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Oral and Oropharyngeal Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 09/2017

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. Use the menu to see other pages. Think of that menu as a roadmap for this complete 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, also called 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

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.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to head and neck cancer. This fact sheet is available as a PDF, so it is easy to print out.

  • Cancer.Net Blog: Read an ASCO expert’s opinion about what newly diagnosed patients should know about head and neck cancer.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert in head and neck cancers that provides basic information and areas of research.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with these diseases and general survival rates. You may use the menu to choose a different section to read in this guide.

Oral and Oropharyngeal Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 09/2017

ON THIS PAGE: You will find information about the number of people who are diagnosed with oral and oropharyngeal cancer each year. You will also read general information on surviving these diseases. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, an estimated 51,540 adults (37,160 men and 14,380 women) in the United States will be diagnosed with oral and oropharyngeal cancer. Rates of these cancers are more than twice as high in men as in women. Cancer of the oral cavity is the eighth most common cancer among men. The average age of diagnosis is 62.

Overall, the number of men who develop these cancers has remained similar in recent years, and the number of women diagnosed with these cancers has decreased slightly. However, there has been an increase in HPV-related oral and oropharyngeal cancers among white men and women (see Risk Factors and Prevention).

It is estimated that 10,030 deaths (7,280 men and 2,750 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. 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.

The overall 5-year survival rate for people with oral or oropharyngeal cancer is 65%. The 5-year survival rates for white people and black people with oral or oropharyngeal cancer are 66% and 48%, respectively. Research shows that survival rates are higher in patients who have HPV (See Risk Factors).

If the cancer is diagnosed at an early stage, the overall 5-year survival rate is 84%. For white people diagnosed at an early stage, the rate is 83%. For black people diagnosed at an early stage, the survival rate is 79%. About 30% of oral and oropharyngeal cancers are diagnosed at this stage. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the overall 5-year survival rate is 64%. If the cancer has spread to a distant part of the body, the overall 5-year survival rate is 39%.

It is important to remember that statistics on the survival rates for people with oral and oropharyngeal cancer are an estimate. The estimate comes from annual data based the number of people with these cancers in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. People should talk with their doctor if they have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts and Figures 2017: Special Section – Rare Cancers in Adults, and the ACS website (January 2018).

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by oral and oropharyngeal cancer. Use the menu to choose a different section to read in this guide.

Oral and Oropharyngeal Cancer - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 09/2017

ON THIS PAGE: You will find a drawing of the main body parts affected by these diseases. Use the menu to see other pages.

This illustration shows the oral cavity and oropharynx within the head and neck region. The oral cavity includes the lips, the front two-thirds of the tongue, and the hard palate, or roof of the mouth. The oropharynx begins where the oral cavity stops. It includes the soft palate at the back of the mouth, the tonsils, the base of the tongue, and the part of the throat behind the mouth. The illustration also shows the throat, including the esophagus and the windpipe, or trachea, and nasal cavity, the air-filled cavity behind the nose. Copyright 2005-2011 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease. You may use the menu to choose a different section to read in this guide.

Oral and Oropharyngeal Cancer - Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 09/2017

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

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. 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 recent years, HPV-related oropharyngeal cancer in the tonsils and the base of the tongue has become more common. Sexual activity, including oral sex, with someone who has HPV 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.

    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 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.

Reducing your risk of HPV infection is also important. The HPV vaccine can prevent HPV-related cancers. Limiting your number of sexual partners can also reduce your risk of HPV. Using a condom during sex cannot fully protect you from HPV.

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. You may use the menu to choose a different section to read in this guide.  

Oral and Oropharyngeal Cancer - Screening

Approved by the Cancer.Net Editorial Board, 09/2017

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. Use the menu to see other pages.

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. You may use the menu to choose a different section to read in this guide.

Oral and Oropharyngeal Cancer - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 09/2017

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

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 a different 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 figure 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 the 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. You may use the menu to choose a different section to read in this guide.  

Oral and Oropharyngeal Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 09/2017

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. Use the menu to see other pages.

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 an area 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 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 suspicious area. 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.

