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Treatments for locally advanced oral cancer
The following are treatment options for locally advanced (stage 3, stage 4A and stage 4B) oral cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. They will usually do a nutritional assessment and dental assessment before treatment begins. You may need a feeding tube to make sure you get enough nutrition during treatment. It is important to have any necessary dental work done before treatment starts.
Locally advanced oral cancers are usually treated with a combination of surgery first, and then radiation therapy, with or without chemotherapy.
Surgery to remove the tumour is usually done before other treatments. The type of surgery done will depend on the location of the cancer.
Wide local excision removes the tumour along with a margin of normal tissue around it. The amount of tissue removed along with the tumour will vary according to the location of the tumour.
Glossectomy is surgery to remove part or all of the tongue.
Mandibulectomy may be done for some tumours. This is surgery to remove part or all of the lower jawbone (mandible).
Neck dissection removes lymph nodes from the neck. It is usually done for advanced oral cancer.
Reconstructive surgery may be needed for larger tumours. Reconstruction may be done using skin from another part of the body (called a skin graft) or using tissue (skin, muscle, bone or a combination of these) from another part of the body (called flaps).
Radiation therapy is often used to treat locally advanced oral cancer. Radiation therapy may be given as external beam radiation therapy, brachytherapy or both. Sometimes chemotherapy is given along with radiation therapy (called chemoradiation).
Radiation therapy is often given after surgery, with or without chemotherapy, if the oral cancer has certain features that increase the risk of cancer coming back (recurring), such as:
- positive margins
- a tumour that involves or has grown along the nerves (called perineural invasion) or blood vessels (called vascular invasion)
- a tumour that has spread outside of the lymph nodes in the neck (called extracapsular spread)
- tumours that are larger than 4 cm
- spread to more than one lymph node
- a lymph node that is larger than 3 cm
In some cases, radiation therapy may be used as the main treatment, with or without chemotherapy. This is called organ preservation. This may be considered if you cannot have surgery or if the tumour can’t be completely removed.
Radiation therapy can also be used to treat lymph nodes in the neck.
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.
We realize that our efforts cannot even be compared to what women face when they hear the words ... ‘you have cancer.’
Taking action against all cancers
The latest Canadian Cancer Statistics report found that of all newly diagnosed cancers in 2017, half are expected to be lung, colorectal, breast and prostate cancers. Learn what you can do to reduce the burden of cancer.