Oral cancer treatment options

Oral cancer, which can affect the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and throat, requires a multidisciplinary approach to treatment. The treatment strategy depends on several factors including the stage and location of the cancer, the patient’s overall health, and personal preferences. Understanding the available treatment options is crucial for patients and caregivers to make informed decisions and achieve the best possible outcomes.

Surgery

Surgery is often the first line of treatment for oral cancer, especially when the tumor is localized. The primary goal is to remove the cancerous tissue completely, with clear margins to reduce the risk of recurrence. Types of surgeries may include:

• Tumor Resection: Removal of the tumor and some surrounding healthy tissue.

• Glossectomy: Partial or total removal of the tongue depending on the tumor size and spread.

• Mandibulectomy or Maxillectomy: Removal of part of the jawbone (mandible or maxilla) if the cancer has invaded bone tissue.

• Neck Dissection: Removal of lymph nodes in the neck if the cancer has spread or is at high risk of spreading.

Advanced surgical techniques can minimize disfigurement and maintain oral function. Reconstructive surgery, often using grafts or flaps from other parts of the body, may be necessary to restore appearance and functionality after major resections.

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells or shrink tumors. It may be used alone in early-stage cancers or in combination with surgery and/or chemotherapy for more advanced cases. The two primary types of radiation therapy for oral cancer are:

• External Beam Radiation Therapy (EBRT): The most common form, which directs radiation from outside the body to the tumor site.

• Brachytherapy: Involves placing radioactive materials directly into or near the tumor, often used in specific cases or for recurrent cancer.

Radiation can cause side effects such as dry mouth, mucositis, altered taste, and fatigue, which are managed with supportive care. Advances in radiation technology like IMRT (Intensity-Modulated Radiation Therapy) allow for more precise targeting, minimizing damage to surrounding healthy tissues.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop their growth. It is typically used in combination with radiation therapy (chemoradiation) for advanced oral cancers or when surgery is not possible. Common chemotherapeutic agents include:

• Cisplatin

• 5-Fluorouracil (5-FU)

• Carboplatin

• Paclitaxel or Docetaxel

Chemotherapy may be given before surgery to shrink tumors (neoadjuvant therapy), after surgery to kill remaining cancer cells (adjuvant therapy), or for palliative purposes in metastatic disease. Side effects such as nausea, vomiting, hair loss, lowered immunity, and fatigue are managed through supportive medications and care plans.

Targeted Therapy

Targeted therapies are drugs that block specific molecules involved in the growth and spread of cancer cells. The most commonly used targeted therapy for oral cancer is Cetuximab, an EGFR inhibitor. It can be used alone or with radiation therapy for patients who cannot tolerate chemotherapy.

Unlike traditional chemotherapy, targeted therapy tends to spare normal cells, potentially leading to fewer side effects. However, it may still cause skin reactions, diarrhea, and infusion-related symptoms.

Immunotherapy

Immunotherapy is an emerging treatment that stimulates the body’s immune system to fight cancer more effectively. Immune checkpoint inhibitors like:

• Nivolumab

• Pembrolizumab

are approved for use in recurrent or metastatic head and neck squamous cell carcinoma, including oral cancers. These drugs block proteins that prevent T-cells from attacking cancer cells, essentially “releasing the brakes” on the immune system.

Immunotherapy is generally well-tolerated, but it can cause immune-related side effects such as colitis, hepatitis, pneumonitis, and endocrinopathies, requiring close monitoring and sometimes corticosteroid treatment.

Photodynamic Therapy (PDT)

Photodynamic therapy uses light-sensitive drugs and a special light source to destroy cancer cells. It is typically reserved for very early-stage oral cancers or pre-cancerous lesions. After administration of a photosensitizing agent, light is applied to the targeted area, activating the drug to destroy cancer cells.

PDT can preserve more normal tissue than conventional treatments, but it’s not widely used and is usually part of clinical trials or in specialized centers.

Clinical Trials

Participation in clinical trials may provide access to cutting-edge treatments not yet available to the public. These trials test new drugs, combinations, or techniques such as gene therapy, novel immunotherapies, and advanced radiation modalities. Patients should discuss clinical trial eligibility with their oncologist, particularly if standard treatments have not been effective.

Supportive and Palliative Care

Throughout all stages of treatment, supportive care plays a vital role in maintaining quality of life. This includes:

• Nutritional support: Since eating may become difficult, dietary guidance, feeding tubes, or supplements may be needed.

• Speech and swallowing therapy: Especially after surgeries involving the tongue or throat.

• Pain management: Addressing pain from surgery, radiation, or tumor growth.

• Psychological support: Coping with the emotional and mental stress of a cancer diagnosis and treatment.

For patients with advanced or incurable oral cancer, palliative care focuses on symptom relief and improving comfort rather than curative treatment.

Post-Treatment Surveillance

Regular follow-ups are essential after treatment to monitor for recurrence or secondary cancers. This typically involves:

• Physical examinations

• Imaging studies (CT, MRI, or PET scans)

• Biopsies if suspicious lesions appear

Long-term survivorship care also addresses rehabilitation, dental care, speech restoration, and emotional well-being.

Multidisciplinary Care Approach

Optimal management of oral cancer requires a team of specialists, including:

• Oral and maxillofacial surgeons

• Medical oncologists

• Radiation oncologists

• Speech therapists

• Nutritionists

• Psychologists

• Reconstructive surgeons

This coordinated care ensures that all aspects of the patient’s health are addressed, from effective tumor control to functional and cosmetic outcomes.

Conclusion

Oral cancer treatment has evolved significantly, offering various approaches tailored to the stage, location, and characteristics of the tumor, as well as the patient’s individual needs. While surgery, radiation, and chemotherapy remain the mainstays, newer options like targeted therapy and immunotherapy are expanding possibilities for more effective and personalized care. Early diagnosis and a comprehensive treatment plan developed by a skilled, multidisciplinary team are essential for improving survival rates and quality of life.