MOUTH CANCER
treatment

ALSO KNOWN AS Oral Cancer,
​includes Cancers of the Tongue, Gum and Jaw

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.


 
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1. Treatment options for Mouth Cancer

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: 


2. Surgery for 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. 

How can I prepare for the surgery?

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.

Surgical procedures 

The different options for oral cancer include: 

GLOSSECTOMY

This involves removing part of, or all of the tongue. It is used if the cancer is growing in the tissue of the tongue.
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MANDIBULECTOMY

This involves removing part of the lower jaw (mandible). It is used if the cancer has spread into the bone of the jaw or is next to the jaw.
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MAXILLECTOMY

This involves removing part of the upper jaw (maxilla), in the roof of the mouth. It is used when the cancer is affecting the roof of the mouth or upper gums.
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MANDIBULOTOMY

This involves cutting the jaw bone to allow better access to the cancer in the mouth. This may be needed if the cancer is further back and difficult to reach through the mouth. The jaw is put back together at the end of the operation with titanium plates.
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NECK DISSECTION

This involves removing lymph nodes from the neck. It is used when oral cancer has spread to the lymph nodes in the neck or there is a risk of cancer in the lymph nodes of the neck.
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RECONSTRUCTIVE SURGERY (SOFT TISSUE FREE FLAP OR BONY FREE FLAP

This may be considered if a large area of tissue is removed. This may involve taking tissue from another part of the body called a free flap repair. If your jaw has been removed, bone from another part of the body may be used to replace your jaw bone. This operation is carried out by a surgeon who specialises in reconstructive surgery, your head and neck surgeon or another surgeon.
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TRACHEOSTOMY

A tracheostomy is used to create an opening in the trachea (windpipe) in the lower neck, where a tube is inserted to allow air to flow in and out, when you breathe. This is used as swelling after major head and neck surgery may affect your ability to breathe. The tracheostomy tube is usually removed within a week of surgery once normal breathing is possible.
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FEEDING TUBES

  • A gastrostomy tube (called a PEG tube) goes through the skin and the muscles of your abdominal wall into the stomach. Gastrostomy is recommended if feeding is needed for a medium to longer time (months or years).
  • A nasogastric tube goes through the nose down into the stomach. Nasogastric feeding is used for short time (days or weeks).

Side effects of surgery

Treatment for oral cancer may lead to a number of side effects . You may not experience all of the side effects. Speak with your doctor if you have any questions or concerns about treatment side effects.
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3. Radiation therapy for Mouth Cancer

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: 

Definitive

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.

Adjuvant

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.

Palliative

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.

Side effects

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.

Side effects associated with radiation therapy depend on:
  • the dose of radiation therapy

  • the area being treated

  • whether or not chemotherapy is added to the radiation.

Each person responds to radiation therapy differently. Some people may experience a few side effects while others may not experience any at all. The following are some common side effects of radiation therapy.
  • 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.

Once your radiation therapy ends, you will have regular follow-up appointments so your cancer care team can check your recovery, make sure the cancer has not returned, and monitor and treat any side effects that you may have.

Your doctor may recommend that you receive some specific supportive care to help during your recovery such as help with changes in speech, voice or swallowing, diet and nutrition and teeth and mouth care.
 

To learn more about Radiation Therapy and to watch
a video of an Immobilisation Maks being made click here



Immobilisation-Mask.png

4. Chemotherapy for Mouth Cancer

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: 

Adjuvant

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. 

Neo-adjuvant

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.

Palliative

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.

Side effects

The side effects of chemotherapy depend on the medication used and and how much you is given by your doctor (the dose). The most common medications used are called cisplatin, carboplatin and cetuximab. 

Each person responds to chemotherapy differently. Some people may experience a few side effects while others may not experience any at all. The following are common side effects of chemotherapy: 
  • 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. 

Once your treatments end, you will have regular follow-up appointments so that your doctor can check your recovery, make sure the cancer has not returned and monitor and treat any side effects that you may have.

Your doctor may recommend that you receive some specific supportive care to help during your recovery. 
PRINT
All the information in this section is available in a PDF.
Download it here.
IN THIS SECTION
  • What is Mouth Cancer?
  • What is the oral cavity
  • What does the oral cavity do?
  • What causes Mouth Cancer?
  • Signs and Symptoms of Mouth Cancer
  • Tests for Mouth Cancer
  • Treatment options for Mouth Cancer
  • Surgery 
  • Radiation Therapy
  • Chemotherapy
FURTHER INFORMATION
  1. Head and Neck Cancer Australia Resources 
  2. External Links to other Head and Neck Cancer Resources