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The mouth and oropharynx help us breathe, talk, eat, chew and swallow. The medical term for the mouth is the oral cavity. Mouth cancer includes cancer that starts anywhere in the oral cavity. In other words, the
Lips Front two thirds of the tongue Upper and lower gums, (the gingiva) Inside lining of the cheeks and lips (the buccal mucosa) Floor of the mouth, under the tongue Roof of the mouth (the hard palate) Area behind the wisdom teeth (called the retromolar trigone)
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The oropharynx
Pharynx is the medical name for the throat. The pharynx is divided into 3 parts, and the oropharynx is one of these parts. The other two parts are the nasopharynx and the laryngopharynx. The oropharynx connects the mouth to the top of the throat. It is the part of the throat just behind the mouth. Cancers that start in this area are called oropharyngeal cancers. Oropharynx is pronounced oar-oh-fah-rinks. Oropharyngeal is pronounced oar-oh-fah-rin-jee-al.
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There are major groups of lymph nodes in the neck. Mouth and oropharyngeal cancers can spread to these lymph nodes. So people with these types of cancer often need an operation to remove lymph nodes from the same side of the neck as the cancer. More rarely, a surgeon may suggest removing nodes from both sides. These operations are called neck dissections. There is information about the lymph glands and the lymphatic system in the about your body section. Cancer that begins in the lymph nodes (rather than spreading to them) is called lymphoma. If you are looking for information about lymphoma, this is not the right section for you. You need to go to thenon Hodgkin lymphoma or Hodgkin lymphoma section.
Some people have worried that long term irritation to the lining of the mouth can cause mouth cancer. For example, dentures that do not fit properly could cause irritation. But most research studies have not found a link. Even so, you should have dentures checked by your dentist at least once every 5 years. It is also important to clean and rinse them twice a day and take them out at night. This helps to prevent substances known to cause mouth cancer, such as tobacco and alcohol, staying trapped under your dentures.
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Mouth cleanliness
Studies show that people who brush their teeth only once a day or less, compared to two or more times a day, and people who go to the dentist rarely, have a slightly increased risk of oral cancer.
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Mouthwash
Some studies have suggested that mouthwashes with a high alcohol content could increase the risk of mouth cancer. But other studies have found that this is not the case. An overview of studies in 2012 found that mouthwashes do not increase the risk of mouth or oropharyngeal cancer
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Difficulty in swallowing
Mouth cancer can cause pain or a burning sensation when chewing and swallowing food. Or you may feel that your food is sticking in your throat. Difficulty swallowing can also be caused by other conditions such as a harmless narrowing of the food pipe (oesophagus). If you have this symptom it is important to see your doctor and get some treatment.
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Speech problems
Cancer in your mouth or throat can affect your voice. Your voice may sound different. It may be quieter, husky, or sound as if you have a cold all the time. Or you may slur some of your words or have trouble pronouncing some sounds.
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Weight loss
Weight loss is a common symptom of many cancers. With mouth or oropharyngeal cancer you may eat less due to mouth pain or because it is difficult for you to swallow. Extreme weight loss may be a sign of advanced cancer. See your doctor if you have lost 10lbs or more in a short time and you are not dieting.
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Other symptoms
Other symptoms of mouth cancer might include one or more of the following
A lump or thickening on the lip A lump in the mouth or throat Unusual bleeding or numbness in the mouth Loose teeth for no apparent reason
This page is about the current situation in the UK regarding screening for mouth and oropharyngeal cancer. There is information about
A quick guide to what's on this page Cancer screening The current situation for mouth and oropharyngeal cancer What you can do
Cancer screening
Screening means testing people for early signs of cancer before they have any symptoms. To be able to carry out screening, doctors need to have an effective and accurate screening test. The test must be reliable at picking up cancers that are there. And it must not give false positive results in people who do not have cancer.
