Cancer of the oral cavity and cancer of the oropharynx are 2 of the most common types of cancer that develop in the head and neck region, a grouping called head and neck cancer. The oral cavity and oropharynx, along with other parts of the head and neck, give us the ability to chew, swallow, breathe, and talk.
The oral cavity includes the following:
- Lips
- lining of the lips and cheeks, called the buccal mucosa
- Upper and lower gums, called the gingiva
- Front two-thirds of the tongue
- Floor of the mouth under the tongue
- roof of the mouth, also called the hard palate
- Retromolar trigone, which is the small area behind the wisdom teeth
The oropharynx begins where the oral cavity stops. It includes the following:
- Soft palate at the back of the mouth
- Part of the throat behind the mouth
- Tonsils
- Base of the tongue
More than 90% of oral and oropharyngeal cancers are squamous cell carcinoma. This means that they begin in the flat, squamous cells found in the lining of the mouth and throat. The most common locations for cancer in the oral cavity are:
- Tongue
- Tonsils
- Oropharynx
- Gums
- Floor of the mouth
Although oral cancer and oropharyngeal cancer are commonly described using 1 phrase, it is important to identify exactly where the cancer began. This is because there can be differences in treatment between the 2 locations.
Oral and Oropharyngeal Cancer: Statistics
ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with oral or oropharyngeal cancers each year. You will also read general information on surviving these diseases. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.
Every person is different, with different factors influencing their risk of being diagnosed with these cancers and their chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have about the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.
How many people are diagnosed with oral and oropharyngeal cancer?
In 2023, an estimated 54,540 adults (39,290 men and 15,250 women) in the United States will be diagnosed with oral or oropharyngeal cancer. Worldwide, an estimated 476,125 people were diagnosed with oral or oropharyngeal cancer in 2020.
The rates of these 2 cancers are more than twice as high in men as in women. White people are slightly more likely to be diagnosed with them than black people. Together, oral and oropharyngeal cancers are the eighth most common cancer among men. The average age of diagnosis is 64. These types of cancer can be diagnosed at any age, with about 20% of cases occurring in people younger than 55.
From 2015 to 2019, oral and oropharyngeal cancers increased slightly (under 1%) per year (see Risk Factors and Prevention) in women and stayed steady in men. However, during the same years, oropharynx cancers related to human papillomavirus (HPV) infection rose by 1.3% in women and 2.8% in men. An estimated 50% of all oral cancers were diagnosed in the tongue or tonsils during 2015–2019, compared to 25% in the late 1970s.
It is estimated that 11,580 deaths (8,140 men and 3,440 women) from oral and oropharyngeal cancer will occur in the United States in 2023. After dropping for several decades, the death rate for these 2 diseases increased by slightly under half a percent each year from 2009 to 2020. This change was mainly due to a 2% increase in deaths during those years from oropharyngeal cancer related to HPV. In 2020, an estimated 225,900 people worldwide died from oropharyngeal cancer.
What is the survival rate for oral and oropharyngeal cancer?
It is important to remember that statistics on the survival rates for people with oral or oropharyngeal cancer are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.
The survival rates for oral and oropharyngeal cancer vary based on several factors. These include the stage and grade of cancer, a person’s age and general health, and how well the treatment plan works. Another factor that can affect outcomes is the original location.
The 5-year relative survival rate for oral or oropharyngeal cancer in the United States is 68%. The 5-year relative survival rate for Black people is 52%. For White people, it is 70%. Research shows that survival rates are higher in people who have HPV-associated cancer, which is more frequently diagnosed in White people (see Risk Factors and Prevention). However, a survival disparity still exists.
Experts measure relative survival rate statistics for oral and oropharyngeal cancer every 5 years. This means the estimate may not reflect the results of advancements in how oral and oropharyngeal cancer is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.
Statistics adapted from the American Cancer Society’s (ACS) publication, Cancer Facts & Figures 2023, the ACS website, the International Agency for Research on Cancer website, and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. (All sources accessed March 2023.)
