Treatments for oral cancer
If you have oral cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for oral cancer, your healthcare team will consider:
- the size of the cancer
- the stage of the cancer
- the location of the cancer
- your overall health and ability to recover from surgery, radiation therapy or chemotherapy
- how a treatment will affect appearance and function (such as your speech and ability to swallow and chew)
- your personal preferences
Your healthcare team may include a number of healthcare professionals with special training in treating people with oral cancer, including:
- head and neck surgeon (also called an otolaryngologist or ear, nose and throat (ENT) doctor) (specializes in surgery of the mouth, jaw, face and neck)
- head and neck reconstructive surgeon (specializes in reconstruction around the head and neckand facial plastic surgery)
- oral and maxillofacial surgeon (specializes in surgery of the mouth, jaws and teeth)
- medical oncologist (specializes in treating cancer with drugs)
- radiation oncologist (specializes in treating cancer with radiation therapy)
- maxillofacial prosthodontist (specializes in replacing lost head and neck tissues and teeth with prosthetics)
- speech therapist (speech-language pathologist)
- registered dietitian
- social worker
Oral cancer can make it difficult to eat, so you may not eat enough and you may lose weight. Before you start treatment, a dietitian may do a nutritional assessment to see how oral cancer has affected your nutrition. If you aren’t getting good enough nutrition, you may need to have a feeding tube placed before you start treatment. This is to make sure you get enough nutrition to maintain your weight and strength during treatment.
It is important to assess if and how oral cancer has affected your speech. You will often see a speech therapist when you are first diagnosed and throughout your treatment to help manage any speech problems you may have as a result of oral cancer or its treatment.
It is also important to have a complete dental exam as you may need dental work done before treatment can start.
If you are a smoker, your healthcare team will talk to you about how they can help you quit. Smoking can limit how well your cancer treatment works, so it is important to quit before you start treatment.
Oral cancer is usually treated with surgery first. Surgery may be followed with radiation therapy or sometimes radiation therapy and chemotherapy. Reconstruction may be needed to repair structures in the mouth and jaw or to help with speech and swallowing. Reconstruction is planned at the same time as treatment. It is important for the healthcare team involved in reconstruction to assess and talk to you about what your expectations are before any surgery or other treatments are done.
You may be offered one or more of the following treatments for oral cancer.
Surgery is the main treatment for most oral cancers. Depending on the stage and location of the tumour, you may have one of the following types of surgery.
Wide local excision removes the tumour along with a margin of normal tissue around it. It is used for small, early-stage oral cancers.
Glossectomy is surgery to remove part or all of the tongue.
Mandibulectomy is surgery to remove part or all of the lower jawbone (mandible).
Maxillectomy is surgery to remove part or all of the upper jawbone (maxilla).
Neck dissection removes lymph nodes from the neck. It is usually done when cancer has spread to the lymph nodes in the neck. It may be done at the same time as surgery to remove the tumour. Neck dissection may also be done to prevent the cancer from spreading and reduce the risk that the cancer will come back (recur). Neck dissection is also commonly done to determine whether the cancer has spread to lymph nodes or not.
Gastrostomy involves inserting a tube into the stomach to provide nutrition.
Tracheostomy is done to make an opening (called a stoma) in the trachea through the neck so air can reach the lungs. It is often done during cancer surgery that involves the head and neck to ensure that swelling after surgery does not affect your ability to breathe. Tracheostomy is also needed when a tumour or swelling presses on or blocks the trachea and makes it difficult to breathe.
Tooth removal (dental extraction) is used to remove unhealthy teeth.
Reconstruction is used to restore function to and the appearance of the mouth.
Radiation therapy uses high-energy rays or particles to destroy cancer cells. It may be used to treat oral cancer. It is most commonly used after surgery to destroy cancer cells that may have been left behind and to reduce the risk of the cancer recurring. Sometimes radiation is given together with chemotherapy (called chemoradiation).
Radiation therapy may also be given to the neck to prevent the spread of cancer to the lymph nodes or lower the risk of cancer recurring.
Radiation therapy may be used, with or without chemotherapy, as the main treatment in rare cases when surgery is not possible. Radiation therapy may also be used to relieve symptoms of advanced cancer that is unable to be removed with surgery (called palliative therapy).
External beam radiation, brachytherapy and intensity-modulated radiation therapy (IMRT) are the types of radiation therapy that may be used to treat oral cancer. During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it. Brachytherapy is internal radiation therapy. IMRT delivers radiation from many different angles to treat the entire tumour.
Chemotherapy is sometimes used to treat oral cancer. It is often used with radiation therapy after surgery to treat oral cancer. It can also be used along with radiation if surgery is not possible or to treat advanced cancer.
An immunotherapy drug may be given if the cancer comes back (recurs) or spreads and has stopped responding to chemotherapy with drugs such as cisplatin or carboplatin.
If you can’t have or don’t want cancer treatment
You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.
Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 5 years after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment.
Talk to your doctor about clinical trials open to people with oral cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.