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Oral and Oropharyngeal Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find some basic information about these diseases and the parts of the body they may affect. This is the first page of Cancer.Net’s Guide to Oral and Oropharyngeal Cancer. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

Cancer begins when healthy cells change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Cancer of the oral cavity and cancer of the oropharynx are 2 of the most common types of cancer that develop in the head and neck region, a grouping called head and neck cancer. The oral cavity and oropharynx, along with other parts of the head and neck, contribute to our ability to chew, swallow, breathe, and talk.

The oral cavity includes the:

  • Lips

  • Lining of the lips and cheeks, called the buccal mucosa

  • Gingiva, which is the upper and lower gums

  • Front two-thirds of the tongue

  • Floor of the mouth under the tongue

  • Hard palate or the roof of the mouth

  • Retromolar trigone, which is the small area behind the wisdom teeth

The oropharynx begins where the oral cavity stops. It includes the:

  • Soft palate at the back of the mouth

  • Part of the throat behind the mouth

  • Tonsils

  • Base of the tongue

More than 90% of oral and oropharyngeal cancers are squamous cell carcinoma. This means that they begin in the flat, squamous cells found in the lining of the mouth and throat. The most common locations for cancer in the oral cavity are:

  • Tongue

  • Tonsils

  • Oropharynx

  • Gums

  • Floor of the mouth

Oral - Normal Lip

Oral - Normal Lip Tissue
Click to Enlarge

Oral cavity - Squamous Cell Carcinoma

Oral cavity - Squamous Cell Carcinoma
Click to Enlarge

These images used with permission by the College of American Pathologists.

Although oral cancer and oropharyngeal cancer are commonly described using 1 phrase, it is important to identify exactly where the cancer began. This is because there are differences in treatment between the 2 locations.

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If you would like additional introductory information, explore these related items. Please note that these links take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain how many people are diagnosed with these diseases and general survival rates. Or, use the menu to choose another section to continue reading this guide.

Oral and Oropharyngeal Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find information about how many people are diagnosed with oral or oropharyngeal cancer. You will also learn some general information on surviving these diseases. Remember, survival rates depend on several factors. To see other pages, use the menu.

This year, an estimated 48,330 adults (34,780 men and 13,550 women) in the United States will be diagnosed with oral or oropharyngeal cancer. Rates of oral and oropharyngeal cancer are more than twice as high in men as in women. Cancer of the oral cavity ranks as the eighth most common cancer among men. This number of people with these types of cancer is increasing, probably because of infection with a virus called HPV (see the Risk Factors and Prevention section for more information).

It is estimated that 9,570 deaths (6,910 men and 2,660 women) from these 2 diseases will occur this year.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with oral or oropharyngeal cancer is 63%. The 10-year survival rate is 52%.

If the cancer is diagnosed at an early stage, the 5-year survival rate is 83%. About 31% of cases are diagnosed at this stage. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 62%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 38%. However, survival rates for oral and oropharyngeal cancer vary widely depending on the original location, whether the cancer is related to HPV, and the extent of the disease.

It is important to remember that statistics on how many people survive this type of cancer are an estimate. The estimate comes from data based on thousands of people with this cancer in the United States each year. So, your own risk may be different. Doctors cannot say for sure how long anyone will live with oral or oropharyngeal cancer. Also, experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society’s publication, Cancer Facts & Figures 2016.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by these diseases. Or, use the menu on the left side of your screen to choose another section to continue reading this guide.  

Oral and Oropharyngeal Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing these types of head and neck cancer. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The risk of oral and oropharyngeal cancer is greatly increased by 2 factors:

  • Tobacco use. Using tobacco, including cigarettes, cigars, pipes, chewing tobacco, and snuff, is the single largest risk factor for head and neck cancer. Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Pipe smoking in particular has been linked to cancer in the part of the lips that touch the pipe stem. Chewing tobacco or snuff is associated with a 50% increase in the risk of developing cancer in the cheeks, gums, and inner surface of the lips where the tobacco has the most contact. Secondhand smoke may also increase a person’s risk of head and neck cancer.

  • Alcohol. Frequent and heavy consumption of alcohol increases the risk of head and neck cancer. Using alcohol and tobacco together increases this risk even more.

Other factors that can raise a person’s risk of developing oral and oropharyngeal cancer include:

  • Prolonged sun exposure. Excessive and unprotected exposure to the sun is linked with cancer in the lip area. To reduce your risk of lip cancer, decrease your exposure to sunlight and other sources of ultraviolet (UV) radiation. Read more about protecting your skin from the sun.

