Two of the most common types of head and neck cancer are cancer of the oral cavity (mouth and tongue) and the oropharynx (the middle of the throat from the tonsils to the tip of the voice box). Cancer begins when cells become abnormal and multiply without control or order. These cells form a growth of tissue, called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous). Cancerous cells can invade nearby tissue and sometimes spread to other parts of the body through the bloodstream and the body’s lymphatic system.

The oral cavity includes the lips, buccal mucosa (lining of the lips and cheeks), gingiva (upper and lower gums), front two-thirds of the tongue, floor of the mouth under the tongue, hard palate (roof of the mouth), and the retromolar trigone (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, the part of the throat behind the mouth, the tonsils, and the base of the tongue.

The oral cavity and oropharynx, along with other parts of the head and neck, contribute to the ability to chew, swallow, breathe, and talk.

More than 90% of oral and oropharyngeal cancers are squamous cell carcinoma, meaning they begin in the flat, squamous cells in the lining of the mouth and throat.

Oral and oropharyngeal cancers are among the main types of cancer in the head and neck region, a grouping called head and neck cancer. Although oral cancer and oropharyngeal cancer are commonly combined using one phrase, it is important to identify exactly where the cancer began, because there are differences in treatment between the two locations.

Statistics

In 2009, an estimated 35,720 adults (25,240 men and 10,480 women) in the United States will be diagnosed with oral and oropharyngeal cancer. It is estimated that 7,600 deaths (5,240 men and 2,360 women) from the disease will occur this year.

Rates of oral and oropharyngeal cancer are more than twice as high in men then women. Cancer of the oral cavity ranks as the ninth most common cancer among men.

The most common sites for cancer in the oral cavity are: the tongue, which accounts for 20% to 25% of cases; floor of the mouth, 15%; the lip, 10% to 15%; and minor salivary glands, 10% to 15%.

For all stages and sites combined, about 83% of patients survive at least one year after diagnosis. The overall five-year relative survival rate (percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) of people with oral and oropharyngeal cancer is 60%, and the ten-year relative survival rate is 49%. However, survival rates for oral and oropharyngeal cancer vary widely depending on the original location and the extent of the disease.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with oral or oropharyngeal cancer. Because survival statistics are often measured in multi-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer.

Statistics adapted from the American Cancer Society’s publication, Cancer Facts and Figures 2009.

Find out more about basic cancer terms used in this section.

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A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can 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 communicating them to your doctor may help you make more informed lifestyle and health-care choices.

Two factors greatly increase the risk of oral and oropharyngeal cancer:

Tobacco use. Use of tobacco, including cigarettes, cigars, pipes, chewing tobacco, and snuff, is the single largest risk factor for head and neck cancer. Pipe smoking is particularly linked to cancer in the part of the lips that contact the pipe stem. Chewing tobacco or snuff is associated with a 50% increase in risk of cancers of the cheeks, gums, and inner surface of the lips where the tobacco has the most contact.

Alcohol. Frequent and heavy consumption of alcohol increases the risk of head and neck cancer.

Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Using alcohol and tobacco together increases this risk even more. Recent studies have suggested that people who have used marijuana may be at higher than average risk for head and neck cancer. Second-hand smoke may also increase a person’s risk of head and neck cancer.

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

Prolonged sun exposure. Prolonged sun exposure is linked to cancer in the lip area.

Human papillomavirus (HPV). Research indicates that infection with this virus is a risk factor for oral and oropharyngeal cancer. HPV is passed from person to person during sexual intercourse. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of head and neck cancers.

Gender. Men are more likely to develop lip cancer than women.

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

Age. People over 45 are at increased risk for oral cancer, although this type of cancer can develop in people of any age.

Oral hygiene. People with poor oral hygiene/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 the promotion of oral and oropharyngeal cancer.

Poor diet/nutrition. A diet low in fruits and vegetables, a vitamin A deficiency, and chewing betel nuts (a nut containing a mild stimulant that is popular in Asia) increase the risk of oral and oropharyngeal cancer.

