All cancer treatments must be fully researched before they can be used for everyone. This is so we can be sure that:

• they work
• they work better than the treatments already available
• they are safe

Surgery

Some mouth cancers spread to the lymph nodes in your neck. When this happens, your surgeon takes out the lymph nodes from the affected side of your neck during surgery. This is called a selective neck dissection.

But sometimes your surgeon doesn't know if there are cancer cells in your lymph nodes before you have surgery. So they either take the lymph nodes out just in case, or they just remove your mouth cancer and operate again in the future if needed.

Doctors are comparing these approaches to see if one has a better outcome than the other. 

Iodine dye

Other trials are looking at new ways to show up the areas of cancer cells or pre cancers during surgery. Doctors are using an iodine dye to show up these areas so that the surgeon can remove them. They hope this will lower the number of abnormal cells left after surgery. And reduce the chance of the cancer coming back. 

Radiotherapy

Doctors are looking for 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.

Researchers are looking into:

• giving a larger dose of IMRT with standard chemotherapy
• using less intensive treatment after surgery
• comparing standard radiotherapy to high dose radiotherapy for cancer that has spread into nearby tissues
• combining radiotherapy with targeted cancer drugs

Radio sensitising drugs 

Doctors know that radiotherapy works better on cells with a good supply of oxygen. But cancer cells don't always have high levels of oxygen, especially the cells in the centre of the cancer. 

Researchers want to increase the oxygen levels in cancer cells so that radiotherapy can kill more of them. They are looking at a drug called nimorazole that mimics the effect of oxygen in tumour cells. It is called a radiosensitising drug. 

Targeted cancer drugs and immunotherapy

Targeted cancer drugs work by ‘targeting’ those differences that help a cancer cell to grow and survive. Some seek out and destroy cancer cells. Others help the body's immune system to attack the cancer. So some of these drugs are also called immunotherapies.

Researchers are comparing targeted drugs with chemotherapy for mouth cancer that has spread or come back. They are also looking at the side effects of treatment.

Trials are looking at the following drugs:

• pembrolizumab
• nivolumab
• buparlisib

Gene therapy

Researchers are using a new type of gene therapy called OncoVEX GM-CSF for mouth and oropharyngeal cancer that has spread to the lymph nodes. OncoVEX 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.  

Vaccine therapy

Some researchers are looking at vaccines to treat advanced mouth and oropharyngeal cancer. They are using a vaccine called Reolysin, made from a virus called reovirus. Reovirus rarely causes symptoms, but can kill cancer cells. 

More research is needed to see if these treatments are better than the treatments we have now.

Light treatment

Some researchers are looking at using light treatment together with chemotherapy.

They use drugs that make your body tissues sensitive to light. And direct a laser light onto the surface of the cancer so it helps the chemotherapy to get into the cancer cells. 

Treating HPV positive cancers

Some oropharyngeal cancers are caused by the human papilloma virus (HPV).  We know that oropharyngeal cancers containing HPV tend to do better than cancers that don’t contain HPV.

At the moment, this doesn't affect your treatment. But doctors are looking at this in research to see if people with HPV positive cancers can have less intense treatments in the future. 

Scans before, during and after treatment

Doctors want to know which scan can help them best plan radiotherapy. One trial is looking at the use of PET-CT scans (instead of CT scans) in planning radiotherapy.

Researchers are to keen to find a more accurate way of seeing whether there are any cancer cells left after treatment. They hope that using a type of MRI scan called diffusion weighted MRI (DW-MRI) might be useful. DW-MRI scans measure the water movement between cells. 

Researchers want to find out whether DW-MRI scans are helpful for seeing how well treatment for head and neck cancer has worked. Doctors hope the scans will help them decide who needs more treatment.