The treatment plan for oral cancer varies from patient to patient and
is established according to five main factors: (1) the patient's age,
general health and past medical history, (2) the cancer type, size, and
location, (3) the treatment tolerance, (4) the risk for hidden disease,
and (5) the need to save certain functions.
A better treatment outcome is achieved in patients diagnosed with oral
cancer in early stages.
The main treatment approach in patients with oral cancer are: surgery
and radiotherapy. Chemotherapy is also used to treat oral
cancer, but it is usually used in patients with metastasis and it does
not represent a primary treatment approach for oral cancer.
Surgery is a medical procedure aimed to completely remove the tumor tissue
together with adjacent healthy tissue in order to prevent a future cancer
There are six surgery techniques performed in patients with oral cancer.
Primary tumor resection: This is a type of surgery
where the entire tumor together with surrounding tissue is removed.
Mandible resection: This is a type of surgery
where the tumor is removed together with part or the entire jaw bone.
Maxillectomy: This is a type of surgery where
the tumor is removed together with part or the entire hard palate
(the roof of the mouth). This surgery is usually performed when the
cancer has spread to the mouth roof bone.
Mohs' micrographic surgery: This is an advanced
surgically procedure that relies on the microscope accuracy to trace
and assure a complete removal of the cancer down to its roots, leaving
healthy tissue unharmed. Mohs micrographic surgery removes the
tumor in thin layers. Each layer of tumor removed is checked under
a microscope for cancer cells and the procedure will continue until
there are no more cancer cells in the removed layer. This type of
surgery can be performed when the tumor is on the lip.
Laryngectomy: This type of surgery is performed
in patients with large tumors on the tongue or oropharynx. In some
cases, the surgeon has to remove the larynx (the voice box).
Neck dissection: This type of procedure is performed
when the cancer has spread to the lymph nodes within the neck. During
this procedure, the tumor is removed together with the lymph nodes
affected by cancer.
When performed in early stages, the surgery is small with less post-surgery
scars or disfiguration. When performed in advanced stages, the surgery
is complex, it removes a substantial amount of tissue, and in most cases
requires future reconstruction work.
The side effects are also influenced by the complexity of the surgery
and the tumor size. The most common post-surgery side effects include:
- Swelling (the tissue around the operated area can swell for couple
- Feeling tired
When the removed tumor is too big and the procedure involves removing
surrounding tissues or organs (such as palate, tongue, or jaw), the patient
can experience the following side effects:
- Chewing, swallowing, or talking difficulties
This is a local type of therapy that uses high-energy rays or
particles to destroy cancerous cells. The purpose of this treatment
is to destroy cancerous tissues preserving the healthy tissue.
Radiation therapy is used (1) as a curative treatment in patients
that cannot be operated on with small tumors, (2) as an adjuvant
treatment - in addition to surgery (to enhance the results of
the surgery by destroying possible cancerous cells that could
have been left behind, and reducing the risk of cancer relapse),
3) as a neoadjuvant treatment - before surgery (to reduce the
size of the tumor).
There are two types of radiation therapy performed in patients
with oral cancer:
1. External beam radiation: This form of
radiation therapy uses a device called a linear accelerator that
generates an external beam that is concentrated on the tumor area
and breaks it up into smaller pieces. Sessions last a few minutes
and are administered every day for several weeks.
2. Internal radiation: The radiation is administrated from radioactive
materials (such as seeds, needles, thin tubes) inserted into the tumor.
When this time of treatment is administrated, the patient has to stay
in the hospital.
In some cases, a patient can receive both types of radiation therapy
for a better treatment outcome.
Radiation therapy side effects depend mainly on the
radiation dosage and the targeted area. The most common side effects displayed
by oral cancer patients that undergo radiation therapy are:
- Dry mouth.
- Eating, swallowing, and talking difficulties.
- Mild to major tooth decay (this side effect can be diminished with
a correct and good mouth care, keeping the teeth and gums healthy).
- Sore throat or mouth (painful sores and inflammations).
- Sore or bleeding gums.
- Mouth infections (radiation therapy can damage the mouth lining causing
- Delayed healing (radiation therapy can slow down the healing process
for the mouth tissue).
- Jaw stiffness (radiation therapy can affect the chewing muscle which
leads to difficulties in opening the mouth).
- Denture problems (radiation therapy might cause the denture to not
- Taste and smell changes (during radiation therapy the food might taste
and smell different).
- Voice quality changes (the voice might become weak especially at the
end of the day).
- Larynx swelling (this also cause the voice to change and the patient
can feel a lump in their neck).
- Thyroid changes (radiation therapy might affect the normal function
of the thyroid, decreasing the amount of hormones normally produce by
this gland. These can cause the patient to gain weight, to feel tired,
to have cold sensations, and dry skin and hair.
- Dry, red and extremely sensitive skin in the area exposed to radiation.
Most of these side effects can be controlled and diminished with medication.
This is a systemic type of treatment (affects cells throughout the entire
body) that uses drugs either to stop the abnormal growth and dividing
process of the cancerous cells, or to kill them. This treatment also has
the ability to interfere with the cancerous cells replication.
Chemotherapy can be administrated in combination with surgery and radiation
therapy for a better treatment outcome. The chemotherapy drugs can be
given intravenous or as pills.
Chemotherapy side effects include:
- Mouth bleeding and deep pain (that is felt like a toothache).
- Dry mouth
- Gums pain
- Taste changes
- Mouth infections
- Temporary hair loss
- Nausea with or without vomiting
- Loss of appetite
- General vulnerability to infection
- Easy bleeding and bruising
These side effects vary from patient to patient according to the drugs
and the body reaction to these drugs. Some side effects can be controlled
with medication to increase the patients comfort during the treatment.
Article by Alina Morrow, MS
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