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

Prevention and Early Detection

Use of tobacco and alcohol, in addition to poor oral hygiene (dental decay), are the most significant risk factors that contribute to the development of this type of cancer. Although some of the risk factors for oral and oropharyngeal cancer cannot be controlled, several can be avoided by making lifestyle changes. Stopping the use of tobacco products is the most important thing a person can do, even for people who have been smoking for many years.

To reduce your risk of lip cancer, reduce your exposure to sunlight and other sources of ultraviolent (UV) light. For more information, read the Cancer.Net Feature: Protecting Your Skin From the Sun.

To reduce your risk of HPV infection, limit the number of sex partners, because having many partners increases the risk of HPV infection. Using a condom cannot fully protect you from HPV during sex.

Regular dental examinations by a dentist are helpful in finding oral cavity cancer and some oropharyngeal cancers at an earlier stage.

Often, a dentist is the first person to find this type of cancer during a routine examination. People with oral and oropharyngeal cancer may experience the following symptoms. Sometimes, people with oral and oropharyngeal cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.

• Sore in the mouth or on the lip that does not heal (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 later in the course of the illness.

People who notice any of these warning signs should consult a doctor and/or dentist as soon as possible. When detected early, cancers of the oral cavity and oropharynx have a much better chance of cure.

Because many of these symptoms can be caused by other, noncancerous health conditions as well, it is important for people to receive regular health and dental screenings, especially those who routinely drink alcohol or currently use tobacco products or have used them in the past.

In fact, people who use alcohol and tobacco should receive a general screening examination at least once a year. 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 one or more of the diagnostic procedures mentioned in the Diagnosis section.

Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
• The type of cancer suspected
• Severity of symptoms
• Previous test result

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

Physical examination. Dentists and doctors often find lip and oral cavity cancers during routine check-ups. 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 and 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. This test allows the doctor to see inside the mouth and throat. Typically, an endoscope (a thin, flexible tube with an attached light and view lens) is inserted through the nose to examine the head and neck areas. Sometimes, a rigid endoscope (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 (larynx), pharyngoscopy (pharynx), or a nasopharyngoscopy (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. Tests are often done in the doctor’s office, although sometimes an endoscopy must be performed in the operating room using a general anesthesia.

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 sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). The type of biopsy performed will depend on the location of the cancer. In a fine needle aspiration biopsy, cells are withdrawn using a thin needle inserted directly into the tumor. The cells are examined under a microscope for cancer cells (called cytologic examination).

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

X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer that has spread to the lungs. A dentist may take extensive x-rays of the mouth, including a panorex (panoramic view).

Barium swallow. Two types of these tests are generally used to look at the oropharynx and swallowing. The first is a traditional barium swallow, during which the patient is asked to swallow liquid barium so the doctor can look for any changes in the structure of the oral cavity and throat and to see whether the liquid passes easily to the stomach. X-ray is then used. A modified barium swallow, or videofluoroscopy, is used to assess swallowing; the patient is asked to swallow liquid barium, pudding, and a cracker coated with barium.

Panorex. This is a rotating, or panoramic, x-ray of the upper and lower jawbones to detect bone destruction from cancer, or to evaluate teeth before radiation therapy or chemotherapy.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. A CT scan can help a doctor decide whether the cancer can be surgically removed and determine whether the cancer has spread to lymph nodes in the neck or lower jawbone.

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 base of the tongue. A contrast medium may be injected into a patient’s vein to create a clearer picture.

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) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. PET scans are often used to complement information gathered from CT scan, MRI, and physical examination. PET scanning is especially useful to detect cancer that has spread to other organs or hidden primary tumors.

To learn more about what to expect during common diagnostic tests, read Cancer.Net: Tests and Procedures.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: Newly Diagnosed.

Staging is a way of describing cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine 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 (chance of recovery). There are different stage descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five 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.

TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

• How large is the primary tumor and where is it located? (Tumor, T)
  
  
• Has the tumor spread to the lymph nodes? (Node, N)
  
  
• Has the cancer metastasized to other parts of the body? (Metastasis, M)

Tumor. 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: Indicates the primary tumor cannot be evaluated.

T0: 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 one layer of tissue.

T1: Describes a tumor that is 2 centimeters (cm) at its greatest dimension.

T2: Describes a tumor that is larger than 2 cm, but not larger than 4 cm.

T3: Describes a tumor that is larger than 4 cm.

T4: Describes any of the following conditions:

T4a (lip): Describes a tumor that began on the lip, but invades adjacent tissue, such as the floor of the mouth or the skin of the face.

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

T4b: The tumor invades the base of the skull and/or encases the internal arteries.

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

T4b: The tumor has moved into the nasopharynx, skull base, or nearby arteries and muscles.

Node. The “N” in the TNM staging system is for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the head and neck 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, and careful assessment of lymph nodes is an important part of staging.

NX: Indicates the regional lymph nodes cannot be evaluated.

N0: There is no evidence of cancer in the regional nodes.

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

N2: Describes any of these conditions:

N3: Cancer found in lymph nodes is larger than 6 cm.

Distant metastasis. The "M" in the TNM system describes cancer that has spread to other parts of the body.

MX: Indicates distant metastasis cannot be evaluated.

M0: Indicates the cancer has not spread to other parts of the body.

M1: Describes cancer that has spread to other parts of the body.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

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

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

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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).

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Stage III: Describes all larger tumors (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).

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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).

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

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

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Tumor grade (G). Doctors also describe a primary tumor by its grade, which is determined by using a microscope to examine tissue from a tumor (called a histologic examination). The doctor compares the tumor tissue with normal tissue, and the grade describes how closely the cancer cells resemble normal tissue under a microscope. Normal tissue contains many different types of cells grouped together, which is called differentiated. Tissue from tumors usually has cells that look more alike each other (called poorly differentiated). Generally, the more differentiated the tissue, the better the prognosis. A tumor's grade is described using the letter "G" and a number.

GX: The grade cannot be evaluated.

G1: The cells look more like normal tissue (well differentiated).

G2: The cells are only moderately differentiated.

G3: The cells don’t resemble normal tissue (poorly differentiated).

Recurrent: Recurrent cancer is cancer that comes back after treatment.

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, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.

The treatment of oral and oropharyngeal cancer depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

Oral and oropharyngeal cancer can often be cured, especially if it is found early.

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, how a person feels, looks, talks, eats, and breathes.

In many cases, a team of doctors will work with the patient to determine the best treatment plan. Head and neck cancer specialists often form a multidisciplinary team to care for each patient, and an evaluation should be done before any treatment begins. The team may include medical oncologists, radiation oncologists, surgeons, otolaryngologists (ear, nose, and throat doctors), maxillofacial prosthodontists (specialists who perform restorative surgery to the head and neck area), dentists, physical therapists, speech pathologists, mental health professionals, nurses, dietitians, and social workers. It is crucial that a comprehensive treatment plan is established before treatment begins, and people may need to be seen by multiple specialists before such a plan can be created.

There are three main treatment options for oral and oropharyngeal cancer: surgery, radiation therapy, and chemotherapy. Each is described below in more detail. One of these therapies, or a combination of them, may be used to treat the cancer.

Surgery

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

During surgery, a surgeon performs an operation to remove the cancerous tumor and some of the healthy tissue around it (called a margin). The goal of surgery is to remove all of the tumor and leave negative margins (which means there is no trace of cancer in the healthy tissue). Sometimes surgery is followed by radiation therapy and/or chemotherapy. Depending on the location, stage, and pathology of the cancer, some people may need more than one operation to remove the cancer and to help restore the appearance and function of the tissues affected.

