Treatments for locally advanced oral cancer

The following are treatment options for locally advanced (stage 3, stage 4A and stage 4B) 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 before treatment begins. You may need a feeding tube to make sure you get enough nutrition during treatment. It is important to have any necessary dental work done before treatment starts.

Locally advanced oral cancers are usually treated with a combination of surgery first, and then radiation therapy, with or without chemotherapy.


Surgery to remove the tumour is usually done before other treatments. The type of surgery done will depend on the location of the cancer.

Wide local excision removes the tumour along with a margin of normal tissue around it. The amount of tissue removed along with the tumour will vary according to the location of the tumour.

Glossectomy is surgery to remove part or all of the tongue.

Mandibulectomy may be done for some tumours. This is surgery to remove part or all of the lower jawbone (mandible).

Neck dissection removes lymph nodes from the neck. It is usually done for advanced oral cancer.

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).

Radiation therapy

Radiation therapy is often used to treat locally advanced oral cancer. 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 is often given after surgery, with or without chemotherapy, if the oral cancer has certain features that increase the risk of cancer coming back (recurring), such as:

  • positive margins
  • a tumour that involves or has grown along the nerves (called perineural invasion) or blood vessels (called vascular invasion)
  • a tumour that has spread outside of the lymph nodes in the neck (called extracapsular spread)
  • tumours that are larger than 4 cm
  • spread to more than one lymph node
  • a lymph node that is larger than 3 cm

In some cases, radiation therapy may be used as the main treatment, with or without chemotherapy. This is called organ preservation. This may be considered if you cannot have surgery or if the tumour can’t be completely removed.

Radiation therapy can also be used to treat lymph nodes in the neck.

Clinical trials

Talk to your doctor about clinical trials open to people with oral cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Expert review and references

  • 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 Care Ontario. Evidence-Based Series 5-12: Epidermal Growth Factor Receptor (EGFR) Targeted Therapy in Stage III and IV Head and Neck Cancer. Version 3 ed. 2015.
  • Cancer Care Ontario. Evidence-Based Series 5-10 Section 1: The Role of Postoperative Chemoradiotherapy for Advanced Squamous Cell Carcinoma of the Head and Neck: A Clinical Practice Guidline. 2004.
  • Cancer Care Ontario. Practice Guideline 5-11: Systemic Therapy in the Curative Treatment of Head and Neck Squamous Cell Cancer. 2016.
  • 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.