The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by oral and oropharyngeal cancers. Use the menu to choose a different section to read in this guide.
Oral and Oropharyngeal Cancer: Risk Factors and Prevention
The risk of oral and oropharyngeal cancers is greatly increased by 2 factors:
- Tobacco use. Using tobacco, including cigarettes, cigars, pipes, chewing tobacco, and snuff, is the single largest risk factor for head and neck cancer. Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Pipe smoking in particular has been linked to cancer in the part of the lips that touches the pipe stem. Chewing tobacco or snuff is associated with a 50% increase in the risk of developing cancer in the cheeks, gums, and inner surface of the lips, where the tobacco has the most contact. Secondhand smoke may also increase a person’s risk of head and neck cancer.
- Alcohol. Frequent and heavy consumption of alcohol increases the risk of head and neck cancer. Using alcohol and tobacco together increases this risk even more.
Other factors that can raise a person’s risk of developing oral or oropharyngeal cancer include:
- Prolonged sun exposure. High exposure to the sun, without sun protection measures, is linked with cancer in the lip area.
- Human papillomavirus (HPV). Research shows that infection with the HPV virus is a risk factor for oropharyngeal cancer. In recent years, HPV-related oropharyngeal cancer in the tonsils and the base of the tongue has become more common. Sexual activity, including oral sex, with someone who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers.
It is likely that receiving an HPV vaccination before exposure to HPV can reduce the risk of oropharynx cancer (see below). - Gender. Men are more likely to develop oral and oropharyngeal cancers than women.
- Fair skin. Fair skin is linked to a higher risk of lip cancer.
- Age. People older than 45 have an increased risk for oral cancer, although this type of cancer can develop in people of any age.
- Poor oral hygiene. Lack of dental care and not following regular oral hygiene practices may cause an increased risk of oral cavity cancer. Poor dental health or ongoing irritation from poorly fitting dentures, especially in people who use alcohol and tobacco products, may contribute to an increased risk of oral and oropharyngeal cancers. Regular examinations by a dentist or dental hygienist can help detect oral cavity cancer and some oropharyngeal cancers at an early stage.
- Poor diet/nutrition. A diet low in fruits and vegetables and a vitamin A deficiency may increase the risk of oral and oropharyngeal cancer. Chewing betel nuts, a nut containing a mild stimulant that is popular in Asia, also raises a person’s risk of developing oral and oropharyngeal cancers.
- Weak immune system. People with a weakened immune system may have a higher risk of developing oral or oropharyngeal cancer.
- Marijuana use. Recent studies have suggested that people who have used marijuana may be at higher-than-average risk for head and neck cancer.
Prevention
Different factors cause different types of cancer. Researchers continue to look into what factors cause oral and oropharyngeal cancers, including ways to prevent them. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Several of the risk factors for oral and oropharyngeal cancers can be avoided by making healthy lifestyle choices.
Stopping the use of all tobacco products is the most important thing a person can do to reduce the risk of oral and oropharyngeal cancers, even for people who have been using tobacco for many years.
In the United States, the vaccine is approved for anyone between the ages of 9 and 45. The U.S. Centers for Disease Control (CDC) recommend HPV vaccination for everyone through the age of 26, if not already vaccinated. Some adults between the ages of 27 and 45 who have not already been vaccinated may decide to get it after reviewing their risks for infection and the benefits of the vaccine with their doctor. Even if you already have 1 type of HPV, the vaccine may protect you from types of HPV you do not have.
Another way to reduce your risk of HPV infection is to limit your number of sexual partners. Having many partners increases the risk of HPV infection. Using a condom does not fully protect you from HPV during sex.
Also, to reduce your risk of developing lip cancer, reduce your exposure to sunlight and other sources of ultraviolet (UV) radiation. Read more about protecting your skin from the sun.