Any surgical procedure should be done with the assistance of frozen section determination of the margins at the time of surgery. This will require removal of additional tissues to obtain a margin free of cancer. The use of micrographic surgery, which is very frequent in the treatment of skin cancer, can occasionally be utilized for oral cavity tumors, and it is one way to minimize the amount of normal tissue removed. This technique is often used with cancer of the lip. This technique involves removing the visible tumor, in addition to small fragments of the edge around where the tumor existed. Each small fragment is examined under a microscope until all cancer is removed.

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

Primary tumor surgery. The tumor and an area of surrounding tissue are removed to decrease chances that any of the cancer will be left behind. The tumor can be removed through the mouth or through an incision in the neck. A mandibulotomy, in which the jawbone is split to access the tumor, may also be required.

Glossectomy. The partial or total removal of the tongue.

Mandibulectomy (Full or partial removal of the jaw). If the tumor has entered a jawbone but not spread into the bone, then a piece of the jawbone is removed. If there is evidence of destruction of the jawbone on an x-ray, then the entire bone may need to be removed.

Maxillectomy. A surgery that 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 from this operation.

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

Laryngectomy. A laryngectomy, complete or partial removal of the larynx or voicebox, is rarely necessary for treatment of oral or oropharyngeal cancer. 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. When there is a large tumor of the tongue or oropharynx, the doctor may also need to remove the larynx so that the individual is able to swallow safely. If the larynx is removed, the windpipe is reattached to the skin of the neck where a hole is made, called a stoma, through which the patient breathes. Rehabilitation is required to learn a new way of speaking.

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

Gastrostomy tube. If cancer is inhibiting the ability to swallow, a feeding device called a gastrostomy tube is placed through the skin and muscle of the abdomen directly into the stomach. If the swallowing problem is temporary, a nasogastric (NG) tube (inserted through the nose, down the esophagus, and into the stomach) may be used instead of a tube into the stomach. Tubes placed into the stomach may also be temporary methods for maintaining nutrition until the person can safely and adequately swallow by mouth.

Reconstruction. If treatment requires removing large areas of tissue, reconstructive surgery may be necessary so the patient can 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 to replace part of the lip, tongue, palate, or jaw. A prosthodontist (a dental specialist with expertise and certification in the restoration and replacement of broken teeth with crowns, bridges, or removable prosthetics [dentures]) may be able to make an artificial dental or facial part to facilitate swallowing and speech. A speech pathologist can teach the patient to communicate using new techniques or special equipment. A speech pathologist will also help restore the ability to swallow in patients who have difficulty eating by mouth 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 in chewing, swallowing, or talking; numbness of the ear; weakness in raising arms above the head; lack of movement in the lower lip; and facial disfigurement. Surgery can decrease functioning of the thyroid gland, especially after a total laryngectomy and/or radiation therapy to the area.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is external-beam radiation therapy, which is radiation given from a machine outside the body. External-beam radiation therapy is conducted with a radiation beam aimed at the tumor and is generally done as an outpatient procedure. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Internal radiation therapy involves tiny pellets or rods containing radioactive materials that 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.

A new method of external radiation therapy, known as intensity modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells, thus causing fewer side effects. Proton-beam or charged-particle radiation therapy directs high-energy particles to the tumor, which also reduces the possibility of damage to nearby tissue.

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

Before beginning radiation treatment for any head and neck cancer, people should receive a thorough examination from an oncologic dentist (a dentist with experience in 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.

It is also important that people receive counseling and evaluation from an oncologic speech pathologist (a speech pathologist with experience in treating people with head and neck cancer). Since radiation therapy can cause damage to healthy tissue, people often have difficulty speaking and/or swallowing after radiation therapy. These problems may occur long after radiation is completed. Speech pathologists can teach 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 region. Sometimes, patients may need to be evaluated by an audiologist (hearing specialist) to determine hearing abilities and/or loss.

