Oral Cancer

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If you are diagnosed with mouth or oropharynx cancer, your doctor will explain your prognosis and treatment options. Your prognosis is what the doctor believes will happen: your chance of recovery, the expected course of the cancer, and how long you might be sick.

Your prognosis takes into consideration the location of the tumor and the stage of the cancer—whether and how far the tumor has spread to nearby tissues, lymph nodes, or other parts of the body. Your options for treatment are determined by the stage and location of the cancer, your age and general health, and whether your appearance and the ability to talk and eat will remain the same after treatment.

Take the time to carefully consider all your treatment options. For many people, a second opinion can help you get more information and decide on the treatment to pursue.

Because the mouth and throat are crucial components of eating, breathing, and talking, a group of healthcare professionals referred to as a multidisciplinary team will probably manage your treatment and rehabilitation. This team will be led by a doctor who specializes in treating people with cancer. This doctor may be a surgeon, radiation oncologist, or medical oncologist. Members of the team include:

  • Head and neck surgeons, medical oncologists, and radiation oncologists
  • Plastic and reconstructive surgeons
  • Dentists
  • Speech, occupational, and physical therapists
  • Dietitians
  • Psychologists
  • Rehabilitation specialists
  • This section contains information on:

    • Staging
    • Surgery
    • Radiation therapy
    • Chemotherapy
    • Tumor growth inhibitors
    • Reconstruction and rehabilitation
    • Staging

      Staging helps your doctor plan your treatment. It also provides information about the prognosis (expected outcome) of your cancer. Tumor stage is determined by the size of the primary tumor, how much it has invaded the tissues, and whether the cancer has spread to the lymph nodes.

      Stage 0

      Cancer is "in situ," meaning it is isolated and has not traveled into a deeper layer of tissue or the lymph nodes, small almond-shape glands that help fight infection or trap tumor cells.

      Stage I

      • Tumor is 2 centimeters (about ¾ inch) or smaller.
      • Tumor has not spread to lymph nodes or other parts of the body.
      • Stage II

        • Tumor is between 2 and 4 centimeters (from ¾ to 1½ inches).
        • Tumor has not spread to lymph nodes or other parts of the body.
        • Stage III

          Tumor is either:

          • Larger than 4 centimeters (1½ inches) or
          • Any size and has traveled to one lymph node on the same side of the head or neck. The lymph node with cancer measures 3 centimeters or less.
          • Tumor has not spread to other parts of the body.
          • Stage IV

            Tumor is any size and has invaded deeply into muscle or facial skin or the jaws and has spread to:

            • More than one lymph node on the same side of the head or neck as the main tumor
            • Lymph nodes on one or both sides of the neck
            • Any lymph node that measures more than 6 centimeters (2½ inches)
            • Other parts of the body
            • Recurrent

              The mouth and oropharynx cancer has reappeared after it was treated. It may reappear in the oral cavity or another part of the body.

              Surgery

              Surgery is the most common treatment for mouth cancer, while oropharynx cancer is usually treated with radiation, with or without chemotherapy. Surgery is performed on some patients with cancers of the tonsil and patients with tumor invasion of the jaw. Most salivary gland tumors of the mouth and throat are treated with surgery initially. The type of surgery depends on the type and stage of the cancer. Multiple surgeries may be necessary to treat the cancer and restore function and appearance.

              Common types of surgery for mouth and oropharynx cancer include:

              • Tumor "resection" (removal of the cancerous part of the organ) or a wide local incision to remove the tumor and surrounding noncancerous tissue
              • Removal of part or all of the jaw
              • Maxillectomy to remove bone in the roof of the mouth
              • Neck dissection or removal of lymph nodes and other tissue in the neck
              • Plastic surgery, including skin grafts, tissue flaps, and dental implants to repair or restore tissues removed from the mouth, throat, or neck
              • Tracheotomy, or placing a hole in the windpipe, to assist in breathing for patients with very large tumors or after surgical removal of the tumor
              • Dental surgery to remove teeth or assist with reconstruction
              • Even if the surgeon removes all the cancer, some patients may need additional treatment to increase the chance of successful outcomes. Those may include chemotherapy or radiation therapy.

                Side effects depend on the type of surgery. Possible side effects are:

                • Pain and discomfort. Discuss pain relief with your doctor before and after the surgery.
                • Fatigue
                • Temporary facial swelling
                • Problems with chewing, swallowing, or talking
                • Additional surgeries or other therapy may be necessary to address some of these problems.

                  Radiation therapy

                  Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or shrink tumors. Chemotherapy can be combined with radiation to increase the cancer-killing effects. In cancer of the mouth and oropharynx, radiation therapy may be used alone to treat small to intermediate-stage tumors or to kill remaining cancerous cells after surgery, or it may be combined with chemotherapy for advanced tumors.

