Your treatment team
Mouth cancer may affect structures in the body that are important for breathing, eating, swallowing and speaking. It may also affect your appearance.
As well as being treated by a surgeon and a doctor who specialises in cancer (clinical oncologists), you may also see a dietitian, speech therapist, and a dentist.
You'll also usually have the support of a nurse who specialises in head and neck cancer (clinical nurse specialist).
Being diagnosed with cancer can cause stress and anxiety for you and your family. In some hospitals, a psychologist will be available to provide support if you need them.
If problems with swallowing 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 passed down into your stomach (nasogastric tube).
If the problem is likely to be long-term, a doctor who specialises in stomach and bowel conditions (gastroenterologist) or a radiologist will insert a tube directly into your stomach (gastrostomy).
Your treatment plan
Your treatment for mouth cancer will depend on:
- the type and size of the cancer
- the grade and stage of the cancer (how far it has spread)
- your general health
If the cancer has not spread beyond the mouth or the part of your throat at the back of your mouth (oropharynx) a complete cure may be possible using surgery alone.
Your doctors will make recommendations about your treatment with the help and advice of all your care team, but the final decision will be yours.
Before going to hospital to discuss your treatment, 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 a particular treatment.
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 dental work will be done before treatment begins.
If you smoke or drink, stopping will increase the chances of your treatment being successful.
The aim of surgery for mouth cancer is to remove any affected tissue while minimising damage to the rest of the mouth.
If the 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 on your body, such as your forearm or chest (a skin graft).
If your tongue is affected, part of it will have to be removed, called 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 your 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 done as a preventative measure in case they contain a small number of cancerous cells that cannot be detected on any scans.
The thought of having reconstructive facial surgery can be worrying. Your surgeon should explain the operation to you in detail and answer any questions you have.
You may also find it helpful to talk to other people who've had the same operation.
Your care team can give you the contact details of organisations, such as Saving Faces, which offer helplines or support groups for people with mouth cancer.
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 chemotherapy medicine (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 has spread.
As well as killing cancerous cells, radiotherapy can also affect healthy tissue.
The side effects of radiotherapy include:
- sore, red skin (like sunburn)
- mouth ulcers
- sore mouth and throat
- dry mouth
- loss of taste or changes in taste
- loss of appetite
- tiredness (fatigue)
- feeling sick
- stiff jaw
- bad breath
- exposed bone
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, also known as brachytherapy, can be used to treat early-stage cancers of the tongue.
It involves placing radioactive implants directly into the tumour after you have had 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 will not 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 is sometimes used in combination with radiotherapy if 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.
As well as killing cancerous cells, chemotherapy can also affect healthy tissue.
Side effects of chemotherapy are common and include:
- tiredness (fatigue)
- sore mouth
- mouth ulcers
- feeling and 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 is a new type of medicine, called a targeted therapy, which is sometimes used instead of standard chemotherapy to treat mouth cancer.
It does not cause all the side effects of standard chemotherapy and is usually 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 to grow. By targeting them, cetuximab prevents the cancer from spreading.
The National Institute for Health and Care Excellence (NICE) ruled that cetuximab does not 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 happen 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 you have mouth lesions that are close to turning into cancer, or if cancer is at a very early stage and only found on the surface of your mouth. However, its cure rate has not yet been compared with conventional treatment.
PDT can also be used to temporarily control cancer where it's been decided that further conventional treatment will not 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 directed on to the cancer using lasers. This destroys the surface of the cancer and some mouth lining next to it.
You must stay in a dark room for 7 days with no light whatsoever, including no TV and no bedside light. If you're exposed to any light at all over this period, you'll develop serious burn to your skin.