Oral Cancer : Treatment

by National Cancer Institute

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Many people with oral cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor - to take part in the discussion, to take notes, or just to listen.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat oral cancer include oral and maxillofacial surgeons, otolaryngologists (ear, nose, and throat doctors), medical oncologists, radiation oncologists, and plastic surgeons. You may be referred to a team that includes specialists in surgery, radiation therapy, or chemotherapy. Other health care professionals who may work with the specialists as a team include a dentist, speech pathologist, nutritionist, and mental health counselor.

Getting a Second Opinion

Before starting treatment, you might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if you or your doctor requests it.

Preparing for Treatment

The choice of treatment depends mainly on your general health, where in your mouth or oropharynx the cancer began, the size of the tumor, and whether the cancer has spread. Your doctor can describe your treatment choices and the expected results. You will want to consider how treatment may affect normal activities such as swallowing and talking, and whether it will change the way you look. You and your doctor can work together to develop a treatment plan that meets your needs and personal values.

You do not need to ask all your questions or understand all the answers at once. You will have other chances to ask your doctor to explain things that are not clear and to ask for more information.

Methods of Treatment

Oral cancer treatment may include surgery, radiation therapy, or chemotherapy. Some patients have a combination of treatments.

At any stage of disease, people with oral cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care. You may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods.

Surgery

Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. Patients may have surgery alone or in combination with radiation therapy.

You may want to ask the doctor these questions before having surgery:

• What kind of operation do you recommend for me?
• Do I need any lymph nodes removed? Why?
• How will I feel after the operation? How long will I be in the hospital?
• What are the risks of surgery?
• Will I have trouble speaking, swallowing, or eating?
• Where will the scars be? What will they look like?
• Will I have any long-term effects?
• Will I look different?
• Will I need reconstructive or plastic surgery? When can that be done?
• Will I lose my teeth? Can they be replaced? How soon?
• Will I need to see a specialist for help with my speech?
• When can I get back to my normal activities?
• How often will I need checkups?
• Would a clinical trial be appropriate for me?

Radiation Therapy

Radiation therapy (also called radiotherapy) is a type of local therapy. It affects cells only in the treated area. Radiation therapy is used alone for small tumors or for patients who cannot have surgery. It may be used before surgery to kill cancer cells and shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area.

Radiation therapy uses high-energy rays to kill cancer cells. Doctors use two types of radiation therapy to treat oral cancer:

External radiation: The radiation comes from a machine. Patients go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks.

Internal radiation (implant radiation): The radiation comes from radioactive material placed in seeds, needles, or thin plastic tubes put directly in the tissue. The patient stays in the hospital. The implants remain in place for several days. Usually they are removed before the patient goes home.

Some people with oral cancer have both kinds of radiation therapy.

You may want to ask the doctor these questions before having radiation therapy:

• Which type of radiation therapy do you recommend for me? Why do I need this treatment?
• When will the treatments begin? When will they end?
• Should I see my dentist before I start treatment? If I need dental treatment, how much time does my mouth need to heal before radiation therapy starts?
• What are the risks and side effects of this treatment? What can I do about them?
• How will I feel during therapy?
• What can I do to take care of myself during therapy?
• How will my mouth and face look afterward?
• Are there any long-term effects?
• Can I continue my normal activities?
• Will I need a special diet? For how long?
• How often will I need checkups?
• Would a clinical trial be appropriate for me?

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body.

Chemotherapy is usually given by injection. It may be given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.

You may want to ask the doctor these questions before having chemotherapy:

• Why do I need this treatment?
• Which drug or drugs will I have?
• How do the drugs work?
• Should I see my dentist before I start chemotherapy? If I need dental treatment, how much time does my mouth need to heal before the chemotherapy begins?
• What are the expected benefits of the treatment?
• What are the risks and possible side effects of treatment? What can I do about them?
• When will treatment start? When will it end?
• Will I need to stay in the hospital? How long?
• How will treatment affect my normal activities?
• Would a clinical trial be appropriate for me?

About the Author

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