Cancer of the mouth and throat: Treatment
After you have been evaluated by the surgeon or oncologist treating your cancer, you will have ample opportunity to ask questions and discuss which treatments are available to you.
- Your doctor will explain each type of treatment, give you the pros and cons, and make recommendations
- Treatment for mouth and throat cancer depends on the type of cancer and whether it has affected other parts of the body. Factors such as your age, your overall health, and whether you have already been treated for the cancer before are included in the treatment decision-making process.
- The decision of which treatment to pursue is made with your specialist (with input from other members of your healthcare team) and your family members, but ultimately, the decision is yours.
- Be certain you understand exactly what will be done and why, and what you can expect from your choices. With oral cancers, it is especially important to understand the side effects of treatment.
Like many cancers, mouth and throat cancer is treated on the basis of cancer stage. The most widely used therapies are surgery and radiotherapy. Chemotherapy is used in some advanced cases. Your treatment plan will be customised for your specific situation.
- Your medical team may include an ear, nose and throat (ENT) surgeon; an oral surgeon; a plastic surgeon; and a specialist in prosthetics of the mouth and jaw (prosthodontist), as well as a specialist in radiotherapy and oncology.
- Because cancer treatment can make your mouth sensitive and more likely to be infected, your doctor will probably advise you to have any needed dental work done before your treatment.
- Your team will also include a dietician to ensure that you get adequate nutrition during and after your therapy.
- A speech therapist may be needed to help you recover your speech or swallowing abilities after treatment.
- A physiotherapist may be needed to help you recover function compromised by loss of muscle or nerve activity from the surgery.
- A social worker, counsellor or member of the clergy will be available to help you and your family cope with the emotional, social and financial toll of your treatment.
Your treatment falls into two categories: treatment to fight the cancer and treatment to relieve the symptoms of the disease and the side effects of the treatment (supportive care).
Surgery is the treatment of choice for early stage cancers and many later stage cancers. The tumour is removed, along with surrounding tissues, including - but not limited to - the lymph nodes, blood vessels, nerves and muscles that are affected. For more information, see Surgery.
Radiotherapy involves the use of a high-energy beam to kill cancer cells.
- Radiotherapy can be used instead of surgery for many stage I and II cancers, because surgery and radiotherapy have equivalent survival rates in these tumours. In stage II cancers, tumour location determines the best treatment. The treatment that will have the fewest side effects is usually chosen.
- Stage III and IV cancers are most often treated with both surgery and radiotherapy. The radiotherapy is typically given after surgery. Radiotherapy after surgery kills any remaining cancer cells.
- External radiotherapy is given by precisely targeting a beam at the tumour. The beam goes through the healthy skin and overlying tissues to reach the tumour. These treatments are given at the hospital or clinic. Treatments are usually given once a day, 5 days a week, for about 6 weeks. Each treatment takes only a few minutes. Giving radiotherapy this way keeps the doses small and helps protect healthy tissues. Some clinics are experimenting with giving radiotherapy twice a day to see if it increases survival rates.
- Unfortunately, radiotherapy affects healthy cells as well as cancer cells. Damage to healthy cells accounts for the side effects of radiotherapy. These include sore throat, dry mouth, cracked and peeling lips, and a sunburn-like effect on the skin. It can cause problems with eating, swallowing and speaking. You may also feel very tired during, and for some time after, these treatments. External beam radiotherapy can also affect the thyroid gland in the neck, causing your level of thyroid hormone to be low. This can be treated.
- Internal radiotherapy (brachytherapy) can avoid these side effects in some cases. This involves implanting tiny radioactive ‘seeds’ directly into the tumour or in the surrounding tissue. The seeds emit radiation that destroys tumour cells. This treatment takes several days, and you will have to stay in the hospital during the treatment.