Radiation therapy to the head and neck may cause the following side effects: redness or skin irritation to the treated area; dry mouth or thickened saliva, from damage to salivary glands (this can be temporary or permanent); bone pain; nausea; fatigue; mouth sores and/or sore throat; dental problems (usually preventable, see above); painful or difficulty swallowing; difficulty opening the mouth; difficulty speaking; loss of appetite, due to a change in sense of taste; hearing loss, due to buildup of fluid in the middle ear or nerve damage; and buildup of earwax, which dries out because of the radiation therapy’s effect on the ear canal.

Radiation therapy may also cause a condition called hypothyroidism, in which the thyroid gland (located in the neck) slows down, and this causes 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.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body.

The use of chemotherapy in combination with radiation therapy (called concomitant radiochemotherapy) is commonly recommended. The combination of these two treatments can sometimes control tumor growth, and frequently it will cause a significant increase in the effectiveness compared to either treatment given alone. However, the side effects can be greater when combining these treatments.

Chemotherapy may be used as a neoadjuvant therapy (the initial treatment before surgery, radiation therapy, or both) or an adjuvant therapy (the initial treatment after surgery, radiation therapy, or both).

Chemotherapy for oral cavity cancer is most often given as part of a clinical trial (a research study). Many combined treatments (chemotherapy and radiation therapy) are performed 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 these can typically be well-controlled. In general, chemotherapy may cause the following side effects: 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 and/or constipation; and open sores in the mouth (this condition coupled with a low immunity can lead to infections).

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net’s Drug Information Resources, which provides links to searchable drug databases.

Immunotherapy

Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function.

Targeted therapy

Targeted therapy is a treatment that targets faulty genes or proteins that contribute to cancer growth and development. Unlike chemotherapy that kills both healthy and cancerous cells, these drugs selectively kill cancer cells, which helps to reduce side effects. 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.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment.

Doctors and scientists are always looking for better ways to treat patients with oral and oropharyngeal cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments, such as new chemotherapy drugs, before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

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 this is the only way to make progress in treating oral and oropharyngeal cancer, such as finding new drugs. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with oral and oropharyngeal cancer.

In order to join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so 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. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.

Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur.

Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health.

Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent or control them, visit Cancer.Net’s section on Managing Side Effects, based on ASCO’s curriculum.

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net’s section on Caring for the Whole Patient.

For more information on late effects or long-term side effects, please read the After Treatment section or talk with your doctor.

After treatment for oral or oropharyngeal cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. People treated for oral and oropharyngeal cancer should receive regular follow-up medical and dental examinations to check for signs of recurrent cancer or a secondary cancer (a different type of cancer).

Most recurrences of oral and oropharyngeal cancer happen in the first two or three years after diagnosis, so follow-up visits will be more frequent in the years immediately following treatment. A common follow-up schedule is every two months for the first year, every four months for the second year, every six months for the third year, and once a year thereafter. If recurrent cancer is found, testing and treatment must begin again. If surgery or radiation therapy may have affected the person’s thyroid gland, thyroid function tests should be part of follow-up care testing. Special dental care may also be needed to manage or avoid long-term dental problems due to the cancer or its treatment.

People treated for oral and oropharyngeal cancer have a higher risk of developing secondary cancers. Researchers are evaluating the benefits of chemotherapy to prevent second cancers from developing, called chemoprevention.

If you smoke, it is important to be monitored for possible second cancers in the lung, esophagus, and head and neck, even without recurrence of the initial cancer. This is one of the reasons for medical follow-up. Enrolling in prevention clinical trials may also be an option.

Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People may receive physical therapy, and speech and swallowing therapy. Supportive care to manage symptoms and maintain nutrition during treatment may be recommended. Some people may need to learn new ways to eat or to eat foods prepared differently.

Any treatment for oral and oropharyngeal cancer will make swallowing normal food more difficult. Special nutritional care and support is often needed during treatment and immediately following treatment, while the local reaction to the treatment, such as swelling of tissues, subsides. Speech pathologists can assist people in regaining their normal functions, which becomes an important part of treatment planning and rehabilitation.

