Treatment Options for Oral Cavity Cancer by Stage

Treatment for oral cavity cancer is based largely on the stage (extent) of the cancer, but other factors can also be important.

Most experts agree that treatment in a clinical trial should be considered for any cancer in the head and neck area. This way, people might have the chance of getting new treatments that may be better than standard ones.

Stage 0 (carcinoma in situ) oral cavity cancer

Although cancer in this stage is on the surface layer and has not started to grow into deeper layers of tissue, it can do so if not treated. The usual treatment is surgery (usually Mohs surgery, surgical stripping, or thin resection) to remove the top layers of tissue along with a small margin (edge) of normal tissue. Follow-up is important to watch for any signs that the cancer has come back. Carcinoma in situ that keeps coming back after surgery may also need to be treated with radiation therapy.

Nearly all people with this stage survive a long time without the need for more treatment. Still, it's important to note that continuing to smoke increases the risk that a new cancer will develop. If you're thinking about quitting smoking and need help, talk to your doctor, or call the American Cancer Society at 1-800-227-2345 for information and support.

Stages I and II oral cavity cancer

Most patients with stage I or II oral cavity cancers do well when treated with surgery and/or radiation therapy. Chemotherapy (chemo) given along with radiation (called chemoradiation) is another option. Both surgery and radiation work equally well in treating these cancers. The choice depends on your preferences and the expected side effects, including how the treatment might affect how you look and how you swallow and speak.

Lip

Surgery is preferred for small cancers that can be removed. Radiation alone may also be used as the first treatment.

Large or deep cancers often require surgery. If needed, reconstructive surgery can help correct the defect in the lip.

If the tumor is thick, it increases the possibility that the cancer might have spread to lymph nodes in the neck. If abnormal lymph nodes are felt or seen on an imaging test,  the surgeon might remove them (called lymph node dissection) so they can be checked for cancer spread.

Oral cavity

For cancers of the floor of the mouth, front of the tongue, inside of the cheek, gums, and hard palate, surgery is the main treatment. Lymph nodes in the neck might be removed (called lymph node dissection) to check them for cancer spread. If it looks like surgery hasn't completely removed the cancer or if there is a high chance of it coming back, radiation alone or chemoradiation might be added.

Radiation can be used instead of surgery as the main treatment for some people. This is most often done for people who can’t have surgery because of other medical problems.

Stages III and IVA oral cavity cancer

These cancers in the floor of the mouth, front of the tongue, inside of the cheek, gums, and hard palate include bigger cancers, those that have grown into nearby tissues, and/or those that have spread to nearby lymph nodes in the neck. Surgery is usually done first and includes taking out some of the neck lymph nodes (lymph node dissection). Surgery is most often followed by radiation alone or chemoradiation. 

Stages IVB and IVC oral cavity cancer

Stage IVB cancers have already spread into nearby tissues, structures, and maybe lymph nodes. Stage IVC cancers have spread to other parts of the body, such as the lungs.

People with stage IVB cancers that cannot be removed by surgery or who are too weak for surgery might be treated with radiation alone. Depending on a person’s overall health, chemoradiation or chemotherapy first followed by radiation might be options. Chemotherapy alone may also be recommended.

Stage IVC cancers are usually treated with chemo, cetuximab, or both. Immunotherapy, alone or with chemo, might be another option. Treatments such as radiation can also be used to help relieve symptoms from the cancer or to help prevent new problems.

Recurrent oral cavity cancer

When cancer comes backs after treatment, it's called recurrent cancer. It can come back in or near the same place the cancer first started (local), in nearby lymph nodes (regional), or it can spread to other organs such as the lungs or bone (distant). Treatment options for recurrent cancers depend on the location and size of the cancer, what treatments have already been used, and the person’s general health. Because these cancers can be hard to treat, clinical trials of newer treatments may be a good option for some people.

If the cancer comes back in the same area and radiation therapy was used as the first treatment, surgery is often the next treatment, if the cancer can be removed completely and the patient is healthy enough for surgery. Usually, external beam radiation therapy cannot be repeated in the same site except in certain cases. But internal radiation (brachytherapy) can often be used to control the cancer if it has come back in the place it started. If surgery was used first, more surgery, radiation therapy, chemo, cetuximab, immunotherapy, or a combination of these may be options.

If the cancer comes back in the lymph nodes in the neck, the nodes are often removed with surgery (lymph node dissection). This may be followed by radiation or chemoradiation.

If the cancer comes back in a distant area, chemo (and/or cetuximab) is often used. Immunotherapy with or without chemo might be an option as well. These treatments may shrink or slow the growth of some cancers for a while and help relieve symptoms, but these cancers are very hard to cure.

If further treatment is recommended, it’s important to talk to your doctor so that you understand what the goal of treatment is — whether it's to try to cure the cancer or to keep it under control for as long as possible and to relieve symptoms. This can help you weigh the risks and benefits of each treatment.