  • Human papillomavirus (HPV). Research shows that infection with the HPV virus is a risk factor for oropharyngeal cancer. In fact, HPV-related oropharyngeal cancer in the tonsils and the base of the tongue has become more common in recent years. Sexual activity with someone who has HPV, including oral sex, is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. There are vaccines available to protect you from HPV infection.

    To reduce your risk of HPV infection, limit your number of sexual partners. Having many partners increases the risk of HPV infection. Using a condom does not fully protect you from HPV during sex. It is also likely that receiving an HPV vaccination before exposure to HPV can reduce the risk of oropharynx cancer. The  Cenn UC. Arcadia Cruz can help ing against HPV befroe ordinating center for multi-site trails within UC. Arcadia Cruz can help Centers for Disease Control and Prevention has recommended HPV vaccination for all preteen boys and girls.

  • Gender. Men are more likely to develop oral and oropharyngeal cancer than women.

  • Fair skin. Fair skin is linked to a higher risk of lip cancer.

  • Age. People older than 45 have an increased risk for oral cancer, although this type of cancer can develop in people of any age.

  • Poor oral hygiene. People with poor oral hygiene or dental care may have an increased risk of oral cavity cancer. Poor dental health or ongoing irritation from poorly fitting dentures, especially in people who use alcohol and tobacco products, may contribute to an increased risk of oral and oropharyngeal cancer. Regular examinations by a dentist or dental hygienist can help detect oral cavity cancer and some oropharyngeal cancers at an early stage.

  • Poor diet/nutrition.A diet low in fruits and vegetables and a vitamin A deficiency may increase the risk of oral and oropharyngeal cancer. Chewing betel nuts, a nut containing a mild stimulant that is popular in Asia, also raises a person’s risk of developing oral and oropharyngeal cancer.

  • Weakened immune system. People with a weakened immune system may have a higher risk of developing oral and oropharyngeal cancer.

  • Marijuana use. Recent studies have suggested that people who have used marijuana may be at higher-than-average risk for head and neck cancer.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Several of the risk factors for oral and oropharyngeal cancer can be avoided by making healthy lifestyle choices. Stopping the use of all tobacco products is the most important thing a person can do to reduce the risk of oral and oropharyngeal cancer, even for people who have been using tobacco for many years.

Talk with your doctor if you have concerns about your personal risk of developing these types of cancer.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Or, use the menu to choose another section to continue reading this guide.  

Oral and Oropharyngeal Cancer - Screening

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find out more about screening for these types of cancer. You will also learn the risks and benefits of screening. To see other pages, use the menu.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for oral and oropharyngeal cancer

Many of the symptoms of oral and oropharyngeal cancer can be caused by other noncancerous health conditions. Therefore, it is important for people to receive regular health and dental care, especially those who routinely drink alcohol, currently use tobacco products, or have used tobacco products in the past.

People who use alcohol and tobacco should receive a routine evaluation from their dentist and doctor on a regular basis. This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination using 1 or more of the diagnostic procedures mentioned in the Diagnosis section.

Cancers of the oral cavity and oropharynx have a much better chance of being cured when they are caught early.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems these diseases can cause. Or, use the menu to choose another section to continue reading this guide.

Oral and Oropharyngeal Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

People with oral or oropharyngeal cancer may experience the following symptoms or signs. Sometimes, people with oral or oropharyngeal cancer do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not cancer. Often, a dentist is the first person to find oral or oropharyngeal cancer during a routine examination.

  • Sore in the mouth or on the lip that does not heal; this is the most common symptom

  • Red or white patch on the gums, tongue, tonsil, or lining of the mouth

  • Lump on the lip, mouth, neck, or throat or a feeling of thickening in the cheek

  • Persistent sore throat or feeling that something is caught in the throat

  • Hoarseness or change in voice

  • Numbness of the mouth or tongue

  • Pain or bleeding in the mouth

  • Difficulty chewing, swallowing, or moving the jaws or tongue

  • Ear and/or jaw pain

  • Chronic bad breath

  • Changes in speech

  • Loosening of teeth or toothache

  • Dentures that no longer fit

  • Unexplained weight loss

  • Fatigue

  • Loss of appetite, especially when prolonged; this may happen during the later stages of the disease

If you are concerned about any changes you experience, please talk with your doctor and/or dentist as soon as possible. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.  

