Treatment options for oral cancer: Surgery, Radiation, Chemotherapy

Not many years ago, a diagnosis of oral cancer meant enduring radical surgical procedures. Today's advances in treatment mean less invasive procedures, including combinations of surgery, radiation therapy, and chemotherapy.

The choice of treatment depends mainly on the patient's general health, the location and size of the cancer and whether the cancer has spread. People with early-stage oral cancer may be treated with surgery alone, whereas advanced oral cancer patients may require a combination of surgery, radiation and chemotherapy.

 

At the NYU Oral Cancer Center, clinical research is an important part of our work. Because there is currently no cure for oral cancer, testing new drugs and treatment options is critical to advancing the field. Almost all of our patients are enrolled in – and can potentially benefit from - a clinical research study.


NYU's treatment for oral cancers is a multidisciplinary approach involving the efforts and expertise of a diverse array of medical experts, including oral and maxillofacial surgeons, head and neck surgeons (otolaryngologists), radiation and chemotherapy oncologists, dentists, oral medicine and oral health specialists, periodontists, nutritionists, psychologists and rehabilitation specialists. This care team works together to develop an individualized treatment plan once a precise diagnosis is made and the cancer has been staged.

The most common aspects of oral cancer management include:


Surgery

Management of oral cancer almost always requires surgery. Oral cancers have a high chance of spreading to the neck lymph nodes even when a lump cannot be felt or there is no evidence of lymph node involvement on the CT or MRI. Therefore, surgical treatment often includes removal of the at-risk neck lymph nodes (known as a neck dissection). Late detection may mean the oral cancer has grown significantly and may have invaded surrounding tissue. In this situation, surgery may be extensive and require removal of other tissue in the mouth such as part of the palate, tongue, or jaw. Sometimes a tracheostomy is also necessary; this is insertion of a breathing tube into the neck and trachea (windpipe) to allow the patient to breathe without the using his or her nose or mouth. The tracheostomy is usually a temporary measure used postoperatively to assist breathing and is almost always removed prior to hospital discharge.

Oral cancer can be capricious in its capacity to metastasize to the neck, an event that dramatically worsens the outcome. Current methods of assessing the risk for metastasis are prone to underestimation, especially since metastasis can occur even in earlier stage cancer when no neck lymph node involvement is clinically detectable or visualized on CT or MRI scans. The uncertainty of disease progression means doctors differ on the most appropriate surgical approach.

Oral cancers have 20 percent to 40 percent rates of metastasis even when an enlarged neck lymph node cannot be felt. We often recommend removal of the lymph nodes at the time of oral cancer resection to prevent future development of metastasis. This type of extensive head and neck surgery has the potential to affect the ability to chew, swallow and talk and may also alter facial features. In these cases, reconstructive or plastic surgery is often necessary to rebuild the bones or tissues and to restore function.


Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. Radiation may be used after surgery to destroy any remaining cancer cells in the mouth or neck. Two types of radiation therapy are used to treat oral cancer:

External radiation therapy:
The radiation is generated by a machine (similar to having an x-ray).
– External Beam Radiation Therapy (EBRT)
– Accelerated and Hyperfractionated Radiation Therapy
– Intensity Modulated Radiation Therapy (IMRT)

Internal radiation therapy:
Also known as implant radiation therapy, internal radiation or brachytherapy.
The radiation is generated from radioactive materials that are placed in the mouth in direct contact with the cancer.
– High-dose rate brachytherapy
– Low-dose rate brachytherapy, temporary or permanent


Chemotherapy

Chemotherapy treatment uses drugs to kill fast-growing cancer cells, for instance after the cancer has spread to other parts of the body. The drugs are given through a vein (intravenous) directly into the bloodstream. This allows the drugs to reach and kill cancer cells n anywhere the body. Unfortunately chemotherapy also affects the normal fast-growing cells, such as blood cells, cells in hair roots and the lining of the mouth and intestine. Chemotherapy may also be used to shrink a tumor before surgery or to sensitize cancer cells to radiation.


Targeted Therapy

Targeted drug therapy offers patients treatment that hones in on the tumor while lessening the side effects often associated with chemotherapy. This type of therapy interferes with cancer growth and progression in a number of possible ways: by delivering toxic drugs to cancer cells, by limiting cell growth signaling or tumor blood vessel development, or by stimulating the immune system to destroy cancer cells. Unlike chemotherapy, which affects all cells in the body, targeted drug therapy aims to leave healthy cells unscathed targeting only the cancer cells.