Mouth and oropharyngeal cancer research
This page is about research into the causes, prevention and treatments of mouth and oropharyngeal cancer. You can find the following information
- A quick guide to what's on this page
- Why research is important
- Finding a trial
- Research into causes of mouth and oropharyngeal cancer
- Preventing mouth and oropharyngeal cancer
- Diagnosing mouth cancer
- Research into surgery
Mouth and oropharyngeal cancer research
All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know that the treatments are safe.
First of all, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe are they tested in people in clinical trials.
You can view and print the quick guides for all the pages in the Treating mouth cancer section.
All potential new treatments have to be fully researched before they can be used as standard treatment for everyone. This is so that
- We can be sure they work
- We can be sure they work better than the treatments that are already available
- They are known to be safe
First of all, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.
Tests of treatments in patients use clinical trials. There is information about clinical trials, including the 4 phases of clinical trials in the trials and research section. In that section you can also visit our searchable database of clinical trials. Choose 'head and neck cancer' from the dropdown menu box and click 'search'. If you are interested in a particular trial, you can print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to refer you to the research team.
Everything covered on this page is the subject of ongoing research. Until studies are completed and new effective treatments are found, these experimental treatments cannot be used as standard therapy for mouth and oropharyngeal cancers.
The PREGO study is looking at changes in genes that may make cancer develop in the head or neck area. Researchers are collecting samples of cells from people who have different stages of head and neck cancer. They are looking at the genes within the tissues. They hope that this will help them to find out more about what changes in genes may cause head and neck cancer.
A small study is looking at the causes of head and neck cancer. This study is supported by Cancer Research UK and is looking to see if a virus called the human papilloma virus causes abnormal cells (pre cancers) and cancers of the head and neck. HPV is a common virus that affects many people and doesn't usually cause major problems. But we know from research that certain types of HPV may cause some head and neck cancers.
The people taking part in this study are having a sample of tissue taken because they may have a cancer of the head and neck. The researchers want to look at these tissue samples to see if they find HPV and the molecules this virus makes.
There is another study looking at samples of cells taken from the mouth. The researchers want to study genetic changes and other changes in cells that can affect the development of mouth and oropharyngeal cancer. They are collecting cells from normal mouth tissue as well as from people who have mouth diseases, including mouth cancer. The study aims to find out which gene changes are important, and how the changes affect the way the immune system responds to cancer. The researchers hope that this may help to develop better treatments in the future.
Preventing cancer with diet, or particular drugs or vitamins, is called chemoprevention. There is information below about
A diet high in fresh fruit and vegetables seems to reduce the risk of mouth cancer. But we need much more detailed information about this. A major study called EPIC (The European Prospective Investigation of Cancer) is going on in the UK and 8 other European countries. It is looking into the links between diet and cancer. The trial started in 1992 and is producing reports on diet and a variety of cancers. This will continue for the next 10 to 20 years.
Some doctors and researchers think that antioxidant vitamins and minerals may help to prevent mouth and oropharyngeal cancer when included in a healthy, balanced diet. Vitamins A, C and E are antioxidants. We don't know for sure whether eating these can help prevent cancer. This is a very difficult thing to prove.
Scientists are always looking at different types of drugs to see if they can help prevent cancer. Drugs in clinical trials for mouth cancers include
The ASPOD study is looking at whether aspirin can prevent pre cancerous white patches (leukoplakia) in the mouth becoming cancerous. We know from research that aspirin may help protect some people from certain types of cancer. The researchers want to find out if an aspirin mouthwash can help to prevent mouth cancer. They also want to find out whether aspirin mouthwashes have any side effects.
Cyclooxygenase-2 (COX-2) inhibitors
Cyclooxygenase-2 (COX-2) inhibitors are a group of drugs that reduce inflammation. One of these drugs is called celecoxib. Scientists are studying the possible benefits of regularly taking celecoxib to see if it can help to stop precancerous areas in the mouth from turning into cancers. We don’t know of any patient trials using celecoxib in the UK for head and neck cancer.
Some studies are looking into new ways of collecting and testing cells from the lining of the mouth that could help to diagnose mouth cancer. Doctors usually take a tissue sample (a biopsy) from the inside of the mouth to diagnose mouth cancer. In one study the doctor takes a sample of cells using a soft small bristle brush. The cells are examined using a computer. In another study, they test the cells using a method called dielectrophoresis.