Talk with your health care team if you have concerns about your personal risk of developing these types of cancer.
Screening information for oral and oropharyngeal cancers
Many of the symptoms of oral or oropharyngeal cancer can be caused by other, noncancerous health conditions. Therefore, it is important for people to receive regular health and dental care, especially those who routinely drink alcohol, currently use tobacco products, or have used tobacco products in the past.
Many dentists now perform oral and oropharyngeal cancer screening checks at regular dental appointments for everyone. If you currently use alcohol and tobacco or have used them in the past, you should receive a routine evaluation from their dentist and primary care doctor on a regular basis. This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination using 1 or more of the diagnostic procedures mentioned in the Diagnosis section.
Cancers of the oral cavity and oropharynx have a much better chance of being cured when they are caught early.
The next section in this guide is Symptoms and Signs. It explains what changes or medical problems oral or oropharyngeal cancer can cause. Use the menu to choose a different section to read in this guide.
Oral and Oropharyngeal Cancer: Symptoms and Signs
- The most common symptom is a sore in the mouth or on the lip that does not heal
- Red or white patch on the gums, tongue, tonsil, or lining of the mouth
- Lump on the lip, mouth, neck, or throat or a feeling of thickening in the cheek
- Persistent sore throat or feeling that something is caught in the throat
- Hoarseness or change in voice
- Numbness of the mouth or tongue
- Pain or bleeding in the mouth
- Difficulty chewing, swallowing, or moving the jaws or tongue
- Ear and/or jaw pain
- Chronic bad breath
- Changes in speech
- Loosening of teeth or toothache
- Dentures that no longer fit
- Unexplained weight loss
- Fatigue
- During later stages of the disease, people may experience a loss of appetite
If you are concerned about any changes you experience, please talk with your doctor and/or dentist as soon as possible. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.
If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. Managing symptoms may also be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.
Oral and Oropharyngeal Cancer: Diagnosis
For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.
How oral or oropharyngeal cancer is diagnosed?
There are many tests used for diagnosing oral or oropharyngeal cancer. Not all the tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:
- The type of cancer suspected
- Your signs and symptoms
- Your age and general health
- The results of earlier medical tests
The following tests may be used to diagnose oral or oropharyngeal cancer:
- Physical examination. Dentists and doctors often find lip and oral cavity cancers during routine checkups. If a person shows signs of oral or oropharyngeal cancer, the doctor will take a complete medical history, asking about the patient’s symptoms and risk factors. The doctor will feel for any lumps on the neck, lips, gums, and cheeks. Because people with oral or oropharyngeal cancer have a higher risk of other cancers elsewhere in the head and neck region, the doctor will examine the area behind the nose, the larynx (voice box), and the lymph nodes of the neck.
- Endoscopy. An endoscopy allows the doctor to see inside the mouth and throat. Typically, a thin, flexible tube with an attached light and view lens, called an endoscope, is inserted through the nose to examine the head and neck areas. Sometimes, a rigid endoscope, which is a hollow tube with a light and view lens, is placed into the back of the mouth to see the back of the throat in more detail.
Endoscopic examinations have different names depending on the area of the body that is examined, such as laryngoscopy to view the larynx, phonoscope to view the pharynx, or nasopharyngoscopy to view the nasopharynx. To make the patient more comfortable, these examinations are performed using an anesthetic spray to numb the area. If an area looks suspicious, the doctor will take a biopsy (see below). Tests are often done in the doctor’s office. However, sometimes an endoscopy must be performed in an operating room at a hospital using general anesthesia, which blocks the awareness of pain. - Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer. During a fine needle aspiration biopsy, cells are removed using a thin needle inserted directly into the suspicious area. A pathologist then analyzes the cells. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.
- Oral brush biopsy. During routine dental examinations, some dentists are using a newer, simpler technique to detect oral cancer, in which the dentist uses a small brush to gather cell samples of a suspicious area. The specimen is then sent to a laboratory for analysis. This procedure can be done in the dentist’s chair with very little or no pain. If cancer is found using this method, a traditional biopsy is recommended to confirm the results.