  • HPV testing. HPV testing may be done on a sample of the tumor removed during the biopsy. As described in Risk Factors and Prevention, HPV has been linked to a higher risk of oropharyngeal cancer. Whether a person has HPV can help determine the cancer’s stage and the treatment options that are likely to be most effective. ASCO recommends that HPV testing is done for all patients newly diagnosed with oropharyngeal squamous cell carcinoma. This is a type of oropharyngeal cancer that starts in flat, scale-like cells called squamous cells. Testing is not usually recommended for oropharyngeal cancer that starts in other types of cells or for other types of head and neck cancer. Learn more details about recommendations for HPV testing on a separate ASCO website.  

  • 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 to 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 combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can 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 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. You may use the menu to choose a different section to read in this guide.

Oral and Oropharyngeal Cancer - Stages and Grades

Approved by the Cancer.Net Editorial Board, 09/2017

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

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 TNM system differs depending whether the diagnosis is oral cancer, oropharyngeal cancer, or HPV-related oropharyngeal cancer.

The results of the TNM system are combined to determine the stage of cancer for each person. There are 4 or 5 stages, depending on the diagnosis. Stage 0 (zero) is only used for non-HPV-related oropharyngeal cancer. Stages I through IV (1 through 4) are used for all 3 types of oral and oropharyngeal cancer. 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.

Oral cavity

TX: The primary tumor cannot be evaluated.

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) or less at its greatest dimension. The tumor has invaded nearby tissues to a depth of 5 millimeters (mm) or less; this is called depth of invasion.

T2: The tumor is 2 cm or smaller, and the depth of invasion is between 5 and 10 mm. Or, the tumor is larger than 2 cm but not larger than 4 cm, and the depth of invasion is 10 mm or less.

T3: The tumor is larger than 4 cm, or it is any tumor with a depth of invasion greater than 10 mm.

T4: This is moderately advanced or very advanced local disease.

  • T4a (lip): The tumor began on the lip but has invaded bone or spread to the inferior alveolar nerve in the mouth, the floor of the mouth, or the skin of the face.

  • T4a (oral cavity): The tumor has invaded nearby structures in the mouth, such as the jaw, sinuses, or skin of the face.

  • T4b: The tumor has invaded the muscles and bones that form the mouth or the base of the skull, and/or it encases the internal arteries.

Oropharynx

TX: The primary tumor cannot be evaluated.

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) or smaller 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 or has spread to the epiglottis, which is the flap of cartilage that diverts food into the esophagus.

T4a: The tumor has invaded the larynx, muscle of the tongue, muscles in the jaw, roof of the mouth, or jawbone.

T4b: The tumor has invaded muscles and bones in the region of the mouth; the nasopharynx, which is the air passageway at the upper part of the throat behind the nose; or the base of the skull, or the tumor encases the carotid artery.

HPV-related oropharyngeal cancer

T0 (T plus zero): No tumor can be found.

T1: The tumor is 2 centimeters (cm) or smaller 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 or has spread to the epiglottis, which is the flap of cartilage that diverts food into the esophagus.

T4: The tumor has invaded the larynx, muscle of the tongue, muscles in the jaw, roof of the mouth, or jawbone.

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.

When cancer has spread through a lymph node and into the tissues directly surrounding it, it is called extranodal extension (ENE). Knowing whether ENE is present plays an important role in the evaluation of lymph nodes in oral and oropharyngeal cancers that are not related to HPV.

There are 2 methods of categorizing N in the TNM system: clinical and pathological. Clinical N is used for patients who have not received a neck dissection (see “Surgery” in Treatment Options). Pathological N is used for those who have had a lymph node dissection.

Oral cavity and oropharynx—clinical

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. There is no ENE.

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. There is no ENE.

N2b: Cancer has spread to more than 1 lymph node on the same side as the primary tumor, and none measures larger than 6 cm. There is no ENE.

N2c: Cancer has spread to more than 1 lymph node on either side of the body, and none measures larger than 6 cm. There is no ENE.

N3a: The cancer is found in a lymph node and is larger than 6 cm. There is no ENE.

N3b: There is ENE in any lymph node.

Oral cavity and oropharynx—pathological

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. There is no ENE.

N2a: Cancer has spread to 1 lymph node and is 3 cm or smaller, but there is ENE. Or, 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, and there is no ENE.

N2b: Cancer has spread to more than 1 lymph node on the same side as the primary tumor, and none measures larger than 6 cm. There is no ENE.

N2c: Cancer has spread to more than 1 lymph node on either side of the body, and none measures larger than 6 cm. There is no ENE.

N3a: The cancer is found in a lymph node and is larger than 6 cm. There is no ENE.