Oral and Oropharyngeal Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

The following tests may be used to diagnose oral or oropharyngeal cancer:

  • Physical examination. Dentists and doctors often find lip and oral cavity cancers during routine checkups. If a person shows signs of oral or oropharyngeal cancer, the doctor will take a complete medical history, asking about the patient’s symptoms and risk factors. The doctor will feel for any lumps on the neck, lips, gums, and cheeks. Since patients with oral or oropharyngeal cancer have a higher risk of other cancers elsewhere in the head and neck region, the area behind the nose, the larynx (voice box), and the lymph nodes of the neck are also examined.

  • Endoscopy. An endoscopy allows the doctor to see inside the mouth and throat. Typically, a thin, flexible tube with an attached light and view lens, called an endoscope, is inserted through the nose to examine the head and neck areas. Sometimes, a rigid endoscope, which is a hollow tube with a light and view lens, is placed into the back of the mouth to see the back of the throat in more detail. The examination has different names depending on the area of the body that is examined, such as laryngoscopy to view the larynx, pharyngoscopy to view the pharynx, or nasopharyngoscopy to view the nasopharynx. To make the patient more comfortable, these examinations are performed using an anesthetic spray to numb the area. If tissue looks suspicious, the doctor will take a biopsy (see below). Tests are often done in the doctor’s office. However, sometimes an endoscopy must be performed in an operating room at a hospital using a general anesthesia, which blocks the awareness of pain.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer. During a fine needle aspiration biopsy, cells are removed using a thin needle inserted directly into the tumor. A pathologist then analyzes the cells. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

  • Oral brush biopsy. During routine dental examinations, some dentists are using a newer, simple technique to detect oral cancer in which the dentist uses a small brush to gather cell samples of a suspicious area. The specimen is then sent to a laboratory for analysis. This easy procedure can be done in the dentist’s chair with very little or no pain. If cancer is found using this method, a traditional biopsy is recommended to confirm the results.

  • X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. X-rays may be recommended by your dentist or doctor to look for abnormal findings in the mouth or neck.

  • Barium swallow. There are 2 types of these tests that are generally used to look at the oropharynx and check a patient’s swallowing. The first is a traditional barium swallow. During an x-ray exam, the patient is asked to swallow liquid barium. This lets the doctor look for any changes in the structure of the oral cavity and throat and see whether the liquid passes easily to the stomach. A modified barium swallow, or videofluoroscopy, is used to evaluate swallowing. 

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size, help the doctor decide whether the tumor can be surgically removed, and show whether the cancer has spread to lymph nodes in the neck or lower jawbone. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and the base of the tongue. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This test can detect the spread of cancer to the lymph nodes in the neck, called the cervical lymph nodes.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.

Oral and Oropharyngeal Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu.

Staging is a way of describing where a cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for oral and oropharyngeal cancer.

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): No evidence of a tumor is found.

Tis: Describes a stage called carcinoma (cancer) in situ. This is a very early cancer where cancer cells are found only in 1 layer of tissue.

T1: The tumor is 2 centimeters (cm) at its greatest dimension.

T2: The tumor is larger than 2 cm but not larger than 4 cm.

T3: The tumor is larger than 4 cm.

T4a (lip): The tumor began on the lip but has invaded adjacent tissue, such as the bone floor of the mouth or the skin of the face.

T4a (oral cavity): The tumor has invaded through the cortical bone deep into structures in the mouth, such as the muscle of the tongue or into the sinuses.

T4a (oropharynx): The tumor has spread to the larynx, tongue, or jawbone.

T4b (oral cavity): The tumor has invaded the base of the skull and/or encases the internal arteries.

T4b (oropharynx): The tumor has spread into the nasopharynx, skull base, or nearby arteries and muscles.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These tiny, bean-shaped organs help fight infection. Lymph nodes near where the cancer started are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. There are many lymph nodes in the head and neck area. Careful assessment of lymph nodes is an important part of staging.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.

N1: The cancer has spread to a single lymph node on the same side as the primary tumor, and the cancer found in the node is 3 cm or smaller.

N2a: Cancer has spread to a single lymph node on the same side as the primary tumor and is larger than 3 cm but not larger than 6 cm.

N2b: Cancer has spread to more than 1 lymph node on the same side as the primary tumor, and none measure larger than 6 cm.

N2c: Cancer has spread to more than 1 lymph node on either side of the body, and none measure larger than 6 cm.