The LIHNCS trial is looking at using an iodine dye (Lugol's iodine) during surgery to remove cancer of the mouth or the part of the throat just behind the mouth (oropharynx). The iodine stain can show up any areas of cancer cells or precancerous changes close to the tumour so the surgeon can remove them. The doctors and researchers hope that this will lower the number of abnormal cells left after surgery for cancer of the mouth and throat. Hopefully this will reduce the chance of the cancer coming back after this type of surgery.
The SEND-001 trial is supported by Cancer Research UK. It is comparing two standard surgical treatments for mouth cancer, to see if one approach has a better outcome. Mouth cancer can sometimes spread to the lymph glands in your neck. Some people with early mouth cancer may have very small cancers (secondaries) that have spread to their neck that doctor's can’t see, feel or even read on scans.
If surgeons find cancer cells in your neck during surgery, they will remove some of the lymph glands. This is called selective neck dissection or SEND. But surgeons can’t always tell who has hidden secondaries. So they can either do a SEND when your mouth cancer is removed, just in case. Or they can just remove your mouth cancer and operate again in the future if secondaries develop. Surgeons want to find out if one of these approaches is better than the other, so this trial is comparing the 2 types of treatment.
There is a trial comparing surgery with monitoring with PET-CT scans. The trial is for people with squamous cell cancers of the head and neck who are having chemoradiation. After chemoradiation, surgery to remove the lymph glands in the neck is the standard treatment but it can have side effects.
In this study some people will have standard treatment. In other people, instead of removing the lymph glands they will have a PET-CT scan. This type of scan can help doctors to see whether or not there are still cancer cells in the neck. People will only have the lymph glands removed if the scan shows there are (or might still be) cancer cells in the lymph nodes. The trial aims to see if one treatment is better than the other for people with squamous cell cancer of the head and neck. It also wants to learn more about the side effects and how they affect people's quality of life.
Doctors are looking at finding better ways of giving radiotherapy to treat cancers of the mouth and oropharynx. One of these is intensity modulated radiotherapy (IMRT). This is radiotherapy where both the radiotherapy beam and the dose within the beam are shaped to match the tumour shape and thickness.
IMRT gives less radiotherapy to normal tissues compared to standard radiotherapy. Research shows that long term side effects such as a dry mouth can be milder or less common with IMRT. It has been tested in a UK clinical trial called PARSPORT for head and neck cancers, including mouth cancer. The trial found that IMRT worked as well as conventional radiotherapy. The trial also found that 4 out of 10 (40%) people who had IMRT had a dry mouth after treatment compared with just over 7 out of 10 (70%) who had conventional radiotherapy.
The ArChIMEDEs-Op study is looking at giving an increased dose of IMRT with standard chemotherapy for oropharyngeal cancer. This study is for people whose cancer is not linked to the human papilloma virus (HPV).
Other research trials are looking at combining radiotherapy with biological therapy. You can find out more about radiotherapy trials for mouth and oropharyngeal cancer on our clinical trials database. Go to the advanced search and choose 'radiotherapy' from the dropdown menu of cancer types and 'mouth cancer' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.
You may have chemotherapy for mouth and oropharyngeal cancer on its own or in combination with other treatments. Doctors are looking into different combinations of drugs, different doses, and giving treatments in a different order. Some of the chemotherapy drugs used are
Researchers are also looking at different ways of giving chemotherapy. One way is injecting the drugs directly into the arteries that supply the tumour (called intra arterial chemotherapy). Some studies are looking at giving intra arterial chemotherapy at the same time as radiotherapy.
Another way of giving chemotherapy is by injecting the drugs directly into the tumour. This looks promising for mouth and oropharyngeal cancer. But the side effects include pain and damage to the tissue around the tumour. The side effects can be difficult to cope with. So the researchers are looking at how to improve how they give the treatment to reduce the side effects. This is early research.
You can find out more about chemotherapy trials for mouth and oropharyngeal cancer on our clinical trials database. Go to the advanced search and choose 'mouth cancer' from the dropdown menu of cancer types and 'chemotherapy' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.
