Treatment Options for Oral Cavity Cancer by Stage

Treatment for oral cavity cancer is based largely on the stage (extent) of the cancer, but other factors can also be important.

Most experts agree that treatment in a clinical trial should be considered for any cancer in the head and neck area. A clinical trial might offer the chance of getting new treatments that could be better than standard ones.

Stage 0 (carcinoma in situ) oral cavity cancer

Cancer in this stage is on the surface layer and hasn’t started to grow into deeper layers of tissue, but it can do so if it isn’t treated.

The usual treatment is surgery to remove the top layers of tissue along with a small margin (edge) of normal tissue. This is generally Mohs surgery, surgical stripping, or thin resection.

Follow-up is important to watch for any signs that the cancer has come back. Carcinoma in situ that keeps coming back after surgery may also need to be treated with radiation therapy.

Stages I and II oral cavity cancer

Most people with stage I or II oral cavity cancers do well when treated with surgery and/or radiation therapy. Chemoradiation (chemotherapy given along with radiation) is another option.

Both surgery and radiation work equally well in treating these cancers. The choice depends on your preferences and the expected side effects, including how the treatment might affect the way you look, swallow, and speak.

Lip

Surgery is preferred for small cancers that can be removed. Radiation alone may also be used as the first treatment.

Large or deep cancers often require surgery. If needed, reconstructive surgery can help correct the defect in the lip.

If the tumor is thick, it increases the possibility that the cancer might have spread to lymph nodes in the neck. If abnormal lymph nodes are felt, or seen on an imaging test, the surgeon might remove them in a procedure called lymph node dissection. The removed lymph nodes will be checked for cancer spread.

Oral cavity

Surgery is the main treatment for cancers of the floor of the mouth, front of the tongue, inside of the cheek, gums, and hard palate. Lymph nodes in the neck might be removed (lymph node dissection) to check them for cancer spread.

If it looks like surgery hasn't completely removed the cancer, or if there is a high chance of it coming back, chemoradiation or radiation alone might be added.

Radiation can be used instead of surgery as the main treatment for some people. This is most often done for people who can’t have surgery because of other medical problems.

Stages III and IVA oral cavity cancer

These cancers in the floor of the mouth, front of the tongue, inside of the cheek, gums, and hard palate include bigger cancers, cancers that have grown into nearby tissues, and/or cancers that have spread to nearby lymph nodes in the neck.

Surgery is usually the main treatment and includes taking out some of the neck lymph nodes (lymph node dissection). An immunotherapy drug called a checkpoint inhibitor might be given both before and after surgery. Radiation therapy or chemoradiation is often given after surgery as well.

Stages IVB and IVC oral cavity cancer

Stage IVB cancers have already spread into nearby tissues, structures, and maybe lymph nodes.

People with stage IVB cancers that cannot be removed by surgery, or people who are too weak for surgery, might be treated with radiation alone. Depending on a person’s overall health, chemoradiation or chemotherapy first followed by radiation might be options. Chemotherapy alone might also be recommended.

Stage IVC cancers have spread to other parts of the body, such as the lungs.

These cancers are usually treated with chemo, the targeted therapy drug cetuximab, or both. Immunotherapy, alone or with chemo, might be another option. Treatments such as radiation can also be used to help relieve symptoms from the cancer or to help prevent new problems.

Recurrent oral cavity cancer

When cancer comes back after treatment, it's called recurrent cancer. It can:

• Come back in or near the same place it first started (local)
• Come back in nearby lymph nodes (regional)
• Spread to other organs such as the lungs or bone (distant)

Treatment options for recurrent oral cavity cancers depend on the location and size of the cancer, what treatments have already been used, and a person’s general health. Because these cancers can be hard to treat, clinical trials of newer treatments may be a good option for some people.

Local recurrence

If the cancer comes back in the same area and radiation therapy was used as the first treatment, surgery is often the next treatment if the cancer can be removed completely and the person is healthy enough for surgery.

Usually, external beam radiation therapy can’t be repeated in the same site except in certain cases. But internal radiation (brachytherapy) can often be used to control the cancer if it comes back in the place it started.

If surgery was used first, more surgery, radiation therapy, chemo, the targeted drug cetuximab, immunotherapy, or a combination of these may be an option.

Regional recurrence

If the cancer comes back in the lymph nodes in the neck, the nodes are often removed with surgery (lymph node dissection). This may be followed by radiation or chemoradiation.

Distant recurrence

If the cancer comes back in a distant area, chemo (and/or cetuximab) is often used. Immunotherapy with or without chemo might be an option as well. These treatments might shrink or slow the growth of some cancers for a while and help relieve symptoms, but these cancers are very hard to cure.

If further treatment is recommended, it’s important to talk to your cancer care team so you understand the goal of treatment. Ask whether the goal is to try to cure the cancer or to relieve symptoms and keep the cancer under control for as long as possible. This can help you weigh the risks and benefits of each option.