide which is best for you.
You may want to get a second opinion before you have your treatment. A second opinion may confirm what your own specialist has said, but can give you more information and help you to feel more confident about your treatment plan. Most doctors are happy to refer you to another specialist for a second opinion if you want one.
Remember that a second opinion doesn't mean that the second doctor will definitely take over your care. Your original specialist may still manage your treatment.
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