Oral Cancer

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Questions to Ask Your Doctor About Your Cancer
(Free Handout)

Treatment

Oral and oropharyngeal cancers are treated using chemotherapy, surgery, and radiation therapy. In many cases of mouth cancer, a combination of treatments is used. Treatment usually depend on the stage and location of the disease, the size of tumor, and if the mouth cancer has spread (metastasized).

Chemotherapy
Chemotherapy involves using medications to destroy cancer cells. This treatment often is administered by injection, in a hospital, clinic, or at home. The drugs travel through the bloodstream and can attack cancer cells throughout the body (called systemic treatment).

Side effects of chemotherapy are common because the drugs used can also attack healthy cells. Patients may experience pain, bleeding, infections, fatigue, hair loss, and digestive problems. Side effects can change during the course of chemotherapy and they vary from patient to patient.

Other types of medications may be used to treat oral and oropharyngeal cancers. The Food and Drug Administration (FDA) recently approved the use of cetuximab (Erbitux®) to be used with radiation to treat patients with advanced oral cancer. This drug can help slow down the growth and spread of cancer cells. Erlotinib (Tarceva®) can help in a similar way. The effectiveness of these drugs is still being investigated.

Surgery
Surgery is often used to treat oral and oropharyngeal cancers. In a primary tumor resection, the tumor and surrounding tissue are surgically removed. In cases that involve the lip, Mohs micrographic surgery may be an option. In this procedure, the surgeon slices the tumor and examines each piece for cancer cells. In this way, less surrounding tissue is removed. If cancer has spread to the lymph nodes, a neck dissection is conducted.

Laryngectomy (removal of the voice box [larynx]) can be performed to keep food from entering the lungs when cancer affects the patient's ability to swallow. Following this procedure, a hole remains in the patient's neck to assist with breathing and talking.

Complications from surgery can include pain, discomfort, swelling, and fatigue. If the tumor is large, parts of the jaw, tongue, or the roof of the mouth may also be removed. In these cases, reconstructive surgery may be performed. Certain tissues and bones can be rebuilt, a dental implant can help a patient chew, a gastrostomy tube (feeding tube) can help ensure proper nutrition, and a tracheostomy can help a patient breathe more easily.

Because neck dissection involves damage to nearby nerves, additional side effects (e.g., ear numbness, weakness in the arm and lip) may occur. In some cases, this weakness is permanent. Physical therapy can help patients regain strength.

Radiation Therapy
Radiation therapy is used to treat small tumors or in combination with other types of treatment (e.g., surgery). In external radiation, a beam of radiation is aimed at the treatment area. Doctors are careful to use only the amount of radiation necessary to treat the cancer. Radiation usually is administered 5 times a week for 5–7 weeks.

Internal radiation requires a hospital stay. In this treatment, radioactive material is placed directly into the cancerous tissue for several days. The material usually is removed before the patient leaves the hospital. While the material is implanted, visits to the patient must be short due to the risk for radiation exposure.

Side effects of radiation therapy include the following:

• Changes in voice, taste, and smell
• Dry mouth
• Fatigue
• Infection
• Soreness
• Thyroid problems
• Tooth decay

Side effects can be temporary or permanent, usually depending on the amount of radiation required, and often can be managed with additional treatment measures.

Clinical Trials
Some patients choose to participate in a clinical trial as a treatment option. Clinical trials are experimental treatments that help researchers study the benefits and risks of certain methods. Patients should consult with their physicians to decide whether a clinical trial is best for them. They also should understand the types of drugs and procedures used, what side effects may occur, how the side effects can be handled, and whether a hospital stay is required during treatment.

Follow-up
Patients should be sure to keep all follow-up medical appointments. These appointments are usually scheduled more frequent immediately following treatment, and less frequently once the risk for recurrence lowers. If oral and oropharyngeal cancers recur, this generally happens within 2 years of treatment. Maintaining adequate medical insurance is essential.

Some patients require reconstructive surgery and therapy after treatment for mouth cancer. Surgeons can use dental implants and muscle, bone, and skin grafts to improve the appearance and function of the mouth. Speech therapists can work with patients to help them regain the ability to talk. Other types of therapy can assist with chewing and swallowing so that these functions become comfortable again.

During recovery, it is important to maintain a healthy diet. However, this is difficult for many patients because treatment can affect appetite, taste, and the ability to chew and swallow. Crunchy, chewy, hot, spicy, or acidic foods should be avoided. Foods high in sugar also should be avoided due to the risk for tooth decay. A dietitian or nutritionist can teach patients to manage a healthy diet after cancer treatment.

Many patients feel extremely fatigued during recovery. It is essential to get proper rest and adequate exercise for strength and fitness. Exercise can also ease depression and anxiety and help patients maintain a happier outlook. In some cases, physical therapy is helpful.

It is also important for patients to take care of their mental health. Cancer treatment can be an exhausting, emotional experience, but family, friends, cancer support groups, therapists, and social workers can help. Doctors often can recommend a number of local options.

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