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Mouth cancer is treated by a team of specialists ranging from:
oncologists (cancer specialists)
radiotherapists
oncosurgeons
cosmetic surgeons and plastic surgeons for reconstruction after surgery
oncology nurses
pathologists
dental surgeons
dieticians
social workers
psychologists
counsellors
behavioural, speech and language therapists etc.
The treatment plan is decided upon considering the stage of the cancer as well as the patient’s own preferences and choices.
If the cancer is localized in the mouth and in the throat (pharynx) there is a high possibility of long term survival and recovery using a combination of surgery, radiotherapy and chemotherapy.
Cure is less likely if the cancer is of high grade or if it is spreading rapidly to other organs and tissues via blood and lymphatic system. This type of cancer can also be slowed in its progress using surgery, radiotherapy and chemotherapy.
Before treatment begins a full dental and oral examination is performed to delineate the cancer. Dental work is essential since radiotherapy may damage the teeth and make it prone to infections and breakage.
Quitting tobacco and alcohol is important before any treatment is begun as these, if continued; reduce the chance of cure from the cancer.
Treatment of mouth cancer may include surgery, photodynamic therapy (PDT) and so forth. 1-4
The primary aim of surgical therapy in mouth cancer is to remove any affected tissue. Usually this is a major operation done under general anaesthesia depending on the site and extent of cancer involvement.
Some patients may have a large part of their tongue, cheek or removed due to the cancer. These patients require a reconstructive or plastic surgery to recreate the cheeks and lips. This extra tissue and skin is usually taken from other parts of the body like the chest, forearms, abdomen or thighs.
If the tongue is affected it is dissected out. This is called glossectomy. The tongue may be recreated using grafted tissues or prosthetics.
Some patients may require their jawbones or cheek bones to be removed due to the cancer. The bone may be reconstructed using bone from another part of the body and grafting it in place. Cheek bones may be replaced with prosthetics that are moulded pieces of plastic with the shape of the bone that is removed.
Surgery also involves removal of lymph nodes for biopsy or for removal of the cancer that has spread to the lymph nodes. This is called neck dissection.
Photodynamic therapy (PDT) is preformed in early stages of cancer. This is a type of laser therapy that involves taking a medicine that makes the tissue more sensitive to the light therapy. A laser is then used to remove or kill the tumour.
Radiotherapy uses high energy radiation beams to kill the cancer cells. The cancer is removed using radiotherapy alone or the radiation therapy is performed after surgical removal of the cancer.
The treatment is normally given every day over the course of three to seven weeks. The regimen depends on the extent of spread of the cancer.
Radiotherapy has side effects like:
sore skin
ulcers in the mouth
fatigue
dry mouth
loss of, or changes in, taste
loss of appetite
nausea
bad breath etc.
Radiation may be provided using X-ray like machines which require the patient to visit the hospital for the sessions. This is called external radiotherapy.
Radiation may also be given internally. It involves placing radioactive wires or needles into the tumor and this releases a constant amount of radiation that kills the tumour from within.
Chemotherapy is the use of anticancer drugs like Cisplatin for the treatment of cancers. This is useful when the cancer is of a high grade and has spread to other organs.
These medicines damage the DNA of the cancerous cells or kill them to stop them from multiplying. Common side effects include:
mouth ulcers
hair loss
loss of appetite
nausea
vomiting
tiredness
increased tendency to acquire infections
increased bleeding tendencies
The side effects should stop once the treatment has finished.
Newer drugs are used against cancer of the mouth. Notable among these is Cetuximab that is used in advanced cases of mouth cancer. It is usually used in combination with radiotherapy or chemotherapy.
This type of therapy targets the cancer cells selectively and thus has fewer chemotherapy related side effects.