- HPV testing. HPV testing may be done on a sample of the tumor removed during the biopsy. As described in Risk Factors and Prevention, HPV has been linked to a higher risk of oropharyngeal cancer. Knowing if a person has HPV can help determine the cancer’s stage and the treatment options that are likely to be most effective. ASCO recommends that HPV testing be done for all patients newly diagnosed with oropharyngeal squamous cell carcinoma. This is a type of oropharyngeal cancer that starts in flat, scale-like cells called squamous cells. Testing is not usually recommended for oropharyngeal cancer that starts in other types of cells or for other types of head and neck cancer. Learn more details about recommendations for HPV testing on a separate ASCO website.
- X-ray. An x-ray is a way to create a picture of the structures inside the body using a small amount of radiation. X-rays may be recommended by your dentist or doctor to look for abnormal findings in the mouth or neck.
- Barium swallow/modified barium swallow. There are 2 barium swallow tests that are generally used to look at the oropharynx and to check a patient’s swallowing. The first is a traditional barium swallow. During an x-ray exam, the patient is asked to swallow liquid barium. This lets the doctor look for any changes in the structure of the oral cavity and throat and see whether the liquid passes easily to the stomach. A modified barium swallow, or video fluoroscopy, may be used to evaluate difficulties with swallowing.
- Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size, help the doctor decide whether the tumor can be surgically removed, and show whether the cancer has spread to lymph nodes in the neck or lower jawbone. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.
- Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue such as the tonsils and the base of the tongue. An MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.
- Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This test can detect the spread of cancer to the lymph nodes in the neck, which doctors also call the “cervical lymph nodes.”
- Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.
After the diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.
How oral and oropharyngeal cancers are treated
In many cases, a team of doctors will work together with the patient to create the best treatment plan. Head and neck cancer specialists often form a multidisciplinary team to care for each patient. This team may include:
- Medical oncologist: A doctor who treats cancer using chemotherapy or other medications, such as targeted therapy and immunotherapy.
- Radiation oncologist: A doctor who specializes in treating cancer using radiation therapy.
- Surgical oncologist: A doctor who treats cancer using surgery.
- Otolaryngologist: A doctor who specializes in the ear, nose, and throat.
- Reconstructive/plastic surgeon: A doctor who specializes in reconstructive surgery, which is done to help repair damage caused by cancer treatment.
- Maxillofacial prosthodontist: a specialist who performs restorative surgery in the head and neck areas.
- Oncologic dentists, or oral oncologists, are dentists experienced in caring for people with head and neck cancer.
- Prosthodontist: A dental specialist with expertise in the restoration and replacement of broken teeth with crowns, bridges, or dentures.
- A physical therapist is a health care professional who helps patients improve their physical strength and ability to move.
- Speech-language pathologist: a health care professional who specializes in communication and swallowing disorders. A speech-language pathologist helps patients regain their speaking, swallowing, and oral motor skills after cancer treatment that affects the head, mouth, and neck.
- Audiologist: A health care professional who treats and manages hearing problems that may be caused by the tumor itself or the cancer treatment.
- Psychologist/psychiatrist: These mental health professionals address the emotional, psychological, and behavioral needs of the person with cancer and those of their family.
Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others. It is extremely important for the team to create a comprehensive treatment plan before treatment begins. People may need to be seen by several specialists before a treatment plan is fully developed.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. One of these therapies, or a combination of them, may be used.
Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for oral and oropharyngeal cancers because there are different treatment options. Learn more about making treatment decisions.
