Oral cancer treatments

Developing a treatment plan for oral cancer generally takes into account quality-of-life issues, because oral cancer and its treatments may affect a patient’s ability to perform everyday functions like breathing and eating. In general, surgery is the first-line treatment for oral cancer that is caught early. Other treatment options typically include chemotherapy, radiation therapy and targeted therapy. Oral cancer is typically treated by:

• Otolaryngologist, a surgeon who treats head and neck cancer and other diseases 
• Oral and maxillofacial surgeon, who treats cancer and other diseases of the mouth, including the jaws and teeth
• Radiation oncologist, who treats cancer with radiation therapy
• Medical oncologist, who uses anti-cancer therapies such as chemotherapy, targeted therapy or immunotherapy to treat the disease
• Plastic surgeon, a reconstructive surgery specialist who uses various techniques to repair parts of the body and/or restore function

Chemotherapy for oral cancer

Chemotherapy may be used to treat oral cancer patients whose disease has spread. It may be given alone or in combination with other treatments.

Patients may undergo chemotherapy before or after surgery for oral cancer. When chemotherapy is given before surgery, the goal is often to shrink the cancer for easier removal. When given after surgery, chemotherapy can help kill any errant cancer cells that are left behind, reducing the chance of a recurrence. When chemotherapy is given with radiation, it’s known as chemoradiation. 

Radiation therapy for oral cancer

Radiation therapy can be used in several ways for oral cancer treatment. It may be the only treatment required for small oral cancers, as well as a treatment option for patients who aren’t candidates for surgery. Radiation may be given following surgery with or without chemotherapy to kill any remaining cancer cells. This may help reduce the risk of cancer coming back.

As with chemotherapy, radiation may be ordered before oral cancer surgery to help shrink larger cancers. Radiation may also be used with targeted drugs for larger cancers if chemotherapy isn’t an option. Radiation has other uses, too: It can help alleviate symptoms of oral cancer, including pain and swallowing problems, and/or symptoms that occur when oral cancer spreads. Radiation is also a treatment for oral cancer that has returned.

Oral cancer patients are often treated with two primary types of radiation therapy:

External beam radiation therapy (EBRT): This treatment delivers high doses of radiation to tumor cells from outside the body, using a variety of machine-based technologies. EBRT may also be used to help relieve some of the symptoms of oral cancer, such as pain, bleeding, trouble, swallowing and problems that arise if cancer spreads to the bone. Two examples of oral cancer EBRT include:

• Accelerated and hyperfractionated radiation therapy: This type of radiation therapy is typically given twice a day, and at a higher frequency than normal EBRT.
• Intensity modulated radiation therapy (IMRT): Compared to standard radiotherapy, IMRT delivers higher radiation doses than traditional therapies would allow. IMRT also helps to spare more of the surrounding healthy oral tissue from harmful doses of radiation.

Brachytherapy (internal radiation): Delivers high or low doses of radiation from implants placed close to, or inside, the tumor(s) in the body. Brachytherapy may be an alternative to surgery for some oral cancer patients. Because it requires no incision and leaves no surgical wound to heal, recovery from the procedure is generally rapid.

Surgery for oral cancer

Oral cancer that is detected at an early stage, before the cancer cells have spread to other areas of the body, is generally treated with surgery. Surgery also may be used to treat patients with advanced-stage oral cancer and recurrent cancers, often in combination with radiation therapy, chemotherapy or targeted therapy.

Surgical procedures may include:

• Tumor resection
• Full or partial mandible (jawbone) resection
• Glossectomy
• Maxillectomy
• Laryngectomy
• Neck dissection

Many oral cancer surgery patients are often concerned about disfigurement; but recent advances in reconstructive surgery help patients restore their appearance, sometimes with little or no sign of change. Your doctor will work closely with you to ensure that your treatment is appropriate for your health and well-being.

Learn more about surgery for oral cancer

Targeted therapy for oral cancer

One potential target in oral cancer is the epidermal growth factor receptor (EGFR). Studies have shown that many oral tumor cells contain too many copies of EGFR. This excess hormone allows the cancer cells to grow faster and to become resistant to radiation and/or chemotherapy. Treating oral cancer with a drug that targets EGFR may help kill cancer cells without harming normal tissues.

Your oncologist may recommend an EGFR-targeted drug in combination with chemotherapy or radiation therapy to treat oral cancer. If the cancer has stopped responding to radiation and chemotherapy, targeted therapy may be used on its own to help control the disease.

Immunotherapy for oral cancer

Immunotherapy drugs harness the power of your immune system to find and destroy cancer cells. They target specific proteins on the surface of cancer cells, killing them or preventing them from growing. Some immunotherapy drugs are being studied to see whether they have a role in the treatment of oral cancer, including the checkpoint inhibitors Keytruda (pembrolizumab) and Opdivo (nivolumab). These drugs may also be used when chemotherapy stops working in patients whose oral cancer has returned or spread to other parts of the body.

Next topic: How is oral cancer treated with surgery?