Treatment options for mouth and oropharyngeal cancer

There are different treatment options for mouth and oropharyngeal cancer. These include:

  • surgery
  • chemotherapy
  • radiotherapy
  • chemotherapy with radiotherapy (chemoradiotherapy)
  • targeted cancer drugs and immunotherapy

Deciding what treatment you need

A team of doctors, and other professionals discuss the best treatment and care for you. They are the multidisciplinary team (MDT). Your MDT might include:

  • specialist head and neck surgeons 
  • cancer specialists 
  • a specialist nurse
  • a dietitian
  • a speech and language therapist
  • a restorative dentist (prosthodontist)

Your treatment depends on:

  • where your cancer is in your mouth or oropharynx
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness
  • the side effects of the treatment and how these will affect you

Your MDT will discuss your treatment, its benefits and the possible side effects with you.

Treatment overview

You might have one type of treatment or a combination of treatments. Your doctor and nurse will talk to you about the treatment that is best for you. The main treatments are:

  • surgery
  • radiotherapy
  • chemotherapy
  • chemotherapy with radiotherapy (chemoradiotherapy)
  • targeted cancer drugs and immunotherapy

Surgery 

Surgery is a common treatment for early stage mouth and oropharyngeal cancer. It is often the only treatment you need.

How much surgery you have depends on the size and location of your cancer. Your surgeon removes the cancer and a border (margin) of normal tissue around it. You might also have surgery to remove all or some of the lymph nodes in your neck.

You might need a bigger operation if your surgeon needs to remove part of your jawbone or tongue. When the surgeon removes a large area of tissue, they rebuild (reconstruct) the area.

Radiotherapy 

Radiotherapy uses high energy rays similar to x-rays to destroy cancer cells. External beam radiotherapy directs radiotherapy beams at the cancer from a machine. 

You might have external radiotherapy as your main treatment instead of surgery.

Your doctor might suggest internal radiotherapy for very early mouth cancers. This is called brachytherapy. It is only available in a few specialist centres. Your doctor will tell you more about this treatment if it is suitable for you. 

You might have radiotherapy after surgery. This is to kill any cancer cells that might have been left behind. You might also have radiotherapy to the neck area to kill cancer cells in the lymph nodes. This is to lower the risk of the cancer coming back.

You can have radiotherapy on its own or together with chemotherapy (chemoradiotherapy).

Chemotherapy 

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.

Chemotherapy is often given with radiotherapy (chemoradiotherapy).

You might have chemotherapy on its own before other treatments. This helps to shrink your cancer and lower the risk of your cancer spreading to other parts of your body.

You might have chemotherapy if your cancer has come back. Or if your cancer has:

  • spread into surrounding tissues (locally advanced) or
  • spread to other parts of the body (advanced cancer)

Chemoradiotherapy 

You might have chemotherapy together with radiotherapy. This is called chemoradiotherapy.

You might have chemoradiotherapy:

  • after surgery
  • as your main treatment if surgery is not a suitable option
  • if your cancer has spread into surrounding tissues or into nearby lymph nodes

Targeted cancer drugs and immunotherapy

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. They are called immunotherapies.

You might have a targeted or immunotherapy cancer drugs. For example, cetuximab (also known as Erbitux) or nivolumab (Opdivo). 

Treatment by stage

Your treatment depends on the stage of your cancer.

Stage 0 (carcinoma in situ) 

The cancer cells are all contained within the lining of the mouth or oropharynx. If left untreated, there is a high chance of the cells developing into an invasive cancer. 

Your doctor may completely remove the cancer cells during a biopsy if the affected area is very small. Or you may need to have minor surgery. Your doctor removes the cancer cells by taking a thin layer of tissue from the affected area.

Your doctor will monitor you closely after treatment. If the cancer cells come back, you may have radiotherapy.

If you smoke and continue to do so, it is much more likely that you will develop cancerous cells again in the future.    

Stage 1 and 2

Your treatment depends on where in the mouth or oropharynx your cancer is. When deciding on your treatment plan, your doctor considers the possible side effects of treatment, and your general health. 

The 2 main treatment options are:

  • surgery – you might need to have radiotherapy or chemoradiotherapy after surgery
  • external radiotherapy as your main treatment

You might have surgery to remove the cancer. The surgeon might also remove some of the lymph nodes in your neck. You might need to have radiotherapy after surgery. You may have it on its own or combined with chemotherapy. This is to kill off any remaining cancer cells. 

Or you might have external radiotherapy as your main treatment instead of surgery. The radiotherapy treatment area might include the lymph nodes in your neck.

Stage 3 and 4

The main treatment options are:

  • surgery – you might need to have radiotherapy or chemoradiotherapy after surgery
  • chemoradiotherapy as your main treatment
  • chemotherapy, immunotherapy, or targeted drugs
  • supportive care to treat symptoms

You might have surgery to remove the cancer. This usually includes removing lymph nodes in the neck during an operation called a neck dissection. You may also have radiotherapy after surgery. You might have radiotherapy on its own or together with chemotherapy (chemoradiotherapy). This is to kill off any remaining cancer cells. 

Or your doctor might suggest chemoradiotherapy as your main treatment. You might have a targeted cancer drug called cetuximab alongside radiotherapy if you can’t have chemotherapy, or if chemotherapy isn’t working. You might have radiotherapy on its own if you aren’t able to have combined treatment.

You might have chemotherapy on its own or with immunotherapy or targeted drugs if:

  • the cancer has spread outside of the mouth, throat, and neck area, for example, to the lungs
  • it's not possible to have surgery and radiotherapy

For advanced mouth and oropharyngeal cancer, you have treatment and supportive care to relieve symptoms. For example, pain killers or surgery to help with breathing or eating. 

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

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Last reviewed: 
31 May 2022
Next review due: 
31 May 2025

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