Treatments for metastatic oral cancer

If you have metastatic (stage 4C) 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.

Metastatic oral cancers are often treated with radiation therapy, chemotherapy or both. The following are treatment options for metastatic oral cancer, including treatment for a tumour that can’t be completely removed or for someone who cannot or chooses not to have surgery.

Radiation therapy

Radiation therapy may be given as brachytherapy, external beam radiation therapy or both.

Radiation therapy may be given at the same time as chemotherapy (called chemoradiation) or it may be used after chemotherapy. Palliative radiation therapy may be given alone to treat symptoms.


Induction chemotherapy may be given and followed with radiation therapy or chemoradiation. Chemotherapy may be given alone to treat symptoms.


You may be offered immunotherapy for metastatic oral cancer.

Pembrolizumab (Keytruda) may be used as a first-line therapy to treat metastatic oral cancer. It may be used with or without chemotherapy.

Nivolumab (Opdivo) may be used to treat metastatic oral cancer that stops responding to chemotherapy with drugs such as cisplatin or carboplatin.


Surgery may be used to control symptoms. Surgery may be used to remove a tumour that is blocking the airway to make breathing easier.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

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 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 Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers (Version 1.2015). 2015.