N3: The cancer found in the lymph nodes and is larger than 6 cm.

Metastasis (M)

The "M" in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): Cancer has not spread to other parts of the body.

M1: Cancer has spread to other parts of the body.

Cancer stage grouping

Doctors combine the T, N, and M information to say what stage the cancer is.

Stage 0: Describes a carcinoma in situ (Tis) with no spread to lymph nodes (N0) or distant metastasis (M0).

Stage I: Describes a small tumor (T1) with no spread to lymph nodes (N0) and no distant metastasis (M0).

Stage II: Describes a tumor that is smaller than 4 cm (T2) and has not spread to lymph nodes (N0) or to distant parts of the body (M0).

Stage III: Describes a larger tumor (T3) with no spread to lymph nodes (N0) or metastasis (M0), as well as smaller tumors (T1, T2) that have spread to regional lymph nodes (N1) but have no sign of metastasis (M0).

Stage IVA: Describes any invasive tumor (T4a) with either no lymph node involvement (N0) or spread to only a single, same-sided lymph node (N1) but no metastasis (M0). It is also used for any tumor (any T) with more significant nodal involvement (N2) but no metastasis (M0).

Stage IVB: Describes any tumor (any T) with extensive nodal involvement (N3) but no metastasis (M0).

Stage IVC: Indicates there is evidence of distant spread (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Grade (G)

Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade can help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

GX: The grade cannot be evaluated.

G1: The cells look more like normal tissue and are well differentiated.

G2: The cells are only moderately differentiated.

G3 and G4: The cells don’t resemble normal tissue and are poorly differentiated.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.  

Oral and Oropharyngeal Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat people with oral or oropharyngeal cancer. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for these types of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

Oral and oropharyngeal cancer can often be cured, especially if the cancer is found at an early stage. Although curing the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. When doctors plan treatment, they consider how treatment might affect a person’s quality of life, such as how the person feels, looks, talks, eats, and breathes.

In many cases, a team of doctors will work together with the patient to create the best treatment plan. Head and neck cancer specialists often form a multidisciplinary team to care for each patient. This team may include:

  • Medical oncologists, who specialize in treating cancer with medication

  • Radiation oncologists, who specialize in giving radiation therapy to treat cancer

  • Surgeons

  • Otolaryngologists, who specialize in treating ear, nose, and throat issues

  • Maxillofacial prosthodontists, who specialize in restorative surgery to the head and neck area

  • Dentists

  • Physical therapists

  • Speech pathologists

  • Mental health professionals

  • Oncology nurses

  • Dietitians

  • Social workers

It is extremely important that a comprehensive treatment plan is established before treatment begins. People may need to be seen and evaluated by several specialists before such a plan can be created.

There are 3 main treatment options for oral and oropharyngeal cancer: surgery, radiation therapy, and chemotherapy. Descriptions of these common treatment options are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. One of these therapies, or a combination of them, may be used.

Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue, known as a margin, during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The goal of surgery is to remove all of the tumor and leave negative margins, which means that there is no trace of cancer in the healthy tissue. Sometimes surgery is followed by radiation therapy, chemotherapy, or both. Depending on the location, stage, and pathology of the cancer, some people may need more than 1 operation to remove the cancer and to help restore the appearance and function of the affected tissues.

The most common surgical procedures for the removal of oral and oropharyngeal cancer include:

  • Primary tumor surgery. The tumor and a margin of healthy tissue around it are removed to decrease the chance that any cancerous cells will be left behind. The tumor may be removed through the mouth or through an incision in the neck. A mandibulotomy, in which the jawbone is split to allow the surgeon to reach the tumor, may also be required.

  • Glossectomy. This is the partial or total removal of the tongue.

  • Mandibulectomy. If the tumor has entered a jawbone but not spread into the bone, then a piece of the jawbone or the whole jawbone will be removed. If there is evidence of destruction of the jawbone on an x-ray, then the entire bone may need to be removed.

  • Maxillectomy. This surgery removes part or all of the hard palate, which is the bony roof of the mouth. Prostheses (artificial devices), or more recently, the use of flaps of soft tissue with and without bone can be placed to fill gaps created during this operation.

  • Neck dissection. Cancer of the oral cavity and oropharynx often spreads to lymph nodes in the neck. It may be necessary to remove some or all of these lymph nodes using a surgical procedure called a neck dissection.