There are 3 main treatment options for oral and oropharyngeal cancer: surgery, radiation therapy, and therapies using medication. These types of treatment are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
- Surgery
- Radiation Therapy
- Chemotherapy
- Immunotherapy
- Targeted Therapy
- Physical, emotional, and social effects of cancer
- Metastatic cancer
- Remission and the chance of recurrence
- If treatment does not work
Surgery
Surgery is the removal of the tumor and some surrounding healthy tissue, known as a margin, during an operation. An important goal of the surgery is the complete removal of the tumor with “negative margins.” Negative margins mean that there is no trace of cancer in the margin’s healthy tissue. Surgeons are often able to tell in the operating room if all of the tumor has been removed.
Sometimes surgery is followed by radiation therapy, therapies using medication, or both. Depending on the location, stage, grade, and other features of the cancer, some people may need more than 1 operation to remove the cancer and help restore the appearance and function of the affected tissues.
The most common surgical procedures for the removal of oral or oropharyngeal cancer include:
- Primary tumor surgery. The tumor and a margin of healthy tissue around it are removed to decrease the chance that any cancerous cells will be left behind. The tumor may be removed through the mouth or through an incision in the neck. A mandibulotomy, in which the jawbone is split to allow the surgeon to reach the tumor, may also be required.
- Glossectomy. This is the partial or total removal of the tongue.
- Mandibulectomy. If the tumor has entered a jawbone but not spread into the bone, then a piece of the jawbone or the whole jawbone will be removed. If there is evidence of destruction of the jawbone on an x-ray, then the entire bone may need to be removed.
- Maxillectomy. This surgery removes part or all of the hard palate, which is the bony roof of the mouth. Prostheses (an artificial replacement), or more recently, the use of flaps of soft tissue with and without bone, can be placed to fill gaps created during this operation.
- Neck dissection. Cancer of the oral cavity, or oropharynx, often spreads to lymph nodes in the neck. Preventing the cancer from spreading to the lymph nodes is an important goal of treatment. It may be necessary to remove some or all of these lymph nodes using a surgical procedure called a neck dissection, even if the lymph nodes show no evidence of cancer when examined (see Stages and Grades). A neck dissection may be followed by radiation therapy or a combination of chemotherapy and radiation therapy, called chemoradiation, to make sure there is no cancer remaining in the lymph nodes. Sometimes, for oropharyngeal cancer, a neck dissection will be recommended after radiation therapy or chemoradiation. If a neck dissection is not possible, radiation therapy may be used instead. See “radiation therapy” below for more details on this type of treatment.
- Laryngectomy. A laryngectomy is the complete or partial removal of the larynx or voice box. Although the larynx is important for producing sounds, the larynx is also critical to swallowing because it protects the airway from food and liquid entering the trachea or windpipe and reaching the lungs, which can cause pneumonia. A laryngectomy is rarely needed to treat oral or oropharyngeal cancer. However, when there is a large tumor of the tongue or oropharynx, the doctor may need to remove the larynx to protect the airway during swallowing. If the larynx is removed, the windpipe is reattached to the skin of the neck, where a hole, called a stoma or tracheostomy, is made (see below). Rehabilitation will be needed to learn a new way of speaking (see Follow-up Care).
- Transoral robotic surgery and transoral laser microsurgery. Transoral robotic surgery (TORS) and transoral laser microsurgery (TLM) are minimally invasive surgical procedures. This means that they do not require large cuts to get to and remove a tumor. In TORS, an endoscope is used to see a tumor in the throat, the base of the tongue, and the tonsils. Then 2 small robotic instruments act as the surgeon’s arms to remove the tumor. In TLM, an endoscope connected to a laser is inserted through the mouth. The laser is then used to remove the tumor. A laser is a narrow beam of high-intensity light.
Other types of surgery may also be needed, including:
- Micrographic surgery. This type of surgery is frequently used to treat skin cancer and can sometimes be used for oral cavity tumors. It can reduce the amount of healthy tissue removed. This technique is often used with cancer of the lip. It involves removing the visible tumor in addition to small fragments of tissue surrounding the tumor. Each small fragment is examined under a microscope until all of the cancer has been removed.
