People with early oral cancer may be treated with surgery or radiation therapy. People with advanced oral cancer may have a combination of treatments. For example, radiation therapy and chemotherapy are often given at the same time. Another treatment option is targeted therapy. The choice of treatment depends mainly on your general health, where in your mouth or throat the cancer began, the size of the tumor, and whether the cancer has spread.
Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. You may have surgery alone or in combination with radiation therapy.
Surgery to remove a small tumor in your mouth may not cause any lasting problems. For a larger tumor, however, the surgeon may have to remove part of the palate, tongue, or jaw, and this may change the patient's ability to chew, swallow, or talk. Also, this may change the look or structure of the face. A patient may have reconstructive or plastic surgery to rebuild any bones or tissues that were removed from the mouth. Also, surgery may cause tissues in the face to swell. This swelling usually goes away within a few weeks; however, removing lymph nodes can result in swelling that lasts a longer time.
Radiation therapy uses high-energy rays to kill cancer cells and can be used to treat the area where the patient is affected by oral cancer. This type of treatment focuses on treating the specific area(s) where the cancer was found. Radiation therapy is an option used for small tumors, for people who can’t have surgery, before surgery to shrink the tumor, or after surgery to destroy cancer cells that may remain in the area.
Doctors use two types of radiation therapy to treat oral cancer. Some people with oral cancer have both types:
- External radiation therapy: The radiation comes from a machine. Some cancer treatment centers offer IMRT, which uses a computer to more closely target the oral tumor to lessen the damage to healthy tissue. You may go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks. Each treatment takes only a few minutes.
- Brachytherapy: Brachytherapy, also known as internal radiation or interstitial radiation, is radiation that is delivered directly into or near the cancer. The radiation comes from radioactive material in seeds, wires, or tubes put directly in the mouth or throat tissue. Because external radiation approaches are now very precise, treating lip and oral cancer with brachytherapy is not very common. If this method is used, patients may need to stay in the hospital for several days. Usually, the radioactive material is removed before you go home.
Chemotherapy uses drugs to kill cancer cells. The chemotherapy drugs that treat oral cancer are usually given through a vein (intravenous), and the drugs enter the bloodstream and travel throughout your body. You may receive chemotherapy in outpatient therapy at a cancer center like ours.
Some patients may need a treatment regimen that includes both chemotherapy and radiation therapies. For some patients, the two treatments may be alternated throughout the week. For others, it may be necessary to complete one regimen completely before starting the next.
Chemotherapy and radiation therapy can cause some of the same side effects -- including painful mouth and gums, dry mouth, infection, and changes in taste. Some anticancer drugs can cause bleeding in the mouth and a deep pain that feels like a toothache. Other chemo drugs may cause diarrhea, kidney damage, and numbness and tingling in the hands and feet.
Chemotherapy can also affect the blood-producing cells of the bone marrow, leading to low blood cell counts. Some side effects that may result from this could include:
- Higher risk of infections (due to low white blood cell counts)
- Bruising or bleeding more easily (due to low blood platelet counts)
- Fatigue (due to low red blood cell counts)
While some side effects can be permanent, most improve once treatment has stopped. There are ways to prevent or treat many of the side effects of chemo, so speak with your doctor if you are experiencing any side effects.
Some people with oral cancer receive a type of drug known as targeted therapy. Cetuximab (Erbitux) was the first targeted therapy approved for oral cancer. Cetuximab binds to oral cancer cells and interferes with cancer cell growth and the spread of cancer. You may receive cetuximab through a vein once a week for several weeks at the doctor's office. It may be given along with radiation therapy or chemotherapy.