Your care team
Hospitals operate multidisciplinary teams (MDTs) for the treatment of mouth cancer. An MDT may include different specialists, including:
- a surgeon
- a clinical oncologist (specialist in the non-surgical treatment of cancer, using techniques such as radiotherapy and chemotherapy)
- a pathologist (specialist in diseased tissue)
- a radiologist (specialist in radiotherapy)
- a dentist
- a dietitian
- a social worker
- a speech and language therapist
You may also be assigned a clinical nurse specialist (CNS) who specialises in the treatment of mouth cancer. The CNS will be your first point of contact between you and the members of the MDT. The CNS will provide information and advice about your treatment plan and the various support services available.
Your treatment plan
Your recommended treatment plan will depend on how far the cancer has spread. In general the mainstay of treatment is either surgery or radiotherapy,or a combination,with chemotherapy added for selected patients.
If the cancer has not spread from beyond the mouth or oropharynx (the area of the throat at the back of your mouth), it may be possible to treat the cancer using surgery alone. With early cancers, the aim is treat with one form of treatment alone.
If the cancer has spread to other parts of the body, then achieving a cure is unlikely. However, it is possible to slow the progress of the cancer and help relieve symptoms by using surgery with or without radiotherapy afterwards,or radiotherapy alone .Only a a small proportion of patients will benefit from having chemotherapy.
Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.
Before treatment begins
Before treatment for mouth cancer begins, you will be given a full dental examination and any necessary dental work will need to be carried out. The radiotherapy will make your teeth more sensitive and vulnerable to infection, so it is important to have a good level of dental hygiene before treatment begins.
A hygienist can also give you advice on how to maintain good dental hygiene. If you are smoking and drinking alcohol, it is recommended that you stop, because quitting will increase the chances of your treatment being successful.For information and advice see the Health A-Z topics on Quitting smoking and Treating alcohol misuse.
The mainstay of treatment is either surgery or radiotherapy or a combination, with chemotherapy added in for selected cases
For mouth cancer, the aim of surgical treatment is to remove any affected tissue while minimising damage to the rest of the mouth.
Other forms of surgery
If your cancer is more advanced, it may be necessary to remove part of your mouth lining and, in some cases, facial skin. The removed skin can be replaced using a skin flap. This is a piece of skin that is taken from your forearm or chest, which is then grafted (joined) to the affected area.
If your tongue is affected, part of the tongue will have to be removed. This is known as a partial glossectomy. The tongue is then reconstructed using grafted tissue.
If the cancer has spread to your jawbone it will need to be surgically removed. The jawbone can be replaced by taking some bone from another part of your body and grafting it in place.
Occasionally, other bones, such as cheekbones, may have to be removed to completely remove the cancer. These bones can be replaced with prosthetics, which are molded pieces of plastic that are designed to replicate the shape and appearance of any removed bones. Modern prosthetics are usually very realistic. Although they will take time to get used to, your physical appearance should be largely unaffected.
During surgery, your surgeon may remove lymph nodes that are near the site of the initial tumour. This is known as a neck dissection. Neck dissections are often carried out as a preventative measure, as the nodes may contain small amounts of cancerous cells that cannot be detected through testing.
Radiotherapy uses doses of radiation to kill cancerous cells. It may be possible to remove the cancer using radiotherapy alone, but it is usually used after surgery to prevent the cancer from reoccurring.
While it kills cancerous cells, radiotherapy can also affect healthy tissue, and it has a number of side effects, including:
- sore, red skin (like sunburn)
- mouth ulcers
- sore mouth and throat
- dry mouth
- loss of, or changes in, taste
- loss of appetite
- stiff jaw
- bad breath
Your care team will monitor any side effects that you have and, where possible, provide treatment for them. For example, protective gels can be used to treat mouth ulcers, and there are medicines that treat the symptoms of dry mouth.
The side effects of radiotherapy can be distressing, but most of them will pass once the radiotherapy is complete.
The radioactive implants will cause your mouth to become swollen, and you will experience some pain 5-10 days after the implants are removed. However, the pain should subside within a few weeks. During this time, you may find it more comfortable to eat cool, plain, soft foods, and avoid drinking spirits or smoking.
Chemotherapy is often used in combination with radiotherapy when the cancer is widespread, or if it is thought there is a significant risk of the cancer returning.
Chemotherapy involves the use of powerful cancer-killing medicines. These medicines damage the DNA of the cancerous cells, interrupting their ability to reproduce.
The medicines that are used in chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. Adverse side effects are common.
Side effects of chemotherapy can include:
- sore mouth
- mouth ulcers
- hair loss
The side effects should stop once the treatment has finished.
Chemotherapy can also weaken your immune system and make you more vulnerable to infection.