  • Laryngectomy. A laryngectomy is the complete or partial removal of the larynx or voice box. The larynx is critical to swallowing because it protects the airway from food and liquid entering the trachea or windpipe and reaching the lungs, which can cause pneumonia. A laryngectomy is rarely needed to treat oral or oropharyngeal cancer. However, when there is a large tumor of the tongue or oropharynx, the doctor may need to remove the larynx to protect the airway during swallowing. If the larynx is removed, the windpipe is reattached to the skin of the neck where a hole, called a stoma or tracheostomy, is made (see below). Rehabilitation will be required to learn a new way of speaking.

  • Transoral robotic surgery and transoral laser microsurgery. Transoral robotic surgery (TORS) and transoral laser microsurgery (TLM) are minimally invasive surgical procedures. This means that they do not require large cuts to get to and remove a tumor. In TORS, an endoscope is used to see tumors in the throat, the base of the tongue, and the tonsils. Then 2 small robotic instruments act as the surgeon’s arms to remove the tumor. In TLM, an endoscope connected to a laser is inserted through the mouth. The laser is then used to remove the tumor. A laser is a narrow beam of high-intensity light.

An important goal of the surgery is the complete removal of the tumor with negative margins. Surgeons are often able to tell in the operating room if all of the tumor has been removed.

Micrographic surgery, which is frequently used in the treatment of skin cancer, can occasionally be used for oral cavity tumors. It can minimize the amount of healthy tissue removed. This technique is often used with cancer of the lip and involves removing the visible tumor in addition to small fragments of tissue surrounding the tumor. Each small fragment is examined under a microscope until all of the cancer has been removed.

Other types of surgery may also be needed, including:

  • Tracheostomy. If cancer is blocking the throat or is too large to completely remove, a hole is made in the neck. This hole is called a tracheostomy. A tracheostomy tube is then placed, and a person breathes through this tube. A tracheostomy can be temporary or permanent.

  • Gastrostomy tube. If cancer prevents a person from swallowing, a feeding device called a gastrostomy tube is placed. The tube goes through the skin and muscle of the abdomen and directly into the stomach. These tubes may be used as a temporary method for maintaining nutrition until the person can safely and adequately swallow food taken in through the mouth. For swallowing problems that are temporary, a nasogastric (NG) tube may be used instead of a tube into the stomach. An NG tube is inserted through the nose, down the esophagus, and into the stomach.

  • Reconstruction. If treatment requires removing large areas of tissue, reconstructive surgery may be necessary to help the patient swallow and speak again. Healthy bone or tissue may be taken from other parts of the body to fill gaps left by the tumor or replace part of the lip, tongue, palate, or jaw. A prosthodontist, a dental specialist with expertise in the restoration and replacement of broken teeth with crowns, bridges, or dentures, may be able to make an artificial dental or facial part to help with swallowing and speech. A speech pathologist can teach the patient to communicate using new techniques or special equipment. A speech-language pathologist can also help restore the ability to swallow in patients who have difficulty eating after surgery or after radiation therapy.

In general, surgery for oral and oropharyngeal cancer often causes swelling, making it difficult to breathe. It may cause permanent loss of voice or impaired speech; difficulty chewing, swallowing, or talking; numbness of the ear; weakness raising the arms above the head; lack of movement in the lower lip; and facial disfigurement. Surgery can affect the function of the thyroid gland, especially after a total laryngectomy or radiation therapy to the area. Talk with your health care team before your surgery, so you know what to expect and how your side effects will be managed.

It is important that a person gets the opinion of different members of the multidisciplinary team before deciding on a specific treatment. Even though surgery is the fastest way to eliminate cancerous tissues, other treatment methods exist and may be equally effective in treating the cancer. People are encouraged to ask about all of their treatment options before deciding on a treatment plan.

Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

  • External-beam radiation therapy. This is the most common type of radiation treatment for oral and oropharyngeal cancer. During external-beam radiation therapy, a radiation beam produced by a machine outside the body is aimed at the tumor. This is generally done as an outpatient procedure.

    Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Another method of external-beam radiation therapy, known as intensity modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered to the tumor while reducing damage to healthy cells.

  • Internal radiation therapy. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Tiny pellets or rods containing radioactive materials are surgically implanted in or near the cancer site. The implant is left in place for several days while the person stays in the hospital.

Radiation therapy may be the main treatment for oral cavity cancer, or it can be used after surgery to destroy small areas of cancer that could not be removed.

