Treatment Options for Oral Cavity Cancer
Various treatments are available for patients with lip and oral cavity cancer. The treatment used will depend on the location and stage of your cancer, 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. Surgery, radiation, and chemotherapy are the three standard treatments used for oral cavity cancer.
Surgery for Oral Cancer
Surgery is a common treatment for all stages of oral cavity cancer. Primary tumor removal is the first and most important surgery. It will be done in the area where the cancer was found, removing the tumor and an area of healthy cells surrounding it. Some of these surgeries can be done as minimally invasive surgery that reduces the incision sizes and resulting scarring.
You may need to consult with a plastic surgeon if the cancer removal will be in an area that affects your appearance.
After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation Therapy for Oral Cancer
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. This type of treatment may work better in patients who have stopped smoking before beginning treatment.
There are two types of radiation therapy:
- External radiation therapy uses a machine outside the body to send radiation toward the cancer. For oral cavity cancer, we typically use IMRT, intensity modulated radiation therapy, an advanced form of external beam radiation treatment that allows precise targeting of tumor cells with high energy beams of radiation. This precision allows the radiation oncologist to deliver a maximum dose of radiation to the tumor while sparing much of the surrounding tissue.
- Internal radiation therapy, more commonly called brachytherapy, uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Typically, brachytherapy is not used to treat oral cavity cancer due to the precision of external radiation therapy. However, there are rare times it may be used in combination with external radiation to treat early lip or mouth cancers.
There are some special considerations for oral cancer patients who will receive radiation therapy in or around the mouth and neck area.
- Have a dental exam before radiation therapy begins, so that existing problems can be treated. Radiation therapy given in the mouth area can exasperate any dental problems you already have.
- Consult with the oncologist or an endocrinologist about the possibility of the thyroid taking too much radiation which can make it slow down or stop working. This is called hypothyroidism and is an important possible side effect to be aware of if you get radiation for oral cavity cancer.
- Radiation therapy can damage healthy tissue, which can cause difficulty in speaking and/or swallowing after radiation therapy. A speech-language pathologist can provide exercises and techniques to prevent long-term speech and swallowing problems.
- Hearing can also be affected in patients after receiving radiation therapy to the head due to nerve damage or buildup of fluid in the middle ear. Sometimes, a patient’s hearing ability may need to be evaluated by a hearing specialist, known as an audiologist.
Not all patients have issues with their teeth, speech, hearing or thyroid, but it's important to be aware so you can be prepared. At our family of radiation oncology clinics located throughout the greater Atlanta area, your radiation oncology team is composed of several team members including the radiation oncologist, radiation oncology nurse, radiation therapist, physicist, and dosimetrist.
Chemotherapy, Targeted Therapy and Immunotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Chemotherapy drugs can be given alone, in combination with radiation and other drugs such as targeted therapies or immunotherapies. Because chemo can increase the effectiveness of radiation, the two are often used in combination with one another.