Mouth Cancer Treatment Options
Tests and procedures used to diagnose mouth cancer include:
Physical exam. Your doctor or dentist will examine your lips and mouth to look for abnormalities– areas of irritation, such as sores and white patches (leukoplakia).
Removal of tissue for testing. If a suspicious area is found, your doctor or dentist may remove a sample of cells for laboratory testing in a procedure called a biopsy. Unusual cells can be removed using different techniques, but are most often cut away using a scalpel, scissors or another surgical tool. In the laboratory, the cells are analyzed for cancer or precancerous changes that indicate a risk of future cancer.
Mouth Cancer Stages
Once mouth cancer is diagnosed, your doctor works to determine the extent, or stage, of your cancer. Mouth cancer staging tests may include:
Using a small camera to inspect your throat. During a procedure called endoscopy, your doctor may pass a small, flexible camera equipped with a light through your nose to examine your throat and voice box. Your doctor looks for signs that cancer has spread beyond your mouth. Endoscopy can be done in the doctor’s office and causes very little discomfort.
Imaging tests. A variety of imaging tests may help determine whether cancer has spread beyond your mouth. Imaging tests may include X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, among others. Not everyone needs each test. Your doctor determines which tests are appropriate based on your condition.
Mouth cancer stages are indicated using Roman numerals I through IV. A lower stage, such as stage I, indicates a smaller cancer confined to one area. A higher stage, such as stage IV, indicates a larger tumor or that cancer has spread to other areas of the head or neck, or to other areas of the body. Your cancer’s stage helps your doctor determine your treatment options.
Treatment for mouth cancer depends on your cancer’s location and stage, as well as your overall health and personal preferences. You may have just one type of treatment, or you may undergo a combination of cancer treatments. Treatment options include surgery, radiation and chemotherapy. Discuss your options with your doctor.
Surgery for mouth cancer may include:
Surgery to remove the tumor. Your surgeon may cut away the tumor and a margin of healthy tissue that surrounds it to ensure all of the cancer cells have been removed. Smaller cancers may be removed through minor surgery. Larger tumors may require more-extensive procedures. For instance, removing a larger tumor may involve removing a section of your jawbone or a portion of your tongue.
Surgery to remove cancer that has spread to the neck. If cancer cells have spread to the lymph nodes in your neck or if there’s a high risk that this has happened based on the size of your cancer, your surgeon may recommend a procedure to remove cancerous lymph nodes and related tissue in your neck (neck dissection). Neck dissection removes any cancer cells that may have spread to your lymph nodes.
Neck dissection surgery will leave a scar on your neck. It won’t affect your body’s ability to fight infections in the future.
Surgery to reconstruct the mouth. After an operation to remove your cancer, your surgeon may recommend reconstructive surgery to rebuild your mouth to help you regain the ability to talk and eat. Your surgeon may transplant grafts of skin, muscle or bone from other parts of your body to reconstruct your mouth. Dental implants may be used to replace your natural teeth. Implants may be placed at the time of your cancer treatment or after you’ve healed.
Surgery carries a risk of bleeding and infection. Surgery for mouth cancer often affects your appearance, as well as your ability to speak, eat and swallow.
You may need a tube to help you eat, drink and take medicine. For short-term use, the tube may be inserted through your nose and into your stomach. Longer term, a tube may be inserted through your skin and into your stomach.
You may also require a procedure to insert a breathing tube through your neck (tracheostomy). This breathing tube is usually temporary.
Your doctor may refer you to specialists who can help you cope with these changes. Most people are able to speak, eat, swallow and breathe normally following treatment.
Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells. Radiation therapy is most often delivered from a machine outside of your body (external beam radiation), though it can also come from radioactive seeds and wires placed near your cancer (brachytherapy).
Radiation therapy may be the only treatment you receive if you have an early-stage mouth cancer. Radiation therapy can also be used after surgery. In other cases, radiation therapy may be combined with chemotherapy. This combination increases the effectiveness of radiation therapy, but it also increases the side effects you may experience. In cases of advanced mouth cancer, radiation therapy may help relieve signs and symptoms caused by the cancer, such as pain.
The side effects of radiation therapy to your mouth may include dry mouth, tooth decay, damage to your jaw bone, mouth sores, bleeding gums, jaw stiffness, fatigue and red, burn-like skin reactions.
Your doctor will recommend that you visit a dentist before beginning radiation therapy to be sure your teeth are as healthy as possible. Any unhealthy teeth may need treatment or removal. A dentist can also help you understand how best to care for your teeth during and after radiation therapy to reduce your risk of complications.
Chemotherapy is a treatment that uses chemicals to kill cancer cells. Chemotherapy drugs can be given alone, in combination with other chemotherapy drugs or in combination with other cancer treatments. Chemotherapy may increase the effectiveness of radiation therapy, so the two are often combined.
The side effects of chemotherapy depend on which drugs you receive. Common side effects include nausea, vomiting and hair loss. Ask your doctor which side effects are likely for the chemotherapy drugs you’ll receive.
Targeted Drug Therapy
Targeted drugs treat mouth cancer by altering specific aspects of cancer cells that fuel their growth. Cetuximab (Erbitux) is one targeted therapy approved for treating head and neck cancers in certain situations. Cetuximab stops the action of a protein that’s found in many types of healthy cells, but is more prevalent in certain types of cancer cells.
Targeted drugs can be used in combination with chemotherapy or radiation therapy. Other targeted drugs are being studied in clinical trials, including drugs that target the immune system (immunotherapy).