N3b: There is ENE in a single lymph node on the same side as the primary tumor, and it is larger than 3 cm. Or, cancer has spread to many lymph nodes, and at least 1 has ENE. Or, there is ENE in a single lymph node on the opposite side of the primary tumor that is 3 cm or smaller.

HPV-related oropharyngeal cancer—clinical

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 1 or more lymph nodes on the same side as the primary tumor, and the cancer found in the node is 6 cm or smaller.

N2: Cancer has spread to 1 or more lymph nodes on either side of the body, and none is larger than 6 cm.

N3: The cancer is found in a lymph node and is larger than 6 cm.

HPV-related oropharyngeal cancer—pathological

NX: The regional lymph nodes cannot be evaluated.

pN0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.

pN1: The cancer has spread to 1 to 4 lymph nodes.

pN2: Cancer has spread to more than 4 lymph nodes.

Metastasis (M)

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

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.

Oral cavity

Stage 1: The tumor is 2 centimeters (cm) or smaller, and the depth of invasion is 5 millimeters (mm) or less. The cancer has not spread to lymph nodes or other parts of the body (T1, N0, M0).

Stage II: The tumor is 2 cm or smaller, and the depth of invasion is between 5 and 10 mm. Or, the tumor is larger than 2 cm but not larger than 4 cm, and the depth of invasion is 10 mm or less. The cancer has not spread to lymph nodes or other parts of the body (T2, N0, M0).

Stage III: Either of the following applies:

  • The tumor is larger than 4 cm, or it is any tumor with a depth of invasion greater than 10 mm. The cancer has not spread to lymph nodes or other parts of the body (T3, N0, M0).

  • The tumor is any size, but it has not invaded nearby structures of the oral cavity. There is cancer in a single lymph node on the same side as the primary tumor, and the cancer is 3 cm or smaller. There is no ENE. Cancer has not spread to other parts of the body (T1–T3, N1, M0).

Stage IVA: Either of the following applies:

  • The tumor has invaded nearby structures in the mouth, such as the jaw, sinuses, or skin of the face. If cancer has spread to a lymph node, it is to only 1 node on the same side as the primary tumor, and the cancer is 3 cm or smaller, with no ENE. Cancer has not spread to other parts of the body (T4a, N0 or N1, M0).

  • The tumor may be small or it may have invaded nearby structures. Cancer has spread to 1 or more lymph nodes, but none is larger than 6 cm. There is no ENE. Cancer has not spread to other parts of the body (T1–T4a, N2, M0).

Stage IVB: Either of the following applies:

  • The tumor is any size. The cancer is found in a lymph node and is larger than 6 cm, but there is no ENE; or there is ENE in any lymph node. Cancer has not spread to other parts of the body (any T, N3, M0).

  • The tumor has invaded the muscles and bones that form the mouth or the base of the skull, and/or it encases the internal arteries. The cancer may involve the lymph nodes, but it has not spread to other parts of the body (T4b, any N, M0).

Stage IVC: Cancer has spread to other parts of the body (any T, any N, M1).

Oropharynx

Stage 0: There is carcinoma in situ, with no spread to lymph nodes or other parts of the body (Tis, N0, M0).

Stage I: The tumor is 2 cm or less in size, but cancer has not spread to lymph nodes or other parts of the body (T1, N0, M0).

Stage II: The tumor is between 2 cm and 4 cm, but cancer has not spread to lymph nodes or other parts of the body (T2, N0, M0).

Stage III: Either of the following applies:

  • The tumor is larger than 4 cm or has spread to the epiglottis, but the cancer has not spread to lymph nodes or other parts of the body (T3, N0, M0).

  • The tumor has not invaded nearby tissues, except the epiglottis. Cancer is in 1 lymph node on the same side as the primary tumor, and it is 3 cm or smaller, with no ENE. Cancer has not spread to other parts of the body (T1–T3, N1, M0).

Stage IVA: Either of the following applies:

  • The tumor has invaded the larynx, muscle of the tongue, muscles in the jaw, roof of the mouth, or jawbone. Cancer may have spread to 1 lymph node, but it has not spread to other parts of the body (T4a, N0 or N1, M0).

  • The tumor may be small or it may have invaded nearby structures, like the larynx, muscles of the tongue or jaw, roof of the mouth, or jawbone. Cancer has spread to 1 or more lymph nodes, but none is larger than 6 cm. There is no ENE. Cancer has not spread to other parts of the body (T1–T4a, N2, M0).