Biological therapies are treatments that act on processes in cells. They can control or destroy cancer cells. There are many different types of biological therapy including
Monoclonal antibodies (MABs) can block certain receptors on cancer cells that signal the cancer to grow. Research has shown that a monoclonal antibody called cetuximab (Erbitux) can help people with advanced mouth and oropharyngeal cancer to live longer.
Current research is looking into a number of different monoclonal antibodies including zalutumumab. Zalutumumab blocks epidermal growth factor receptors (EGFR) on cancer cells. A phase 3 trial looked at zalutumumab for people with head and neck cancer that had come back after chemotherapy. It compared zalutumumab and best supportive care with supportive care on its own. Best supportive care means you have treatment to control symptoms. The trial showed that the cancer stopped growing for longer in people who had zalutumumab.
The GEN211 is an early phase trial looking at what effect zalutumumab has on head and neck cancers. The GEN207 trial is looking at giving zalutumumab with radiotherapy for cancer of the mouth that is locally advanced.
The De-ESCALaTE HPV trial is looking at the side effects of treatment for throat cancer. It is looking at people who have oropharyngeal cancer and human papilloma virus (HPV). HPV is linked to a number of oropharyngeal cancers. The researchers want to find out if the side effects of treating oropharyngeal cancer with cetuximab and radiotherapy are better for patients than cisplatin and radiotherapy (chemoradiation).
Tyrosine kinases are proteins within cells that trigger them to grow and divide. Blocking tyrosine kinase stops the cells growing and making more cells. Tyrosine kinase inhibitors (TKIs) being tested for mouth and oropharyngeal cancer include
Iressa is also called ZD 1839 or gefitinib. Doctors hope that it will stop the growth of the cancer cells. Iressa is licensed in the UK for lung cancer. But clinical trials are now going on in the UK for mouth and oropharyngeal cancers that have come back after treatment. The research so far has not shown it to work any better than chemotherapy.
Erlotinib (Tarceva) is another type of TKI being investigated by researchers. Early trials have been combining erlotinib with a monoclonal antibody called bevacizumab. The results found that people could cope well with the side effects. But we need more research to find out how well erlotinib works at treating this type of cancer.
Researchers have used a new type of biological therapy called OncoVEX GM-CSF alongside standard treatment for head and neck cancer that had spread to the lymph nodes. In a small trial, 17 people had treatment with radiotherapy and cisplatin chemotherapy as well as OncoVEX GM-CSF directly into the cancer. OncoVEX treatment uses a type of the cold sore virus that has been genetically changed. It makes a natural substance called GM-CSF that attacks cancer cells. The researchers found that the OncoVEX shrank the cancer or helped to stop it coming back in some people. This is a small study but the cancer responded to the treatment in 14 people. So the researchers plan bigger trials using this treatment.
Trials into gene therapy are still in very early stages. We will need larger trials before we know whether these treatments are any better at treating head and neck cancers than the treatments used now.
Doctors are looking into using a vaccine called Reolysin to help treat advanced head and neck cancer. Reolysin is made from a type of virus called reovirus. Reovirus rarely causes any symptoms, but it can kill cancer cells.
A small trial looked at giving Reolysin at the same time as paclitaxel and carboplatin (PC chemotherapy) in people with advanced cancer. The researchers found that the cancer stayed the same or got smaller in more than half the people with head and neck cancer who had Reolysin and PC chemotherapy. The most serious side effects were a drop in the number of blood cells and low blood pressure.
Another trial is looking at Reolysin injections with radiotherapy for advanced cancer. In this trial Reolysin is injected directly into the cancer. Researchers think that Reolysin can make cancer cells more sensitive to radiotherapy. And radiotherapy may help Reolysin to work better. The aim of the trial is to find out how well the combination of Reolysin and radiotherapy works for advanced cancer and learn more about the side effects.
The REO 18 trial is looking at giving Reolysin with paclitaxel and carboplatin chemotherapy for head and neck cancers. The trial is for people with cancer that has spread to other parts of the body or has got worse despite having other treatment. The aim is to see if having Reolysin helps these people more than having the chemotherapy alone.
Researchers are looking at a new vaccine called ADXS11 001 in a phase 1 trial. The vaccine is designed to boost the immune system of people with oropharyngeal cancer that may have been caused by HPV. The researchers will test the vaccine in a small number of people at first. Depending on the results, larger trials may follow.
You can find more information about these trials on the clinical trials database.
