Mouth cancer - Treatment

Treatment-Mouth cancer




If mouth cancer is caught early, relatively minor surgery can be used, which has a very high chance of curing the cancer so it never comes back.
That's why you should report any changes in your mouth to your dentist and doctor immediately.
Even in cases of advanced mouth cancer, improvements in surgery, radiotherapy and medication mean that the chances of a cure are better than 50:50.
However, you'll need treatment with surgery, radiotherapy and medication over a period of at least four months.

Your treatment team

Mouth cancer may affect structures in the body that are important for breathing, eating and speaking. It may also affect appearance.
This means that as well as being treated by surgeons and clinical oncologists, you'll also see a dietitian, speech and language therapist, and dentist.
You'll also usually have the support of a nurse who specialises in head and neck cancer (a clinical nurse specialist).
Being diagnosed with cancer can cause stress and anxiety for both you and your family. In some hospitals, a psychologist will be available to provide help and support if you need them.
If swallowing difficulties temporarily make it difficult for you to get the nutrition you need by mouth, you may need to have a tube inserted through your nose and fed down into your stomach (nasogastric tube).
If the problem is likely to be long-term, a specialist gastroenterologist or radiologist will insert a tube directly into your stomach (gastrostomy).

Your treatment plan

Your treatment for mouth cancer will depend on a number of different things, including:
  • the type and size of the cancer
  • the grade and how far it's spread
  • your general health
If the cancer hasn't spread beyond the mouth or oropharynx – the bit of your throat at the back of your mouth – a complete cure may be possible using surgery alone.
If the cancer is large or has spread to your neck, surgery, radiotherapy and even chemotherapy may be necessary to control it.
Your surgeons and doctors will make recommendations about your treatment with the help and advice of all of your care team, but the final decision will be yours.
Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist.
For example, you may want to find out about the advantages and disadvantages of particular treatments.

Before treatment begins

Radiotherapy makes the teeth more sensitive and vulnerable to infection, so you'll be given a full dental examination and any necessary work will be carried out before you begin your treatment.
If you smoke or drink, stopping will increase the chances of your treatment being successful.
Your GP and specialist nurse can give you help and support if you're finding it difficult to quit smoking and give up drinking.

Surgery

For mouth cancer, the aim of surgery is to remove any affected tissue while minimising damage to the rest of the mouth.
If your cancer is advanced, it may be necessary to remove part of your mouth lining and, in some cases, facial skin. This can be replaced using skin taken from elsewhere in the body, such as your forearm or chest.
If your tongue is affected, part of it will have to be removed, known as a partial glossectomy. 
The tongue may be left to heal on its own – this usually takes 3 to 4 weeks – or it may need to be reconstructed using grafted tissue.
If the cancer has invaded deep into your jawbone, the affected part of the jaw will need to be removed. 
Surgeons now use a complex technology called 3D printing to plan the reconstruction so that the replacement bone matches the removed bone almost exactly.
The grafted bone is kept alive by carefully joining tiny arteries and veins under a microscope (microvascular surgery). This increases the length of the operation.
The bone and muscle used for this replacement is usually taken from the lower leg, hip or shoulder blade. Dental implants can often be put into the new bone so that dental bridges can be made to replace lost teeth.
Occasionally, other bones, such as cheekbones, may have to be removed to get rid of the cancer completely.
These can be replaced with bone from other parts of the body, or a specialist dentist can make an extensive denture called an obturator, which holds the cheek out from the inside to give a relatively normal appearance.
During surgery, your surgeon may also remove lymph nodes near the site of the initial tumour. This is often carried out as a preventative measure in case they contain small numbers of cancerous cells that can't be detected on any scans.
The thought of having reconstructive facial surgery can be worrying. Your surgeon will explain the operation to you in detail and answer any questions or concerns you have.
You may also find it useful and reassuring to talk to other people who've had the same operation.
Your surgeon may be able to put you in touch with one of their former patients. Or a support group, such as Saving Faces, will be able to put you in phone contact with former patients.

Radiotherapy

Radiotherapy uses doses of radiation to kill cancerous cells.
In mouth cancer, it's usually used after surgery to prevent the cancer returning.
In throat cancer, it's often the first treatment to be given, in combination with medication (chemoradiotherapy).
The treatment is usually given every day over the course of 6 weeks, depending on the size of the cancer and how far it's spread.
As well as killing cancerous cells, radiotherapy can also affect healthy tissue.
It has a number of side effects, including:
Any side effects will be monitored by your care team and treated where possible.
The side effects of radiotherapy can be distressing, but many of them will improve once the radiotherapy is complete.

Internal radiotherapy

Internal radiotherapy, also known as brachytherapy, can be used to treat early-stage cancers of the tongue.
It involves placing radioactive implants directly into the tumour while you're under a general anaesthetic.
The implants will be left in for 1 to 8 days, during which time the cancer cells will receive a much higher dose of radiation than the rest of your mouth.
Visits by friends and family will need to be restricted because of the radiation. Pregnant women and children won't be able to visit you.
The radioactive implants will cause your mouth to become swollen, and you'll experience some pain 5 to 10 days after the implants are removed.

Chemotherapy

Chemotherapy is sometimes used in combination with radiotherapy when the cancer is widespread, or if it's thought there's a significant risk of the cancer returning.
Chemotherapy uses powerful cancer-killing medicines, which damage the DNA of the cancerous cells, interrupting their ability to reproduce.
The medicines used in chemotherapy can sometimes damage healthy tissue, as well as the cancerous tissue.
Adverse side effects are common and include:
  • tiredness (fatigue)
  • sore mouth
  • mouth ulcers
  • feeling sick 
  • being sick
  • hair loss
  • hearing and balance problems
  • kidney problems
  • numbness and tenderness of the hands and feet
These side effects usually stop once treatment has finished.
Chemotherapy also weakens your immune system and makes you more vulnerable to infection.

Cetuximab

Cetuximab is a new type of medication, known as a biologic or antibody, which is sometimes used instead of standard chemotherapy to treat mouth cancer. 
It doesn't cause all of the side effects of standard chemotherapy and is normally used in combination with radiotherapy.
Cetuximab targets proteins on the surface of cancer cells, known as epidermal growth factor receptors. These receptors help the cancer grow – by targeting them, cetuximab prevents the cancer spreading.
The National Institute for Health and Care Excellence (NICE) ruled that cetuximab didn't represent a cost effective treatment in most cases and has recommended it only be used in people who are:
  • in a good state of health and likely to make a good recovery if treated
  • unable to have chemotherapy for medical reasons – for example, because they have kidney disease or are pregnant
Skin reactions often occur during the first 3 weeks of treatment with cetuximab. About 8 out of 10 (80%) people who have cetuximab are affected. An acne-like rash is the most common type of skin reaction.

Photodynamic therapy (PDT)

Photodynamic therapy (PDT) may be recommended if there are mouth lesions that are close to turning into cancer, or the cancer is just on the surface of the mouth lining at a very early stage. However, its cure rate hasn't yet been compared with conventional treatment.
PDT can also be used to temporarily control cancer where it's been decided that further conventional treatment won't provide a cure or benefit.
PDT involves taking a medicine that makes all your skin and other tissues sensitive to the effects of light. The cancerous tissue becomes even more sensitive.
After receiving the medicine, light is shone on to the cancer using lasers. This destroys the surface of the cancer and some mouth lining next to it.
You have to stay in a dark room for 7 days with no light whatsoever, including no TV and no bed light. If you're exposed to any light at all over this period, you'll develop serious sunburn.
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