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cancer Many dentists routinely check for mouth or oropharyngeal cancer. So they are often the first to spot these cancers in their patients. You need to report any changes that you or your dentist find to your GP. This is especially important if you smoke and drink heavily. There are UK guidelines for GPs that advise them when they need to refer people to a specialist in mouth cancer.
This page has information about the different types of mouth and oropharyngeal cancer. You can find information about
A quick guide to what's on this page Mouth and oropharyngeal cells Squamous cell cancers of the mouth and oropharynx Other types of mouth and oropharyngeal cancer Non cancerous growths in the mouth and oropharynx Precancerous conditions Grade of mouth and oropharyngeal cancers
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Lymphoma
Lymphomas are cancers that develop from cells in the lymph nodes. The base of the tongue and tonsils are made up of lymph tissue that can develop into cancer. There are also many lymph nodes in the neck. Painless swelling of a lymph node is the most common symptom of lymphoma. If you are looking for information about lymphoma, you need to go to the lymphoma section. Your treatment will be very different to treatment for mouth and oropharyngeal cancer.
Melanoma
Melanomas develop from the pigment producing cells that give the skin its colour. Melanomas of the head and neck can occur anywhere on the skin or inside the nose or mouth (oral cavity). If you have a melanoma of the mouth or lip, some of the information in this section will be helpful, for example in the radiotherapy or surgery sections. But there is also a section about melanoma that you may like to look at.
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A growth or tumour is not always a cancer. Non cancerous growths are called benign. The main difference is that a cancer can spread, while a benign tumour doesn't. Some mouth and oropharynx tumours are not cancerous (benign) and so don't spread to other parts of the body. There is information about the differences between cancer cells and normal cells in our section about cancer.
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Precancerous conditions
Two different medical conditions can cause abnormal areas in the mouth or throat. They are harmless to begin with but if left untreated can turn into a cancer in a small number of people. Doctors call these conditions precancerous. They are
Leukoplakia and Erythroplakia
Leukoplakia causes white patches in the mouth. Erythroplakia is a slightly raised red area in the mouth that bleeds easily. These white or red patches may be harmless. But they can be precancerous and contain abnormal cells. If not treated, these cells could go on to develop into a cancer. Doctors call these abnormal cells dysplasia (pronounced dis-play-zee-a). Your doctor will need to take a sample of these cells. This is the only way to find out exactly what the patches are. The tissue sample is called a biopsy. Your doctor will send the biopsy to a lab, where a specialist checks for abnormal cells by examining the sample under a microscope. If left untreated, precancerous changes may go on to develop into a cancer years later. Only about 5 out of every 100 people (5%) diagnosed with leukoplakia have either cancerous or precancerous changes. But about half (50%) of the red erythroplakia lesions can become cancerous. If you have dysplasia, there is a risk that you may go on to develop mouth cancer. But if your doctor removes the dysplasia, your risk of mouth cancer usually disappears. The most common causes of erythroplakia and leukoplakia are smoking or chewing tobacco. Or you may develop it because you have badly fitting dentures that are always rubbing on your gums, the inside of your cheeks or your tongue. So it is important that you get regular dental check ups if you have dentures. The usual treatment for leukoplakia is getting rid of the source of irritation. For most people, stopping smoking or correcting dental problems clears the condition. If that doesnt work, or if the lesions show early signs of cancer, your doctor may choose to remove the patches using a laser or scalpel. Researchers are trying a group of drugs called retinoids on leukoplakia. Retinoids are made from vitamin A. They are used to treat severe acne and other skin conditions. Although retinoids seem to help to treat leukoplakia, they can cause serious side effects.
Beta carotene is an antioxidant that is converted to vitamin A in your body. It may also completely or partially reduce leukoplakia patches. This type of treatment is still experimental and it is not generally prescribed on the NHS. If you develop either of these conditions and you smoke, there is a greater risk that they will come back. Your doctor will strongly advise you to give up smoking.
