What do we mean by 'Mouth Cancer'? Mouth Cancer is a colloquial term for Oral Cancer. Oral cancer includes cancers of the tongue, gum and jaw bone (sarcoma). If these are not the cancer type you're looking for, please explore the information about other types of Head and Neck Cancers.
Following a diagnosis of Mouth Cancer, your cancer care team will discuss the treatment options that are suitable for you. This is also a good time to consider if you would like a second opinion. The most suitable treatment of oral cancer depends on many things including:
size and location of the cancer
whether it has spread
personal factors (e.g. age, general health and treatment history)
types of treatment available (and whether there are any clinical trials that are suitable for you)
your preferences for treatment.
While some people can be treated with surgery alone, others may need extra treatment after surgery to reduce the risk of the cancer returning. Your cancer care team will decide whether it is necessary for you based on a detailed report on the cancer from the pathologist 1–2 weeks after surgery. Adding another type of treatment after surgery is called adjuvant therapy. This can be either radiation therapy alone or combined with chemotherapy (called chemoradiation), which is typically started about 6 weeks after surgery to allow recovery and for planning purposes. The treatment itself usually lasts about 6 weeks. Watch this 3D video explainer about Mouth Cancer:
There are a number of different operations that can be used to remove Mouth Cancer. The type of operation used will depend on the size of the cancer and where it is.
Your doctor will explain details of the surgery, general risks and side effects of surgery. Ask your doctor if you have questions. They may recommend:
stopping blood thinners (e.g. aspirin) before surgery to reduce the risk of bleeding
special stockings to reduce the risk of blood clots
early mobilisation (i.e. not staying in bed) to reduce the risk of blood clots and chest infection
antibiotics to lower the risk of wound infection.
If you smoke, it is important that you consider stopping smoking before starting treatment to help reduce the risk of infection and help you recover after your treatment.
The different options for oral cancer include:
The most common radiation therapy approach for Mouth Cancer is called external beam radiation. This type of radiation therapy applies radiation from outside the body. Radiation therapy can be used in the following ways:
This is when radiation therapy is used without surgery to cure oral cancer, often in combination with chemotherapy. This approach has a very limited role in oral cancer, as most patients are best treated with surgery as first-line therapy. It may however be used if a patient is not a candidate for surgery.
This is when radiation therapy is given after surgery, to kill cancer cells that may not have been taken out during surgery. Adjuvant radiation therapy can also be given in combination with chemotherapy (this is called concurrent chemoradiation). The decision to give radiation therapy, either alone or in combination with chemotherapy, is based on the pathology results after surgery. The aim is to lower the risk of the cancer returning in the mouth or neck, but not all patients may need this.
In cases where a cure is not possible, radiation therapy is used to relieve symptoms of advanced oral cancer. Symptoms that may require palliative radiation therapy include pain, bleeding, breathing and trouble swallowing.
The side-effects of radiation therapy start around two weeks into treatment and progress through treatment to peak in the last week or just after treatment ends. The side effects start to improve 2-3 weeks after the end of treatment.
the dose of radiation therapy
the area being treated
whether or not chemotherapy is added to the radiation.
tiredness
skin irritation in the treated area e.g. redness, dryness and itching, weeping skin, scaling or sometimes skin breakdown (sores)
dry mouth and throat due to lack of saliva (called xerostomia)
loss of taste
pain on swallowing or difficulty with swallowing
loss of weight.
Most side effects are short lived and may go away within 4–6 weeks of finishing radiation therapy. Some side effects may last for months after you finish radiation therapy and some may be permanent.
Chemotherapy works by destroying or damaging cancer cells. For Mouth Cancer, it is usually given into a vein through a needle with a cannula (tube) attached. There are a number of ways that chemotherapy may be used to treat Mouth Cancers including:
This is when chemotherapy is given after surgery in combination with radiation therapy (called concurrent chemoradiation). It may be given once every 3 weeks or once a week throughout the duration of radiation therapy. This makes the radiation more effective at killing cancer cells but also leads to more side effects in most people. Unlike chemotherapy for many other cancers, most people do not lose their hair or have severe nausea and vomiting.
This is when chemotherapy is given before surgery or radiation therapy to help shrink large cancers, making them easier to remove during surgery, or target with radiation therapy. This is very rarely used for oral cancer but may be used for sarcomas.
This is used when the cancer is incurable. The cancer may be too large or has spread too much to be removed by surgery. Palliative chemotherapy helps to slow the growth of cancer and reduce symptoms. It is important to remember that palliative chemotherapy is not as intense as other types and is much less likely to have significant side effects.
Before you start treatment, your medical oncologist will choose one or more chemotherapy medications that will be best to treat the type of cancer you have. The chemotherapy medications your doctor chooses may depend on:
whether the treatment is curative or palliative
when it is used
your medical history.
a feeling of wanting to vomit (nausea) or vomiting
more side effects of radiation, if you have chemotherapy at the same time as radiation
loss of feeling in the fingers and toes
kidney damage (caused by some medications)
hearing loss/thinning
ringing in the ears
rash
higher risk of infection (if the chemotherapy reduces the number of white cells in the blood)
Most of these side effects are short lived and may go away once you finish chemotherapy. Some side effects can take months or years to improve or may be permanent.
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