If you are diagnosed with mouth cancer you may need to be referred to a larger specialist cancer centre or clinic as it is an uncommon form of cancer. This may requiure you to travel to a nearby city.
Your care team
These centres and clinics use multidisciplinary teams (MDTs) for the treatment of mouth cancer. An MDT is made up of a number of specialists, including:
- a surgeon
- a clinical oncologist (specialist in the non-surgical treatment of cancer, such as radiotherapy and chemotherapy)
- a pathologist (specialist in diseased tissue)
- a radiologist (specialist in radiotherapy)
- a dentist
- a dietitian
- a social worker
- a psychologist
- 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 and will provide information 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.
If the cancer has not spread beyond the mouth or oropharynx (the area of the throat at the back of your mouth), it may be possible to completely cure the cancer using a combination of surgery, radiotherapy and chemotherapy.
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, radiotherapy and chemotherapy.
Deciding what treatment is best for you can be difficult. Your care team will make recommendations, but the final decision will be yours.
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, what are 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.
If you are smoking and drinking alcohol, it is recommended that you stop, because quitting will increase the chances of your treatment being successful.
Your CNS and your GP can provide help and support if you are finding it difficult to quit smoking and drinking.
Read more about quitting smoking and cutting down on alcohol.
Surgery
For mouth cancer, the aim of surgical treatment is to remove any affected tissue while minimising damage to the rest of the mouth.
Photodynamic therapy (PDT)
If the cancer is in its early stages, it may be possible to remove any tumours using a type of laser surgery known as photodynamic therapy (PDT). PDT involves taking a medicine that makes your tissue sensitive to the effects of light. A laser is then used to remove the tumour.
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 taken from your forearm or chest, which is then grafted 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 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 moulded pieces of plastic 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 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
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 reocurring.
The treatment is normally given every day over the course of three to seven weeks, depending on the size of the cancer and how far it has spread.
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
- tiredness
- feeling sick
- stiff jaw
- bad breath
Any side effects will be monitored by your care team and treated where possible.
The side effects of radiotherapy can be distressing, but most of them will pass once the radiotherapy is complete.
Internal radiotherapy
Internal radiotherapy is a type of radiotherapy often used to treat cancers of the tongue that are in their early stages. It involves sticking radioactive wires or needles directly into the tumour while you are under a general anaesthetic (put to sleep). The wires or needles then release a dose of radiation into the tumour.
While the internal radiotherapy is taking place, you will be kept in a single room at the hospital. While the levels of radiation you are receiving are generally safe, your treatment staff will only be able to spend short periods of time in the room with you. This is because they are dealing with radiation every day, so it is necessary to minimise any exposure as a precaution.
Visits by friends and family will also have to be restricted due to the risk of exposure. Pregnant women and children will not be able to visit you.
Most courses of internal radiotherapy last one to eight days.
The radioactive implants will cause your mouth to become swollen, and you will experience some pain five to 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
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.
Medicines used in chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. Adverse side effects are common and include:
- sore mouth
- mouth ulcers
- feeling sick
- being sick
- hair loss
- tiredness
The side effects should stop once the treatment has finished.
Chemotherapy can also weaken your immune system and make you more vulnerable to infection.
Cetuximab
Cetuximab is a new type of medication used to treat advanced cases of mouth cancer. It is usually used in combination with radiotherapy or chemotherapy.
Cetuximab is a monoclonal antibody. Monoclonal antibodies are designed to directly target and attack cancer cells. This is why monoclonal antibody therapy is sometimes referred to as targeted therapy.
Cetuximab targets special proteins found on the surface of cancer cells, known as epidermal growth factor receptors. These receptors help the cancer to grow, so by targeting these proteins, cetuximab prevents the cancer from spreading.
The National Institute for Health and Clinical Excellence (NICE) has issued guidance that treatment with cetuximab should only be made available when a person meets both these conditions:
- they are in a good state of health (likely to make a good recovery if treated)
- they are unable to have chemotherapy for medical reasons (for example, because they have kidney disease or are pregnant)
This is because NICE decided that cetuximab did not represent a cost-effective treatment in most cases.
If the above circumstances do not apply to you and you wish to try cetuximab as a treatment, it is likely you will have to pay for the medication. The price will depend on whether the goal of treatment is to cure the cancer (which should cost around £7,000) or to slow the spread of advanced cancer (which costs up to £14,000).
Cetuximab is given through a drip into your vein, which slowly administers the first dose over the space of a few hours. After this, further doses are given on a weekly basis and should only take an hour.
The side effects of cetuximab are usually mild. They include:
- skin rashes
- feeling sick
- diarrhoea
- shortness of breath
- conjunctivitis (inflammation of the eyes)
Cetuximab has been known to trigger allergic reactions in some people, such as a swollen tongue or throat. Occasionally, an allergic reaction can be severe and life-threatening. This is known as an infusion reaction. Infusion reactions occur in around 1 in 30 people receiving cetuximab.
Most infusion reactions happen within 24 hours of the first time somebody begins treatment, so you will be closely monitored once your treatment begins. If you begin to have symptoms of an infusion reaction, anti-allergy medicines can be used to relieve them.
Owing to these precautionary measures, death from an infusion reaction in people taking cetuximab is very rare. It occurs in less than one in 1,000 cases.