Chemotherapy (chemo) is the use of anti-cancer drugs that are given into a vein or taken by mouth. These drugs enter the bloodstream and can reach cancer that has spread to organs beyond the head and neck. It may be used in several different situations:
- Chemo (typically combined with radiation therapy) may be used instead of surgery as the main treatment for some cancers.
- Chemo (combined with radiation therapy) may be given after surgery to try to kill any small deposits of cancer cells that may have been left behind. This is known as adjuvant chemotherapy.
- Chemo may be used (sometimes with radiation) to try to shrink some larger cancers before surgery. This is called neoadjuvant or induction chemotherapy. In some cases this makes it possible to use less radical surgery and remove less tissue. This can lead to fewer serious side effects from surgery.
- Chemo (with or without radiation) can be used to treat cancers that are too large or have spread too far to be removed by surgery. The goal is to slow the growth of the cancer for as long as possible and to help relieve any symptoms the cancer is causing.
The chemo drugs used most often for cancers of the oral cavity and oropharynx are:
- Cisplatin
- 5-fluorouracil (5-FU)
- Carboplatin
- Paclitaxel (Taxol®)
- Docetaxel (Taxotere®)
- Methotrexate
- Ifosfamide (Ifos®)
- Bleomycin
A chemo drug may be used alone or combined with other drugs. Often combining drugs can help tumors shrink better, but will cause more side effects. The most commonly used combination is cisplatin and 5-FU. This combination is more effective than either drug alone in shrinking cancers of the oral cavity and oropharynx. Doctors have also seen good results when adding the drug docetaxel to these 2 drugs.
Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each chemotherapy cycle typically lasts for a few weeks.
Chemo is often given at the same time as radiation (known as chemoradiation). Cisplatin alone is usually the preferred chemo drug when given along with radiation. Some doctors prefer to give the radiation and chemo before surgery. However, the side effects can be severe and may be too much for some patients.
In patients whose cancers are too advanced for surgery but not widespread, chemotherapy and radiation given together might produce a better outcome than radiation alone. But this combined approach is often hard for people who are in poor health to tolerate.
Possible side effects of chemotherapy
Chemotherapy drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles are also affected. This can lead to side effects.
The side effects of chemotherapy depend on the type and dose of drugs given and how long they are taken. These side effects can include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Diarrhea
- Increased chance of infections (due to low white blood cell counts)
- Easy bruising or bleeding (due to low blood platelet counts)
- Fatigue (due to low red blood cell counts)
Along with the risks above, some side effects are seen more often with certain chemo drugs. For example, 5-FU often causes diarrhea. Cisplatin can cause nerve damage (called neuropathy), leading to hearing loss as well as numbness and tingling in the hands and feet. This often improves once treatment is stopped, but it can persist a long time in some cases.
Although most side effects improve once treatment is stopped, some can last a long time or even be permanent. If your doctor plans treatment with chemo you should be sure to discuss the drugs that will be used and the possible side effects. Once chemo is started, let your health care team know if you have side effects, so they can be treated. There are ways to prevent or treat many of the side effects of chemotherapy. For example, many good drugs are available to help prevent or treat nausea and vomiting.
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