Stage IVB: Either of the following applies:

  • The tumor is any size. The cancer is found in a lymph node and is larger than 6 cm, but there is no ENE; or there is ENE in any lymph node. Cancer has not spread to other parts of the body (any T, N3, M0).

  • The tumor has invaded muscles and bones in the region of the mouth; the nasopharynx, which is the air passageway at the upper part of the throat behind the nose; or the base of the skull, or the tumor encases the carotid artery. Lymph nodes may or may not be involved. Cancer has not spread to other parts of the body (T4b, any N, M0).

Stage IVC: Cancer has spread to other parts of the body (any T, any N, M1).

HPV-related oropharyngeal cancer

The stage groups for HPV-related oropharyngeal cancer differ depending on whether the lymph nodes have been assessed clinically or pathologically.

Clinical stage groups

Stage I: The tumor is 4 cm or smaller. If cancer has spread to lymph nodes, none of the cancer is larger than 6 cm and it only affects lymph nodes on the same side of the body as the primary tumor. Cancer has not spread to other parts of the body (T0–T2, N0 or N1, M0).

Stage II: Either of the following applies:

  • The tumor is 4 cm or smaller. Cancer has spread to 1 or more lymph nodes on either side of the body, and none is larger than 6 cm. Cancer has not spread to other parts of the body (T0–T2, N2, M0).

  • The tumor is larger than 4 cm or has spread to the epiglottis. If lymph nodes are involved, none of the cancer is larger than 6 cm. Cancer has not spread to other parts of the body (T3, N0–N2, M0).

Stage III: Either of the following applies:

  • The tumor is any size. Cancer has spread to lymph nodes, and it is larger than 6 cm. There is no spread to other parts of the body (any T, N3, M0).

  • The tumor has invaded the larynx, muscle of the tongue, muscles in the jaw, roof of the mouth, or jawbone. Lymph nodes may or may not be involved. There is no spread to other parts of the body (T4, any N, M0).

Stage IV: Cancer has spread to other parts of the body (any T, any N, M1).

Pathological stage groups

Stage I: The tumor is 4 cm or smaller. The cancer involves 4 or fewer lymph nodes. Cancer has not spread to other parts of the body (T0–T2, pN0­ or pN1, M0).

Stage II: Either of the following applies:

  • The tumor is 4 cm or smaller. Cancer has spread to more than 4 lymph nodes. There is no spread to other parts of the body (T0–T2, pN2, M0).

  • The tumor is larger than 4 cm or it invades nearby structures. The cancer involves 4 or fewer lymph nodes. Cancer has not spread to other parts of the body (T3 or T4, pN0 or pN1, M0).

Stage III: The tumor is larger than 4 cm or it invades nearby structures. Cancer has spread to more than 4 lymph nodes. There is no spread to other parts of the body (T3 or T4, pN2, M0).

Stage IV: Cancer has spread to other parts of the body (any T, any pN, 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 oral and oropharyngeal cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. HPV-related oropharyngeal cancer does not have a grading system. 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 College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. You may use the menu to choose a different section to read in this guide.

Oral and Oropharyngeal Cancer - Treatment Options

Approved by the Cancer.Net Editorial Board, 09/2017

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

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 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 whether the new treatment 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 oncologist: A doctor who treats cancer using chemotherapy or other medications, such as targeted therapy.

  • Radiation oncologist: A doctor who specializes in treating cancer using radiation therapy.

  • Surgical oncologist: A doctor who treats cancer using surgery.

  • Otolaryngologist: A doctor who specializes in the ear, nose, and throat.

  • Reconstructive/plastic surgeon: A doctor who specializes in reconstructive surgery, which is done to help repair damage caused by cancer treatment.

  • Maxillofacial prosthodontist: A specialist who performs restorative surgery in the head and neck areas.

  • Oncologic dentist or oral oncologist: Dentists experienced in caring for people with head and neck cancer.

  • Prosthodontist: A dental specialist with expertise in the restoration and replacement of broken teeth with crowns, bridges, or dentures.

  • Physical therapist: A health care professional who helps patients improve their physical strength and ability to move.

  • Speech-language pathologist (SLP): This health care professional specializes in communication and swallowing disorders. An SLP helps patients regain their speaking, swallowing, and oral motor skills after cancer treatment that affects the head, mouth, and neck.

  • Audiologist: A medical professional who treats and manages hearing problems.

