Mouth cancer - Treating mouth cancer

Your treatment will depend on the type and size of the cancer, the grade and how far it's spread – as well as your general health.

Your treatment plan

If the cancer hasn't spread beyond the mouth or the oropharynx (the bit of your throat at the back of your mouth), a complete cure may be possible using a combination of surgery, radiotherapy and chemotherapy.

If the cancer has spread to other parts of the body, then a cure is unlikely but it will be possible to slow the progress of the cancer and help relieve symptoms by using surgery, radiotherapy and chemotherapy.

Deciding what treatment is best for you can be difficult. Your care team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, what are the advantages and disadvantages of particular treatments.

Before treatment begins

Radiotherapy makes the teeth more sensitive and vulnerable to infection so before treatment begins, you'll be given a full dental examination and any necessary work will be carried out.

If you smoke or drink, stopping will increase the chances of your treatment being successful.

Your specialist nurse and your GP can provide help and support if you are finding it difficult to quit smoking and drinking.

Read more about quitting smoking and cutting down on alcohol.

Surgery

For mouth cancer, the aim of surgical treatment is to remove any affected tissue while minimising damage to the rest of the mouth.

Photodynamic therapy (PDT)

If the cancer is in its very early stages, it may be possible to remove any tumours using a type of laser surgery known as photodynamic therapy (PDT). PDT involves taking a medicine that makes your tissue sensitive to the effects of light. A laser is then used to remove the tumour.

Other forms of surgery

If your cancer is more advanced, it may be necessary to remove part of your mouth lining and, in some cases, facial skin, which can be replaced using skin grafted from your forearm or chest.

If your tongue is affected, part of the tongue will have to be removed. This is known as a partial glossectomy. The tongue is then reconstructed using grafted tissue.

If the cancer has spread to your jawbone it will need to be surgically removed. The jawbone can be replaced by taking bone from another part of your body and grafting it in place.

Occasionally, other bones, such as cheekbones, may have to be removed to completely remove the cancer.

These can be replaced with plastic prosthetic bones which are are usually very realistic, leaving your physical appearance largely unaffected.

During surgery, your surgeon may also remove lymph nodes near the site of the initial tumour. This is often done as a preventative measure in case they contain small numbers of cancerous cells that can't be detected.

Radiotherapy

Radiotherapy uses doses of radiation to kill cancerous cells. It may be possible to remove the cancer using radiotherapy alone, but it is usually used after surgery to prevent the cancer from reocurring.

The treatment is normally given every day over the course of three to seven weeks, depending on the size of the cancer and how far it has spread.

While it kills cancerous cells, radiotherapy can also affect healthy tissue, and it has a number of side effects, including:

• sore, red skin (like sunburn)
• mouth ulcers 
• sore mouth and throat
• dry mouth
• loss of, or changes in taste
• loss of appetite
• tiredness 
• feeling sick
• stiff jaw
• bad breath 

Any side effects will be monitored by your care team and treated where possible.

The side effects of radiotherapy can be distressing, but most of them will pass once the radiotherapy is complete.

Internal radiotherapy

Internal radiotherapy – also called brachytherapy – is often used to treat cancers of the tongue that are in their early stages. It involves placing radioactive implants directly into the tumour while you are under a general anaesthetic.

They will be left for between one and eight days during which time the cancer cells will receive a much higher dose of radiation than the rest of your mouth.

Visits by friends and family will need to be restricted due to radiation and pregnant women and children won't be able to visit you.

The radioactive implants will cause your mouth to become swollen, and you will experience some pain five to 10 days after the implants are removed.

Chemotherapy

Chemotherapy is sometimes used in combination with radiotherapy when the cancer is widespread, or if it is thought there is a significant risk of the cancer returning.

Chemotherapy involves the use of powerful cancer-killing medicines. These medicines damage the DNA of the cancerous cells, interrupting their ability to reproduce.

Medicines used in chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. Adverse side effects are common and include:

• fatigue (tiredness)
• sore mouth
• mouth ulcers
• feeling sick
• being sick
• hair loss
• tiredness

The side effects should stop once the treatment has finished.

Chemotherapy also weakens your immune system and makes you more vulnerable to infection.

Cetuximab

Cetuximab is a new type of medication, known as a biologic, used to treat advanced cases of mouth cancer. It is usually used in combination with radiotherapy or chemotherapy.

Cetuximab targets proteins on the surface of cancer cells, known as epidermal growth factor receptors. These receptors help the cancer to grow, so by targeting these proteins, cetuximab prevents the cancer from spreading.

The National Institute for Health and Care Excellence (NICE) ruled that cetuximab did not represent a cost-effective treatment in most cases and has recommended it only be used in people who:

• are in a good state of health (likely to make a good recovery if treated)
• are unable to have chemotherapy for medical reasons (for example, because they have kidney disease or are pregnant)