Oral Cancer Medical Procedures

The treatments doctors choose to use for oral cancer depend on:

• the stage of the cancer at diagnosis
• the type of cancer you have
• your overall health
• your response to treatment

Regardless of your cancer’s stage, the first treatment option for oral cancer is typically surgery. Surgery may be followed by radiation therapy or a combination of radiation, chemotherapy, or targeted therapy.

The main goal of surgery for oral cancer is to remove as much cancerous tissue as possible. Depending on where the cancer is located, the type of surgery may include:

• Local removal: This medical procedure removes the cancer and some surrounding healthy tissue. Sometimes removal of bone tissue may be needed if cancer has spread into the bone.
• Neck surgery: Lymph nodes and other tissues in the neck are removed. This is done when cancer may have spread from the lip and oral cavity.
• Reconstructive surgery: If large tumors need to be removed from the mouth, throat, or neck, reconstructive surgery may be needed to restore your appearance. This could include dental implants, skin grafts, or other restorative plastic surgery.

Following surgery, chemotherapy or radiation therapy may be used to kill any remaining cancer cells.

Chemotherapy for oral cancer uses powerful drugs to kill or slow the growth of cancer cells.

There are several different types and methods of chemotherapy used for oral cancer. Which medications are used and how it’s given depend on the type and stage of cancer being treated.

Chemotherapy is usually used in combination with radiation therapy as it can make radiation therapy more effective. Chemotherapy is used more frequently for oral cancers in stage 3 or later.

Potential side effects of chemotherapy

Side effects of chemotherapy depend on which medications are prescribed for you, their dose, and how long they’re taken. Common side effects include:

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• diarrhea
• weight loss

Radiation therapy uses high-energy X-rays or other types of radiation to destroy or stop the growth of cancer cells. It can be used alone or in combination with surgery or chemotherapy to treat oral cancer.

The type of radiation therapy you receive will depend on your stage of cancer.

There are two types of radiation therapy, external and internal:

• External therapy: Also known as external beam radiation therapy (EBRT), this is the most common type of radiation therapy used in oral cancer treatments. It uses a machine outside the body to send radiation toward the area affected by cancer. The procedure itself is short and painless, but the preparation requires being fitted with a sturdy mesh frame to help focus the radiation. Advanced EBRT procedures can include:
  • 3D-CRT: Three-dimensional conformal radiation therapy uses special computers to accurately map the tumor location. This makes the radiation less likely to damage healthy tissue.
  • IMRT: Intensity modulated radiation therapy is a form of 3D-CRT that can adjust the strength of the radiation beams to limit the dose reaching nearby normal tissues, possibly allowing a higher dose to be delivered to the tumor.
  • Proton beam radiation therapy: This procedure uses proton beams instead of X-rays which exposes unaffected tissues to less radiation. Due to cost and insurance issues, proton therapy is not widely available in the US.

• Internal therapy: Also known as brachytherapy, this puts a radioactive implant inside the body either on or near the tumor. This type of radiation is rarely used as a first treatment for oral cancers but might be used if the cancer comes back.

Potential side effects of radiation therapy

Radiation therapy can involve several short and long-term side effects. Short-term side effects can include:

• dry mouth
• fatigue
• trouble swallowing
• loss of taste
• mouth sores and hoarseness

Long-term radiation side effects can include:

• trouble swallowing
• dry mouth
• thyroid issues
• carotid artery damage
• lymphedema
• jaw bone damage

As with chemotherapy, it’s important to stop smoking before starting radiation therapy. You should also treat any existing dental issues prior to treatment.

If your cancer has progressed or is not responding to standard treatments, additional treatment options may be suggested. This can include:

• Targeted therapy: Targeted therapies are drugs directed at proteins called epidermal growth factor receptor (EGFR) carried by cancer cells. These proteins help the cancer cells thrive. The goal is to kill the cancer cells by destroying the proteins. Targeted therapy may be combined with radiation therapy.
• Immunotherapy: This treatment uses your immune system to fight cancer cells. It works on certain immune system proteins to increase your immune response and hopefully kill cancer cells. PD-1 inhibitors target a specific protein on immune system T cells with the goal of stimulating an immune response.
• Clinical trials: You may want to consider a clinical trial as part of your treatment options. These trials can help determine if new cancer treatments are safe and effective and may be considered if other treatments have not worked.

Medical procedures for oral cancer include surgery, radiation, chemotherapy, or a combined treatment approach. Your specific treatment will depend on the stage of the cancer, the type of cancer you have, and your response to treatment.

If diagnosed early, oral cancer can often be successfully treated. It’s important to work closely with your doctor to determine which treatments will have the best outcome for your situation.