Learning about your treatment choices

Once you know the type and stage of oral cancer you have, you and your healthcare provider will decide on a treatment plan. Talking about your treatment choices will be one of the most important discussions you'll have with your provider.

You may have questions and concerns about your treatment choices. You may want to know how you’ll feel, how you'll look, how your body will work after treatment, and if you’ll have to change your normal activities.

Your provider is the best person to answer your questions. They can explain what your treatment choices are, how well treatment is expected to work, what the risks and side effects may be, and how much it’s likely to cost.

Your healthcare provider may advise a specific treatment. Or they may offer more than one and ask you to decide which one you’d like to use. It can be hard to make this decision. It’s important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your choices. You may want to get a second opinion before deciding on your treatment plan. You may also want to include your family and friends in this process.

Understanding the goals of treatment

Treatment may control or cure the oral cancer. It can also improve your quality of life by helping to control the symptoms of the disease. The goal of treatment for oral cancer is to do one or more of these things:

• Remove the primary (main) tumor or other tumors while doing as little damage as possible to nearby areas 

• Kill cancer cells or keep them from spreading

• Control further spread of cancer cells

• Keep the cancer from coming back or delay its return

• Ease symptoms caused by the cancer, such as pain and pressure in nearby tissues 

Each type of treatment has a different goal. Talk with your healthcare provider about treatment goals so you know what to expect.

Types of treatment for oral cancer

Treatment for cancer is either local or systemic. You may have both:

Local treatments. These remove, destroy, or control cancer cells in a certain place in the body. Surgery and radiation are local treatments.

Systemic treatments. These destroy or control cancer cells throughout the body. Chemotherapy (chemo) and targeted therapy are examples.

Commonly used treatments for oral cancer

Surgery

Most people with oral cancer have surgery first. There are many types of surgery that can be done. The kind you have depends on where the tumor is. The goal is to take out the tumor along with an edge of healthy tissue around it. In some cases, this may cure the cancer. Nearby lymph nodes might also be taken out if the cancer has spread to them.

The smaller the tumor, the better the chance of keeping normal functions, such as speaking and swallowing. Sometimes plastic or reconstructive surgery is needed after the tumor is removed.

Radiation treatment

This is the use of strong rays of energy to kill cancer cells and shrink tumors. In external beam radiation therapy, a large machine sends the radiation through your skin to the tumor. Radiation can be used alone or along with chemotherapy or targeted therapy.

Radiation can be used to shrink a tumor before surgery so it's easier to remove without damaging nearby healthy tissues. It might be used after surgery, too, to kill any cancer cells that may be left behind. Radiation can also be used if the cancer comes back after treatment. For more advanced cancer, radiation may be used to help control symptoms.

Chemotherapy

This is the use of strong medicines to treat cancer. You may get one or more chemotherapy (or chemo) medicines. Chemo is often given at the same time as radiation. This is called chemoradiation. The chemo helps the radiation work better. Sometimes chemoradiation is used as the main treatment instead of surgery.

Chemo can be used to shrink a tumor before using other types of treatment. This means left tissue has to be removed. It can also help decrease the chance that the cancer will spread to other parts of your body. Chemo can be used after surgery to kill cancer cells left in your body. Chemo may also be used for more advanced cancers, when radiation or surgery can’t be used. Or it may be used when the cancer has spread to other parts of the body.

Targeted therapy

Oral cancer can be treated with a medicine called cetuximab. This is a type of targeted therapy called a monoclonal antibody. It's a man-made protein that mimics part of your immune system. It targets a protein on cancer cells that helps them grow and divide. It may be used for all stages of oral cancer. It can be used alone, or along with radiation or chemo.

Immunotherapy

These medicines help your immune system find and kill cancer cells. Some head and neck cancer cells use a protein called PD-L1 to keep your immune system from attacking them. Medicines that block PD-L1 can boost the immune system against these cancer cells. Sometimes immunotherapy is the first treatment used. It can also be used if the cancer has spread or comes back after other treatments.

Combining treatments

Your provider may suggest that you get more than one type of treatment. Getting two or more treatment types is called combination treatment or combination modality treatment.

For instance, you may have surgery and get chemotherapy. Or you may have surgery and radiation, or radiation and chemotherapy. You may even have all three types of treatment.

The order that you get treatments has a specific name. For instance, when you have a treatment before having surgery, it's called neoadjuvant treatment. You may have chemotherapy, radiation, or both before surgery. These help shrink the tumor. A smaller tumor is easier to take out. They also help keep the cancer from spreading.

Or, you may have more treatment after surgery. This is called adjuvant treatment. You may have chemotherapy or radiation soon after surgery. The goal is to kill any cancer cells that are left. Even if there's no sign of cancer, your healthcare provider may still suggest adjuvant treatment. It helps reduce the risk that cancer may come back or spread.

Clinical trials for new treatments

Research is ongoing to find new and better ways to treat oral cancer. These new methods are tested in clinical trials. Taking part in a clinical trial means you get the best treatment available today, and you might also get new treatments that are thought to be even better. Talk with your healthcare provider to find out if there are any clinical trials you should think about.