Chemotherapy for Oral Cavity and Oropharyngeal Cancer

Chemotherapy (chemo) is the use of anti-cancer drugs to treat cancer. For oral cavity and oropharyngeal cancers, the drugs are given into a vein or taken by mouth, which allows them to enter the bloodstream and reach cancer that has spread throughout the body.

How is chemo used to treat oral cavity and oropharyngeal cancers?

Chemo 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. (This is called chemoradiation.)
  • 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 (sometimes with radiation therapy) may be used 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 therapy) 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.

Which chemo drugs are used?

The chemo drugs used most often for cancers of the oral cavity and oropharynx are:

  • Cisplatin
  • Carboplatin
  • 5-fluorouracil (5-FU)
  • Paclitaxel (Taxol®)
  • Docetaxel (Taxotere®)
  • Hydroxyurea

Other drugs that are used less often include

  • Methotrexate
  • Bleomycin
  • Capecitabine

A chemo drug may be used alone or combined with other drugs. Combining drugs can often shrink tumors better, but tend to cause more side effects. A commonly used combination is cisplatin and 5-FU. This combination works better than either drug alone in shrinking cancers of the oral cavity and oropharynx. Another combination often used is cisplatin, 5-FU, plus docetaxel.

Doctors give chemotherapy in cycles, with each treatment followed by a rest period to allow the body time to recover. Each chemo cycle lasts for a few weeks.

For cancers of the head and neck (such as oral cavity and oropharyngeal cancers), chemo is often given at the same time as radiation (called chemoradiation). Cisplatin alone is the preferred chemo drug when given along with radiation. Some doctors prefer to give the radiation and chemo before surgery. But for some people, the side effects can be too severe.

For people whose cancers are too advanced for surgery but not widespread, getting chemo and radiation together might produce a better outcome than radiation alone. But this combined approach can be hard to tolerate, especially for people in poor health.

Possible side effects of chemotherapy

Chemo 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 divide quickly and are also affected. This can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Side effects can include:

  • Hair loss
  • Mouth sores
  • Loss of appetite
  • Nausea and vomiting
  • Diarrhea
  • Low blood counts

Chemo can affect the blood-producing cells of the bone marrow, leading to low blood cell counts. This can lead to:

  • 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. This might need to be treated with drugs like loperamide. Cisplatin, docetaxel, and paclitaxel can cause nerve damage (called neuropathy). This can lead to numbness and tingling in the hands and feet. This often improves once treatment is stopped, but for some people it can last a long time. Cisplatin can also kidney damage. To help prevent this, intravenous (IV) fluid is given before and after each dose.

Although most side effects get better over time once treatment is stopped, some can last a long time or even be permanent. If your doctor plans treatment with chemo be sure to discuss the drugs that will be used and the possible side effects. Once chemo is started, tell your health care team if you notice any changes or have any side effects. There are ways to prevent or treat many of the side effects of chemo. For example, many drugs are available to help prevent or treat nausea and vomiting.

More information about chemotherapy

For more general information about how chemotherapy is used to treat cancer, see Chemotherapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: July 16, 2014 Last Revised: August 8, 2016

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Koch WM, Stafford E, Bajaj G. Cancer of the Oral Cavity. Part A: General Principles and Management. In: Harrison LB, Sessions RB, Hong WK, eds. Head and Neck Cancer: A Multidisciplinary Approach. Philadelphia, Pa: Lippincott Williams and Wilkins; 2009: 250-265.

Menedenhall WM, Werning JW, Pfister DG. Treatment of head and neck cancer. In: DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2011:729-780.

National Cancer Institute. Drugs Approved for Head and Neck Cancer. September 22, 2015. Accessed at www.cancer.gov/about-cancer/treatment/drugs/head-neck
on February 28, 2018.

National Cancer Institute. Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®)–Patient Version. January 29, 2018. Accessed at www.cancer.gov/types/head-and-neck/patient/adult/lip-mouth-treatment-pdq on February 28, 2018.

National Cancer Institute. Oropharyngeal Cancer Treatment (Adult) (PDQ®)–Patient Version. January 12, 2018. Accessed at www.cancer.gov/types/head-and-neck/patient/adult/oropharyngeal-treatment-pdq on February 28, 2018.

National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Head and Neck Cancers, Version I.2018 -- February 15, 2018. Accessed at www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf on February 28, 2018.