Treatments for early-stage oral cancer
The following are treatment options for early-stage (stage 1 or stage 2) oral cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. They will usually do a nutritional assessment and dental assessment as part of your treatment plan. You may need a feeding tube to make sure you get enough nutrition during treatment.
Early-stage oral cancers are usually treated with surgery as the main therapy. In certain situations, surgery may be followed with radiation therapy, with or without chemotherapy.
Surgery to remove the tumour is the most common treatment used for early-stage oral cancers. The type of surgery done will depend on the location of the cancer. If there are positive
Wide local excision removes the tumour along with a margin of normal tissue around it. The amount of tissue removed along with the tumour depends on the location of the tumour.
Glossectomy is surgery to remove part or all of the tongue.
Mandibulectomy is surgery to remove part or all of the lower jawbone (mandible). It may be done for some tumours when bone must also be removed to get clear margins.
Neck dissection removes lymph nodes from the neck. It may be done even when there are no obvious lymph nodes involved if the tumour is 4 mm or thicker or to help with reconstruction.
Reconstructive surgery may be needed for larger tumours. Reconstruction may be done using skin from another part of the body (called a skin graft) or using tissue (skin, muscle, bone or a combination of these) from another part of the body (called flaps). These flaps generally contain skin, bone or both.
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Radiation therapy may be used after surgery. Radiation therapy may be given as external beam radiation therapy, brachytherapy or both. Sometimes chemotherapy is given along with radiation therapy (called chemoradiation).
Radiation therapy may be given after surgery, with or without chemotherapy, if the oral cancer has certain high-risk features that increase the risk of cancer coming back (recurring), such as:
- positive margins
- a tumour that touches or has grown along the nerves (called perineural invasion) or blood vessels (called vascular invasion)
Radiation therapy may also be used to treat the lymph nodes in the neck for tumours that involve the oral tongue or floor of the mouth and are 4 mm or thicker.
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Alberta Health Services. Oral Cavity Cancer Clinical Practice Guideline HN-002. Alberta Health Services; 2016.
American Cancer Society. Oral Cavity and Oropharyngeal Cancer. 2016.
Cancer Care Ontario. Evidence-Based Series 5-3: The Management of Head and Neck Cancer in Ontario. 2009.
Cancer Research UK. The Mouth and Oropharynx. Cancer Research UK; 2016.
Koch WM, Stafford E, Chung C, Quon H . Cancer of the oral cavity. Harrison LB, Sessions RB, Kies MS. Head and Neck Cancer: A Multidisciplinary Approach. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2014: 16A:335-356.
National Cancer Institute. Lip and Oral Cavity Cancer Treatment (PDQ®). 2016.
National Cancer Institute. Lip and Oral Cavity Cancer Treatment for Health Professionals (PDQ®). 2015.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers (Version 1.2015). 2015.