Mouth cancer is a type of head and neck cancer. Cancers affecting the head and neck are not common. People with this type of cancer are usually treated in specialist centres by a team of specialist healthcare professionals.
Your treatment will depend on the stage and grade of the cancer, as well as your general health. Your specialist doctor or nurse will explain the best treatment for you and any likely side effects.
The main aim is to remove and destroy the cancer, but your doctors will also try to reduce the long-term effects of treatment. For example, they will plan your treatment so the effect on your appearance and ability to speak, chew and swallow is as little as possible.
You may only need one type of treatment. But sometimes 2 or more treatments are given. When chemotherapy and radiotherapy are given together, it is called chemoradiation.
Surgery is often the only treatment needed to remove an early-stage mouth cancer. The surgeon removes the cancer and a small area (margin) of normal tissue all around the tumour. There is less chance of cancer cells being left behind, because the surgeon takes this extra area of normal tissue.
The surgeon may also remove some lymph nodes from the neck. They may do this to remove cancer that has spread to the lymph nodes or to reduce the risk of the cancer coming back.
How the surgeon removes the cancer depends on its size and where it is in the mouth. The main aim of surgery is to remove the cancer completely. But your surgeon will also do everything possible to minimise the changes that surgery may cause to your speech, swallowing or facial appearance.
Some people need a bigger operation. They may need to have part of their jawbone or tongue removed. The surgeon may use tissue, skin or bone taken from somewhere else in the body to rebuild these areas.
Your doctor will explain the operation to you beforehand. You will be able to ask any questions you have about it.
Radiotherapy uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.
Radiotherapy is sometimes given instead of surgery to treat early-stage mouth cancers. It is often used after surgery to reduce the risk of the cancer coming back or to treat cancer that has come back. Radiotherapy may also be used to treat the neck area if there are signs of cancer in the lymph nodes.
You may have side effects during radiotherapy. These usually get better slowly after treatment finishes.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. This treatment can be given:
- before surgery or radiotherapy to shrink the cancer and make it easier to treat
- at the same time as radiotherapy (chemoradiation) – the chemotherapy can make the cancer cells more sensitive to radiotherapy treatment
- to treat cancer that has spread or come back after earlier treatment.
The chemotherapy drugs most often used to treat mouth cancer are cisplatin and fluorouracil (5FU). These are usually given into a vein (intravenously). Chemotherapy is not usually used to treat lip cancer.
Chemoradiation is when you have chemotherapy and radiotherapy together. Chemotherapy can make the cancer cells more sensitive to radiotherapy treatment. Chemoradiation can be given instead of surgery to treat early-stage mouth cancers. Or it can be given after surgery to reduce the risk of cancer returning.
Having chemoradiation is more effective than having chemotherapy or radiotherapy alone, but it can cause more severe side effects. It is important that you are well enough to cope with the side effects of having both treatments together.
Targeted therapy drugs work by targeting something in or around the cancer cell that is helping it grow and survive.
Cetuximab is the most commonly used targeted therapy to treat mouth cancer. This drug may stop the cancer cells growing and dividing. It may also make the cancer more sensitive to the effects of radiotherapy.
You might have cetuximab with radiotherapy if you cannot have chemoradiation. You may also have it with chemotherapy to treat cancer that has spread or come back.