Photodynamic therapy (PDT) uses light treatment to kill cancer cells. Doctors hope that PDT may be useful for treating patients with advanced cancer who are not able to have any more standard treatment. PDT will not be able to cure advanced cancer. But it may help to shrink or slow the growth of the cancer and relieve symptoms. Some early research is also looking into using PDT for precancer or early cancer in the mouth.
Rarely, radiotherapy to the head and neck area can damage the jawbone. This damage is called osteoradionecrosis (ORN). The problem develops because the blood supply to the area is reduced. Doctors think that a high pressure oxygen therapy called hyperbaric oxygen (HBO) may be able to stop this happening. The idea is that HBO works by increasing the supply of blood to the jaw.
The HOPON trial is supported by Cancer Research UK. It is looking at HBO for osteoradionecrosis. You may be able to join this trial if your cancer has been successfully treated with radiotherapy and you are going to have jaw or dental surgery. Doctors think that having surgery can trigger the problem. There is information about this trial on our clinical trials database.
Treatment for head and neck cancer can sometimes cause side effects that are difficult to cope with. There is information below about research into
- Helping to relieve a dry mouth
- Helping people with mouth opening problems (trismus)
- Acupuncture for pain after a neck dissection
- Acupuncture and moxibustion to help relieve lymphoedema
One of the main side effects of radiotherapy to the head and neck area is a dry mouth. Doctors call this xerostomia. It happens because radiotherapy affects the glands that make saliva (spit) to keep your mouth moist. You may make less saliva than usual, or none at all.
A dry mouth is very uncomfortable and can make chewing, swallowing and even talking difficult. It can lead to serious weight loss problems. There is a need for new treatments because current treatments are limited. If you are making some saliva, a drug to stimulate your salivary glands may help. These include the drugs pilocarpine and bethanechol. But in about 1 in every 6 patients (15%) these drugs cause unbearable side effects such as blurred vision, sickness, and sweating.
Recent research suggests that a drug called amifostine can help to prevent a dry mouth. This drug is a chemoprotectant, meaning it helps to protect against the harmful side effects of chemotherapy and radiotherapy. A few minutes before each radiotherapy treatment, you have an amifostine injection into a vein in your arm. It works by collecting in the salivary glands and limiting the amount of damage that radiation can cause to the salivary glands. Side effects of amifostine include low blood pressure, dizziness, flushing, chills, and feeling or being sick. This drug is still only being tested at the moment and is not used as standard treatment.
The LEONIDAS-2 study is looking at a medical device to stimulate the gums to increase the amount of saliva in the mouth. The researchers hope this will reduce the symptoms of dry mouth and improve quality of life.
Some studies suggest that having acupuncture can help with a dry mouth caused by radiotherapy in people with head and neck cancers. But we need more research before we will know exactly how much it can help.
Some people find it difficult to open their mouth properly after radiotherapy for mouth or oropharyngeal cancer. This is because radiotherapy can affect the muscles that you use to open and close your mouth. It is called trismus.
Trismus can be treated by gently stretching the jaw muscles using wooden spatulas. The Trismus trial is comparing this with the Therabite device. This is a hand operated device you put inside your mouth. The aim of the trial is to see which is best to treat trismus, which improves quality of life the most and which exercise routine people stick to best.
Some people who have a neck dissection operation to remove lymph nodes in their neck also have their accessory nerve removed. This nerve controls shoulder movement, and the surgery can leave your shoulder and neck stiff and painful. These side effects are usually treated with physiotherapy and non steroidal anti inflammatory pain killers (NSAIDs). Early research in USA suggests that acupuncture may also help to relieve the pain caused by having a neck dissection.
Lymphoedema is swelling caused by a build up of lymph fluid in the body. It can be a side effect of surgery or radiotherapy treatment if the lymph nodes that usually drain the fluid are removed or damaged. Lymphoedema can cause discomfort, pain and difficulty moving. There is no cure for lymphoedema, but treatments can relieve symptoms.
There is a small trial looking at 2 complementary therapies for lymphoedema. The therapies being researched are acupuncture and moxibustion. Acupuncture uses fine sterile needles which are put just under the skin at particular points (acupuncture points) on the body. Moxibustion uses a dried herb called mugwort which is rolled into a stick. The moxibustion practitioner holds the glowing end of the lit stick over acupuncture points to warm them.
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