Most mouth or oral cancers are squamous cell carcinomas, according to the National Institutes of Health, NIH. The treatment of mouth cancers should be a well coordinated team endeavor, says the National Cancer Society, NCI, because of the many functions affected by the cancer and the side effects of treatment. The mouth is used for feeding, talking and breathing. Thus, many experts should be involved, according to the American Society of Clinical Oncology. Actual treatment plans will depend on the size, position and extent of spread of the cancer.
Surgery
The American Cancer Society, ACS, says surgery is the treatment of choice in mouth cancers. There are several surgery options. For small growths, local excision, involving removal of the growth with a margin of normal tissue is recommended. Access to the tumor may involve cutting through facial bones. Small superficial growths on the lips are treated with Mohs or micrographic surgery. Extension to the lymph nodes necessitates lymph node dissection.
Tumors that have grown into the bones around the mouth like the mandible or the maxilla, require resection of the involved bone--maxillectomy or mandibullar resection. Defects in the face after surgery are repaired by plastic surgery involving skin flaps or grafts and prosthesis, or artificial replacements.
More advanced or inoperable cancers may block major pathways for food or air. If there is obstruction of the food passage, an alternative path way is created by way of a gastrostomy. A blocked air passage is bypassed by a tracheostomy.
Radiation Therapy
Radiation therapy is used in a number of cases of mouth cancer. According to the ACS, in small cancers, perhaps in hard-to-reach areas, it can be employed alone to kill the cancer cells or stop them from growing. In larger cancers, it can be given as an adjunct treatment following surgery or combined with chemotherapy or targeted therapy. In more advanced or end stage cancers, it can be used to relieve pain and discomfort from metastases as a palliative treatment.
There are two approaches to radiation therapy. External sources of radiation are applied in external beam radiation therapy, EBRT. Other forms of external radiation include 3-dimensional conformal radiation therapy, 3D-CRT and intensity modulated radiation therapy, IMRT. Internal radiation, also called brachytherapy, employs internal sources of radiation. The two types of brachytherapy are high dose rate brachytherapy, HDR, and low dose rate brachytherapy, LDR.
Chemotherapy
Chemotherapy is usually not effective alone in mouth cancers, according to the ACS. It is combined with radiation therapy in some cases. It can also be applied before surgery to shrink the tumors and improve outcome. It can also be given after surgery to mop up any left-over cancer spots.
The drugs used in chemotherapy are designed to kill the cancer cells or stop them from growing. The drugs are typically used in combinations for better effectiveness. One such combination mentioned by the ACS is cisplatin and 5-flourouracil, 5-FU with or without docetaxel. Other drugs used in mouth cancers are carboplatin, paclitaxel, methotrexate, bleomycin and ifosfamide.
Targeted Therapy
Targeted therapy involves the use of drugs specially designed to target structures and attributes specific to cancerous cells in other to destroy the cancer. One such drug mentioned by the Mayo clinic is cetuximab. It can be used in patients no longer responding to chemotherapy or in combination with chemotherapy or radiation therapy.
Other Treatments
Pain killers, like opioid drugs, multivitamins and food supplements, are all used to improve the quality of life of the patients and treat the side effects of other modes of treatment.
