Treatment

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.