- Tracheostomy. If cancer is blocking the airway or is too large to completely remove, a hole is made in the neck. This hole is called a tracheostomy. A tracheostomy tube is then placed, and a person breathes through this tube. A tracheostomy can be temporary or permanent.
- Gastrostomy tube. If cancer prevents a person from swallowing, a feeding device called a gastrostomy tube is placed. The tube goes through the skin and muscles of the abdomen and directly into the stomach. These tubes may be used as a temporary method for maintaining nutrition until the person can safely and adequately swallow food taken in through the mouth. For swallowing problems that are temporary, a nasogastric (NG) tube may be used instead of a tube into the stomach. An NG tube is inserted through the nose, down the esophagus, and into the stomach.
- Reconstruction. If treatment requires removing large areas of tissue, reconstructive surgery may be necessary to help the patient swallow and speak again. Healthy bone or tissue may be taken from other parts of the body to fill gaps left by the tumor or replace part of the lip, tongue, palate, or jaw. A prosthodontist may be able to make an artificial dental or facial part to help with swallowing and speech. A speech-language pathologist can teach the patient to communicate using new techniques or special equipment and can also help restore the ability to swallow in patients who have difficulty eating after surgery or after radiation therapy. Learn more about the basics of reconstructive surgery.
In general, surgery for oral and oropharyngeal cancer often causes swelling, making it difficult to breathe. It may cause permanent loss of voice or impaired speech; difficulty chewing, swallowing, or talking; numbness of the ear; weakness raising the arms above the head; lack of movement in the lower lip; and changes to your facial appearance. Surgery can affect the function of the thyroid gland, especially after a total laryngectomy or radiation therapy in the area. Talk with your surgeon about the possible side effects of your specific surgery in advance and how they will be managed or relieved.
It is important that a person receive the opinion of different members of the multidisciplinary team before deciding on a specific treatment. Even though surgery is the fastest way to remove cancer, other treatment methods exist and may be equally effective in treating the cancer. You are encouraged to ask about all of the treatment options before deciding on a treatment plan.
Talk with your health care team before surgery, so you know what to expect and how your side effects will be managed. Learn more about the basics of cancer surgery.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
- External-beam radiation therapy. This is the most common type of radiation treatment for oral or oropharyngeal cancer. During external-beam radiation therapy, a radiation beam produced by a machine outside the body is aimed at the tumor. This is generally done as an outpatient procedure, meaning the patient comes into the center for treatment and then returns home after each session.
Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Another method of external-beam radiation therapy, known as intensity modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered to the tumor while reducing damage to healthy cells. - Internal radiation therapy. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Tiny pellets or rods containing radioactive materials are surgically implanted in or near the cancer site. The implant is left in place for several days while the person stays in the hospital.
Radiation therapy may be the main treatment for oral cavity cancer, or it can be used after surgery to destroy small areas of cancer that could not be removed. Radiation therapy can also be used to treat the lymph nodes. Combining radiation therapy with cisplatin (a chemotherapy drug; see below) may be used for this purpose in some cases. This approach is called chemoradiation.
Before beginning radiation treatment for any head and neck cancer, people should receive a thorough examination from a dentist with experience treating people with head and neck cancer. Since radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented by proper treatment from a dentist before beginning treatment. Learn more about dental and oral health.
It is also important that people receive counseling and evaluation from an oncologic speech-language pathologist. This is a speech-language pathologist who has experience treating people with head and neck cancer. Because radiation therapy can damage healthy tissue, people often have difficulty speaking and/or swallowing after radiation therapy. These problems may occur long after radiation therapy is completed. Speech-language pathologists can provide exercises and techniques to prevent long-term speech and swallowing problems.
Hearing problems may affect patients who receive radiation therapy for the head due to nerve damage or the buildup of fluid in the middle ear. Earwax may also dry out and build up because of the radiation therapy’s effect on the ear canal. Sometimes, a patient’s hearing ability may need to be evaluated by a hearing specialist, known as an audiologist.