Before beginning radiation treatment for any head and neck cancer, people should receive a thorough examination from a dentist with experience treating people with head and neck cancer. Since radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented by proper treatment from a dentist before beginning treatment. Learn more about dental and oral health.

It is also important that people receive counseling and evaluation from an oncologic speech pathologist. This is a speech pathologist who has experience treating people with head and neck cancer. Because radiation therapy can damage healthy tissue, people often have difficulty speaking and/or swallowing after radiation therapy. These problems may occur long after radiation therapy is completed. Speech pathologists can provide exercises and techniques to prevent long-term speech and swallowing problems.

Hearing may also be affected in patients who receive radiation therapy to the head due to nerve damage or buildup of fluid in the middle ear. Earwax may also dry out and build up because of the radiation therapy’s effect on the ear canal. Sometimes, a patient’s hearing ability may need to be evaluated by a hearing specialist, known as an audiologist.

Radiation therapy may also cause a condition called hypothyroidism. In this condition, the thyroid gland slows down, causing the patient to feel tired and sluggish. Every patient who receives radiation therapy to the neck area should have his or her thyroid checked regularly.

Other side effects from radiation therapy to the head and neck may include redness or skin irritation to the treated area, dry mouth or thickened saliva from damage to salivary glands (which can be temporary or permanent), bone pain, nausea, fatigue, mouth sores, sore throat, difficulty opening the mouth, and a loss of appetite due to a change in a person’s sense of taste. Talk with your doctor about possible side effects that you can expect and ways to manage them.

Learn more about the basics of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). Some people may receive chemotherapy in their doctor's office or an outpatient clinic; others may go to the hospital.

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time.

The use of chemotherapy in combination with radiation therapy, called concomitant radiochemotherapy, is often recommended. The combination of these 2 treatments can sometimes control tumor growth, and it often is more effective than giving either of these treatments alone. However, the side effects can be worse when combining these treatments.

Chemotherapy may be used as the initial treatment before surgery, radiation therapy, or both, which is called a neoadjuvant chemotherapy. Or it can be given after surgery, radiation therapy, or both, which is called adjuvant chemotherapy. Chemotherapy for oral cavity cancer is most often given as part of a clinical trial.

Each drug or combination of drugs can cause specific side effects. While some can be permanent, most are temporary and can typically be well controlled. In general, chemotherapy may cause fatigue, nausea, vomiting, hair loss, dry mouth, hearing loss, loss of appetite (often due to a change in sense of taste), difficulty eating food, weakened immune system, diarrhea, constipation, and open sores in the mouth that can lead to infection.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.  

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them.

Currently, antibodies directed against a cellular receptor called the epidermal growth factor receptor (EGFR) are being used in combination with radiation therapy for head and neck cancers. Cetuximab is the only targeted therapy approved for use in combination with radiation therapy. Talk with your doctor about the possible side effects of the specific treatment you will be receiving and how they can be managed.

Learn more about the basics of targeted treatments.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.  People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Metastatic oral or oropharyngeal cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy. Immunotherapy is explained in the Latest Research section. Palliative care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.  

Oral and Oropharyngeal Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with oral or oropharyngeal cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating oral and oropharyngeal cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with oral or oropharyngeal cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time, for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for oral and oropharyngeal cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for these types of cancer. Or, use the menu to choose another section to continue reading this guide.  

Oral and Oropharyngeal Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about oral and oropharyngeal cancer and how to treat them. To see other pages, use the menu.

Doctors are working to learn more about oral and oropharyngeal cancer, ways to prevent them, how to best treat them, and how to provide the best care to people diagnosed with these diseases. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • New treatments. Many new treatments have become available as we have learned more about the biology of cancer. Some of these treatments, including immunotherapy and targeted therapy, are available through clinical trials. Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Therapies being researched include tyrosine kinase inhibitors; antiangiogenic therapy, which prevents the formation of blood vessels needed for tumor growth; immune modulating approaches; and drugs that trigger cancer cell death. These and other treatment approaches are in various stages of research.

  • Radiofrequency thermal ablation (RFA). RFA uses heat to destroy cancer cells. It is a minimally invasive treatment option that may be useful for localized tumors that cannot be removed with surgery.

  • Palliative care. Clinical trials are underway to find better methods of reducing the symptoms and side effects of current oral and oropharyngeal treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding oral and oropharyngeal cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu to choose another section to continue reading this guide. 