  • Psychologist/psychiatrist: These mental health professionals address the emotional, psychological, and behavioral needs of the person with cancer and those of his or her family.

Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others. It is extremely important to create a comprehensive treatment plan before treatment begins. People may need to be seen by several specialists before a treatment plan is fully developed.

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. Talk with your doctor about the goals of each treatment 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. 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 needed to learn a new way of speaking (see Follow-up Care).

  • 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 a tumor 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 reduce the amount of healthy tissue removed. This technique is often used with cancer of the lip. It 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 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.

It is important that a person receive the opinion of different members of the multidisciplinary team before deciding on a specific treatment. Even though surgery is the fastest way to remove cancer, 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.

Talk with your health care team before surgery, so you know what to expect and how your side effects will be managed. 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 radiation therapy regimen, or 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 ending 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, or 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 given 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.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Pembrolizumab (Keytruda) and nivolumab (Opdivo) are 2 immunotherapy drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of people with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) that has not been stopped by platinum-based chemotherapy (see below for information on recurrent cancer and metastatic cancer). Both are immune checkpoint inhibitors that are also approved for the treatment of some people with advanced lung cancer or melanoma.

Different types of immunotherapy can cause different side effects. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

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 this 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 treatments intended 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 at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time 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. 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. 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 new cycle of testing will begin again to learn as much as possible about the recurrence. After this 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 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 doesn’t work

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 for many people, advanced cancer is difficult to discuss. 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option 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. You may use the menu to choose a different section to read in this guide.  

Oral and Oropharyngeal Cancer - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 09/2017

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. Use the menu to see other pages.

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 are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

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 a way to contribute to the 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.

Insurance coverage of clinical trials costs differs by location and by study. In some programs, some of the patient’s expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” 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:

  • Describe all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different than the risks of standard treatment.

  • 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.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

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.

PRE-ACT, Preparatory Education About Clinical Trials

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 ResearchIt explains areas of scientific research currently going on for these types of cancer. You may use the menu to choose a different section to read in this guide. 

Oral and Oropharyngeal Cancer - Latest Research

Approved by the Cancer.Net Editorial Board, 09/2017

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. Use the menu to see other pages.

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 best diagnostic and treatment options for you.

  • New treatments. Many new treatments have become available as doctors have learned more about the biology of cancer. Some of these treatments, including immunotherapy and targeted therapy, are available through clinical trials. As described in Treatment Options, immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight cancer. Therapies being researched include tyrosine kinase inhibitors; antiangiogenic therapy, which prevents the growth 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 treating 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:

  • To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

  • Review head and neck cancer research announced at recent scientific meetings by visiting the Cancer.Net Blog.

  • Listen to podcasts from ASCO experts discussing highlights from scientific meetings in 2015, 2016, and 2017.

  • Visit the website of the Conquer Cancer Foundation to find out how to help support cancer research. Please note that this link takes you to a separate ASCO website. 

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. You may use the menu to choose a different section to read in this guide.  

Oral and Oropharyngeal Cancer - Coping with Treatment

Approved by the Cancer.Net Editorial Board, 09/2017

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. Use the menu to see other pages.

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 they are 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 sadness, 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 response.

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. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. 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 checkups after you finish cancer treatment. You may use the menu to choose a different section to read in this guide.  

Oral and Oropharyngeal Cancer - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 09/2017

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

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 or 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 and after 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 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 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.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

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. 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 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 to find out if thyroid hormone medication is needed. 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 discuss 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 when 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 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 and with 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. You may use the menu to choose a different section to read in this guide.  

Oral and Oropharyngeal Cancer - Survivorship

Approved by the Cancer.Net Editorial Board, 09/2017

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

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 about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing 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 when 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

  • 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 place 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.

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 those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. You may use the menu to choose a different section to read in this guide.  

Oral and Oropharyngeal Cancer - Questions to Ask the Doctor

Approved by the Cancer.Net Editorial Board, 09/2017

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. Use the menu to see other pages.

Talking often with your health care team 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 a digital 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 will rehabilitation after treatment consist of?

  • 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 about my treatment plan?

  • 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? If so, what can I expect?

  • 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, targeted therapy, or immunotherapy

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

  • 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?

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. You may use the menu to choose a different section to read in this guide.  

Oral and Oropharyngeal Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 09/2017

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. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer 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. You may use the menu to choose a different section to read in this guide.