Depending on the size and location of the tumor and the type of cancer treatment selected, the abilities to chew and move the food through the mouth and pharynx to the stomach may be impaired. If the cancer treatment changes oral structures or limits their movement, speech will become more difficult to understand. Pre-treatment evaluation of speech and swallowing abilities are necessary to maximize post-treatment functioning and quality of life. 

People may look different, feel tired, and be unable to talk or eat the way they used to. Many people experience depression. The health-care team can help people adjust and connect them with both physical and emotional support services. Again, it is important that people meet with all members of the multidisciplinary team before their head and neck cancer treatment begins (see Treatment).

People recovering from oral and oropharyngeal cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: After Treatment.

Research involving diagnostic procedures and treatments for oral and oropharyngeal cancer is ongoing. The following advancements may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor.

New treatments. Many new treatments have become available as a result of improvement in the knowledge of the biology of cancer. Some of these treatments, including biologic therapy and targeted therapy, are available through clinical trials. Biologic therapy, also called immunotherapy, helps restore or stimulate the body’s immune system to fight the cancer. Targeted therapies, based upon the scientific advances in learning more about the molecular biology and characterization of head and neck cancers, are leading to approaches with less side effects in treating this type of cancer. Therapies being researched include tyrosine kinase inhibitors, antiangiogenic therapy (which prevents blood vessel formation that is needed for tumor growth), immune modulating approaches, and agents that induce cancer cell death. These and other developments are in various stages of research. Patients should talk with their doctors about clinical trials for treating oral and oropharyngeal cancer.

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

Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:

• What type of oral or oropharyngeal cancer do I have? Where exactly is it located?
  
  
• What is the stage of the cancer? What does this mean?
  
  
• What are the treatment options?
  
  
• What clinical trials are open to me?
  
  
• What treatment option do you recommend? Why?
  
  
• Should I get an additional consultation or second opinion?
  
  
• What are the possible side effects of each treatment option, both in the short term and the long term?
  
  
• What can be done to relieve the possible side effects?
  
  
• What functional deficits (in speech, swallowing, or shoulder motion) will likely occur, and what rehabilitation services are available?
  
  
• If I have surgery, will there be need for major reconstruction, and how is this going to affect my ability to speak and eat?
  
  
• If surgery is done, will there be a need for a neck dissection (removing lymph nodes)? If so, what type of dissection will be done? What does this mean?
  
  
• If I receive radiation therapy, what are the lasting side effects of such treatment including loss of saliva, loss of taste, and permanent difficulty in swallowing?
  
  
• How likely is it that I will lose my voice box (larynx), and if this is necessary, what are the options available for voice/speech rehabilitation?
  
  
• How will my nutrition be maintained if the treatment affects my ability to eat the foods I am used to eating?
  
  
• Can you recommend an oncologic dentist?
  
  
• Should I see other specialists prior to treatment? Should I specifically talk with a radiation oncologist, medical oncologist, plastic surgeon, or a speech pathologist?
  
  
• What will rehabilitation after treatment consist of?
  
  
• If I am a smoker, can you help me to quit?
  
  
• If I am a smoker, will quitting this habit help this treatment have a better outcome?
  
  
• After treatment, what follow-up tests will be needed, and how often will I need them?
  
  
• What are the chances this tumor will recur?
  
  
• What are the chances of a secondary cancer?
  
  
• Will there be any lasting or late side effects that will need special care?

The Oral Cancer Foundation
3419 Via Lido, #215
Newport Beach, CA  92663
Phone: 949-646-8000
www.oralcancerfoundation.org

Support for People with Oral, Head, and Neck Cancer
P.O. Box 53
Locust Valley, NY  11560-0053
Toll Free: 800-377-0928
Phone: 516-759-5333
www.spohnc.org

View all of Cancer.Net's Patient Information Resources.