Oral and Oropharyngeal Cancer - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for oral and oropharyngeal cancer are described in the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with oral or oropharyngeal cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of check-ups after you finish cancer treatment. Or, use the menu to choose another section to continue reading this guide.  

Oral and Oropharyngeal Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. A common follow-up schedule is every 2 months for the first year, every 4 months for the second year, every 6 months for the third year, and once a year thereafter.

People treated for oral and oropharyngeal cancer have a higher risk of developing secondary cancers. If you smoke, you should be monitored for possible secondary cancers in the lung, esophagus, and head and neck. Researchers are studying the use of chemotherapy to prevent second cancers from developing, called chemoprevention. This may become a part of follow-up care for oral and oropharyngeal cancer.

Learn more about the importance of follow-up care.

Cancer Rehabilitation

Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People may need physical therapy and speech and swallowing therapy. Palliative care to manage symptoms and maintain nutrition during treatment may be recommended.

Depending on the size and location of the tumor and the type of cancer treatment used, a person may have problems with their ability to chew and move food through the digestive system. People who have been treated for oral or oropharyngeal cancer can have long-term swallowing problems. It is important that they continue to swallow their saliva and as much food as they can throughout treatment to prevent these problems from developing. Special nutritional care and support is often needed during treatment and immediately following treatment. Some people may need to learn new ways to eat or prepare foods differently.

If the cancer treatment changes oral structures or limits movement, a patient’s ability to talk will be affected. Speech pathologists can help people work back toward their normal functions. 

People treated for oral or oropharyngeal cancer may look different, feel tired, and be unable to talk or eat the way they did before treatment. They may experience swelling in the area, called lymphedema. Many people experience depression. The health care team can help people adjust and connect them with both physical and emotional support services.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

People treated for oral or oropharyngeal cancer should receive regular follow-up medical and dental examinations to check for signs of recurrent cancer or a new type of cancer. Most recurrences of oral and oropharyngeal cancer happen within the first 2 to 3 years after diagnosis, so follow-up visits will be more frequent in the years right after treatment.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Surgery and radiation therapy used to treat oral and oropharyngeal cancer can affect a person’s thyroid gland. If your thyroid gland could have been affected by treatment, then thyroid function tests should be part of your follow-up care. Special dental care may also be needed to manage or avoid long-term dental problems.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu to choose another section to continue reading this guide.  

Oral and Oropharyngeal Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from oral or oropharyngeal cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical checkups and tests to take care of your health. Cancer rehabilitation will likely be recommended (see Follow-up Care), and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu to choose another section to continue reading this guide.  

Oral and Oropharyngeal Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of oral or oropharyngeal cancer do I have? Where exactly is it located?

  • Can you explain my pathology report (laboratory test results) to me?

  • What is the stage and grade of the cancer? What does this mean?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • If I am a smoker, will quitting help this treatment work better? Can you help me quit?

  • What are the possible side effects of each treatment option, both in the short term and the long term?

  • What can be done to prevent or treat side effects?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • What problems with speech, swallowing, or shoulder motion will likely occur? What rehabilitation services are available?

  • If my treatment will affect my ability to eat the foods I am used to, how will I receive proper nutrition?

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment? Loss of saliva? Loss of taste? Difficulty swallowing?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • Can you recommend an oncologic dentist who I can see before treatment begins?

  • Can you recommend an oncologic speech pathologist who I can see before treatment begins?

  • Should I see other specialists before treatment? Should I talk with a radiation oncologist, medical oncologist, or a plastic surgeon?

  • Should I get a second opinion?

  • What support services are available to me? To my family?

  • Whom should I call with questions or problems?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

  • Will I need major reconstruction after surgery? If so, how will this affect my ability to speak and eat?

  • Will there be a need for a neck dissection (removal of lymph nodes)? If so, what type of dissection will be done? What does this mean?

  • Will this surgery affect my appearance in any way?

  • How likely is it that I will lose my voice box (larynx)? If this is necessary, what are the options available for voice/speech rehabilitation?

Questions to ask about having radiation therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment? Loss of saliva? Loss of taste? Difficulty swallowing?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about having chemotherapy or targeted therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What are the chances of developing a secondary cancer?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

  • What will rehabilitation after treatment consist of?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.  

Oral and Oropharyngeal Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Oral and Oropharyngeal Cancer. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Oral and Oropharyngeal Cancer. Use the menu to select another section to continue reading this guide.