Advanced mouth and oropharyngeal cancer

Advanced cancer means cancer that started in the mouth or oropharynx has spread to another part of the body beyond the head and neck.

Sometimes cancer is advanced when it is first diagnosed. Or the cancer has come back and spread after treatment for the original cancer.

Unfortunately, advanced cancer can’t usually be cured. But treatment can usually control it, relieve symptoms and improve quality of life. You may be referred to a palliative care doctor.

Cancers that have spread to another part of the body are called:

• secondary cancer

• metastases

• metastatic cancer

Where mouth and oropharyngeal cancer spreads

 The most common sites where mouth and oropharyngeal cancer spread to include: 

• the bones
• the lungs
• the liver

Symptoms of advanced mouth and oropharyngeal cancer

The symptoms of advanced mouth and oropharyngeal cancer depend on where the cancer has spread to. General symptoms can include:

• feeling very tired (fatigue)
• pain
• weight loss for no known reason

Symptoms if cancer has spread to the lungs

The symptoms you may have if your cancer has spread into the lungs can include:

• a cough that doesn’t go away
• shortness of breath
• ongoing chest infections
• weight loss
• chest pain

Symptoms if cancer has spread to the bones 

Symptoms can include:

• pain – the pain is continuous, and people often describe it as gnawing
• backache, which gets worse despite resting
• breaks in the bones because they are weaker
• dehydration, confusion, being sick, tummy (abdominal) pain and constipation due to high levels of calcium in the blood (hypercalcaemia)

Symptoms if cancer has spread to the liver

The symptoms you might have can include:

• tiredness
• discomfort or pain on the right side of your tummy (abdomen) where the liver is
• feeling sick (nausea)
• loss of appetite
• a swollen abdomen
• yellowing of the skin or itchy skin (jaundice)

How you might feel

Finding out that you can’t be cured is distressing and can be a shock. It’s common to feel uncertain and anxious. It's normal to not be able to think about anything else.

Lots of information and support is available to you, your family and friends. Some people find it helpful to find out more about their cancer and the treatments they might have. Many people find that knowing more about their situation can make it easier to cope.

Talk to your doctor or specialist nurse to understand:

• what your diagnosis means

• what is likely to happen

• what treatment is available

• how treatment can help you

• what the side effects of the treatment are

Everyone is different and there is no right way to feel.

Survival

Many people want to know what the outlook is and how their cancer will develop. This is different for each person. Your cancer specialist has all the information about you and your cancer. They're the best person to discuss this with.

You can also talk to your specialist nurse.

Making decisions about treatment

Deciding about treatment can be difficult when you have advanced cancer. Treatments such as chemotherapy or short courses of radiotherapy can help to reduce symptoms and might make you feel better. But they also have side effects that can make you feel unwell for a while.

Ask your doctor to explain what treatment you may have, the possible side effects and how it might affect your quality of life. 

Your doctor might offer you a choice of treatments. You can discuss the benefits and risks of each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments

• if you need more tests

• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

You might also find it helps to talk things over with a close relative, a friend or a counsellor at the hospital.

Your treatment

Treatment depends on:

• the size of the cancer and where it is in the body

• the treatment you have already had

• your general health

Types of treatment for advanced mouth and oropharyngeal cancer

Other treatments may include:

• surgery

• radiotherapy

• chemotherapy

• chemotherapy with radiotherapy (chemoradiotherapy)

• a targeted drug, for example, cetuximab

• immunotherapy, for example, pembrolizumab or nivolumab

• treatment to control symptoms, for example, drugs or radiotherapy to control pain

Clinical trials

Treatments that are still in development may be another option for you. This will mean taking part in a clinical trial.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.