Radiation therapy may also cause a thyroid problem called hypothyroidism. In this condition, the thyroid gland slows down, causing the patient to feel tired and sluggish. Every patient who receives radiation therapy to the neck area should have their thyroid function checked regularly.
Other side effects from radiation therapy to the head and neck may include redness or skin irritation to the treated area, dry mouth or thickened saliva from damage to salivary glands (which can be temporary or permanent), temporary swelling (called edema) or long-term swelling (called lymphedema), bone pain, nausea, fatigue, mouth sores, sore throat, difficulty opening the mouth, and a loss of appetite due to a change in a person’s sense of taste. Talk with your doctor about possible side effects that you can expect and ways to manage them.
Learn more about the basics of radiation therapy.
Therapies using medication
The treatment plan may include medications used to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.
This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed orally. If you are given oral medications, be sure to ask your health care team about how to safely store and handle them.
The types of medications used for oral and oropharyngeal cancer include:
- Chemotherapy
- Immunotherapy
- Targeted therapy
Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.
It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.
Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.
Some people may receive chemotherapy in their doctor’s office or an outpatient clinic. Others may go to the hospital.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.
The use of chemotherapy in combination with radiation therapy, called chemoradiation, is often recommended. The combination of these 2 treatments can sometimes control tumor growth, and it is often more effective than giving either of these treatments alone. This combined treatment, using cisplatin, may be an option for oral or oropharyngeal cancer that may have spread to the lymph nodes. Sometimes, chemoradiation for oropharyngeal cancer will be followed by neck dissection (see “Surgery” above). However, the side effects can be worse when combining these treatments.
Chemotherapy may be used as the initial treatment before surgery, radiation therapy, or both, which is called neoadjuvant chemotherapy. Or it can be given after surgery, radiation therapy, or both, which is called adjuvant chemotherapy. Chemotherapy for oral cavity cancer is most often given as part of a clinical trial.
Each drug or combination of drugs can cause specific side effects. While some can be permanent, most are temporary and can typically be well controlled. In general, chemotherapy may cause fatigue, nausea, vomiting, hair loss, dry mouth, hearing loss, loss of appetite (often due to a change in sense of taste), difficulty eating food, a weakened immune system, diarrhea, constipation, and open sores in the mouth that can lead to infection. Your health care team will help you understand what to expect with your prescriptions and how side effects can be managed.
Learn more about the basics of chemotherapy.
Immunotherapy
Immunotherapy uses the body’s natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells.
Pembrolizumab (Keytruda) and nivolumab (Opdivo) are 2 immunotherapy drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of people with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) that has not been stopped by platinum-based chemotherapy (see below for information on recurrent cancer and metastatic cancer). Both are immune checkpoint inhibitors that are also approved for the treatment of some people with advanced cancers of other kinds.
Immunotherapy, in combination with chemotherapy and radiation therapy, may also be used in clinical trials.
Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.
Targeted therapy
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.
Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them.
Currently, antibodies directed against a cellular receptor called the epidermal growth factor receptor (EGFR) are being used in combination with radiation therapy for head and neck cancers. Cetuximab (Erbitux) is a targeted therapy approved by the FDA for this use in combination with radiation therapy.
Talk with your doctor about the possible side effects of the specific treatment you will be receiving and how they can be managed.
Learn more about the basics of targeted treatments.
Physical, emotional, and social effects of cancer
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age, type, or stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.
During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
Metastatic cancer
If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.
Your treatment plan may include a combination of surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy. Palliative care will also be important to help relieve symptoms and side effects.
For most people, a diagnosis of metastatic oral or oropharyngeal cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.
Remission and the chance of recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).
If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often, the treatment plan will include the treatments described above, such as surgery, medications, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent oral and oropharyngeal cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.
If treatment does not work,
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are nearing the end of their lives. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