                  A radiation oncologist, a doctor who specializes in radiation therapy, will give you radiation treatments. This doctor will determine the length of your radiation treatment.

                  Radiation therapy has a much higher chance of success if you do not use tobacco during treatment.

                  Since oral side effects are common, any necessary dental care or extractions should be taken care of at least two weeks before the radiation treatment.

                  External radiation therapy

                  External radiation therapy is the most common type of radiation used to treat cancers of the mouth and oropharynx. It uses a beam of radiation that is carefully targeted from a machine outside the body. Treatment commonly includes five sessions a week for five to seven weeks.

                  You will lie on a treatment table, and the radiation therapist will position you so the radiation reaches the correct part of your body. Once you are positioned, you cannot move until the treatment, which takes only a few minutes, is finished. To help you remain still, a custom-fitted plastic head or shoulder mask may be used. Like an X-ray, the procedure is painless. New techniques for delivering external radiation are designed to keep normal tissues safe from the effects of radiation. Known as intensity-modulated radiotherapy, these highly focused beams treat the tumor while sparing salivary gland tissue, thus decreasing the loss of saliva production.

                  Internal radiation or brachytherapy

                  In this treatment, radiation is delivered to the body from seeds, needles, or tubes that are implanted into the tumor. After the implants are in place, you will remain in the hospital for several days with limited human contact. The implants will be removed before you leave the hospital.

                  The method of radiation treatment used depends on the type and stage of cancer. Sometimes both methods are used.

                  Side effects of radiation treatment may include:

                  • Soreness of the mouth and other oral problems
                  • Permanent loss of salivary function
                  • Fatigue
                  • Red, dry, tender, itchy skin, similar to a sunburn
                  • Sore throat
                  • Hair loss in treated area
                  • Loss of appetite
                  • Changes in senses of taste and smell
                  • Voice changes
                  • Jaw bone damage or fracture
                  • Reduced white blood cell count, which may increase likelihood of infections
                  • Hypothyroidism (too little thyroid hormone). Thyroid function tests should be done before and after treatment.
                  • Chemotherapy

                    Chemotherapy uses drugs to kill cancer cells or stop them from growing. The drugs can be given by mouth or injected into a vein or muscle. Usually, chemotherapy is given to a patient through a vein during an outpatient visit.

                    Chemotherapy may be used to shrink the cancer before surgery or radiation, or it may be combined with radiation to increase the effectiveness of both treatments. It may also be used to shrink tumors that cannot be surgically removed.

                    The most commonly used drugs in mouth and oropharynx cancer are cisplatin and 5-fluorouracil. Carboplatin and paclitaxel are also used in combination.

                    Chemotherapy affects normal cells as well as cancer cells. You may experience side effects that include:

                    • Nausea and vomiting
                    • Loss of appetite
                    • Loss of hair
                    • Mouth sores
                    • Diarrhea
                    • Fatigue
                    • Low blood cell count
                    • Bleeding or bruising easily
                    • Numbness or tingling in the hands or feet
                    • Headaches
                    • Darkening of the skin and fingernails
                    • Discuss any side effects with your doctor. Medication is available to help many of them. Most side effects go away when treatment is complete.

                      Tumor growth inhibitors

                      New research on growth factors, hormonelike substances that occur naturally in the body and cause cell growth, shows promise in the treatment of mouth and oropharynx cancer. An epidermal growth factor on the surface of some mouth and oropharynx cancer cells can bind to certain substances that stimulate the tumor to grow. New drugs are being tested that target EGF receptors and may stop cancer cells from growing.

                      The Food and Drug Administration has approved cetuximab (Erbitux), which blocks the EGF receptor, for use with radiation in people with advanced oral cancer. Other drugs are being studied.

                      Reconstruction and rehabilitation

                      After treatment, some patients with mouth and oropharynx cancer may require plastic or reconstructive surgery to restore appearance or function. Grafts of skin, muscle, or bone, which are moved from another part of body to the oral cavity, are often used.

                      Sometimes it is possible for the surgeon to perform reconstructive surgery at the same time as your cancer surgery; in other cases it is best to wait. Your doctor will tell you which method is right for you.

                      If surgery to rebuild the mouth cavity cannot be performed, you may be fitted for a dental prosthesis or dental implant. A therapist will show you how to use the device.

                      Mouth and oropharynx cancer and treatment often cause difficulty in speaking, swallowing, and breathing. After treatment, you may receive therapy and training from various professionals, including dietitians; speech, physical, and occupational therapists; and psychologists.

                      Last reviewed on 6/4/09

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