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This page tells you about tests to diagnose mouth and oropharyngeal cancers. You can find information about
A quick guide to what's on this page Seeing your GP At the hospital Biopsy Scalpel biopsy Nasoendoscopy Fine needle aspiration Panendoscopy Getting the results
Seeing your GP
If you are worried about symptoms that could be due to mouth or oropharyngeal cancer, you usually begin by seeing your GP. Your doctor will examine you and ask about your general health and about your symptoms. They will ask when you get the symptoms and whether anything you do makes them better or worse. Your doctor will examine your mouth and throat. They may also feel the lymph nodes (glands) in your neck and under your arms. After examining you, your doctor may refer you to hospital for tests and X-rays or directly to a specialist. The specialist is usually a head and neck surgeon.
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At the hospital
If you see a specialist, they will ask you about your medical history and symptoms. They will then examine you and may look at the back of your throat using a small mirror that they put into your mouth. This is called indirect laryngoscopy. You may have blood tests and a chest X-ray to check your general health. Then your specialist will arrange for you to have tests in the outpatient department. You may have a biopsy, nasoendoscopy,fine needle aspiration, or panendoscopy.
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Biopsy
To make a definite diagnosis of any mouth or oropharyngeal cancer your doctor needs to take a sample of tissue from the affected area (a biopsy) and look at it under a microscope for signs of cancer. If the area is easy to get at (for example, in your mouth) your doctor will be able to remove a very small amount of tissue and send it to the laboratory. There are different ways of taking a biopsy to diagnose mouth and oropharyngeal cancers. They include scalpel biopsy and panendoscopy. Your doctor may take a sample of cells using fine needle aspiration.
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Scalpel biopsy
A scalpel biopsy means cutting out a circle of tissue from the affected area. Your doctor will inject some local anaesthetic into the area to numb it. Then the doctor cuts round the biopsy area, gently
lifts the piece of tissue using a pair of tweezers and cuts it off. This is uncomfortable but only lasts a short time. For many people, the most uncomfortable part is the local anaesthetic injection.
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Nasoendoscopy
A nasoendoscopy (sometimes spelt nasendoscopy) or laryngoscopy allows your specialist to look at all your upper air passages. This includes the back of your throat (the pharynx). The specialist passes a narrow, flexible telescope (a nasoendoscope) up your nose and down your throat. It can be a bit uncomfortable, so your doctor may use an anaesthetic spray to numb your throat first. But if you have the anaesthetic spray you cant eat or drink until it wears off so you may choose not to have it. If the specialist sees any abnormal area in your throat, they will need to take a biopsy from that area.
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Panendoscopy
Your doctor may ask you to go into hospital to have a panendoscopy. This is usually if they can't get a good view using the mirror or nasoendoscope, or if they see something abnormal and need to take a biopsy. The nasoendoscope is too fine to use for a biopsy. But a panendoscope is thicker so your specialist can use it to remove a sample of the affected tissue. A panendoscope is a series of connected tubes that a head and neck surgeon uses to look at your upper airways. There is a camera and light at one end, and an eyepiece at the other.
You have this test while you are under general anaesthetic. The doctor gently puts the panendoscope up your nose and down into your throat. They will look at all parts of your pharynx, as well as the larynx (voicebox), food pipe (oesophagus), windpipe (trachea) and breathing tubes (bronchi). This is because people with mouth and oropharyngeal cancers are at a greater risk of developing cancers in other areas of the head and neck.
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This page has information about the stages and grades of mouth andoropharyngeal cancers. You can find information about
A quick guide to what's on this page What staging is Staging systems for mouth and oropharyngeal cancers
TNM stages of mouth and oropharyngeal cancers Number stages of mouth and oropharyngeal cancers The grades of mouth and oropharyngeal cancer
What staging is
The stage of a cancer means how big it is and whether it has grown or spread. The staging information helps your doctor to decide on the best treatment. The tests and scans that you had to diagnose your cancer give some staging information. But if you need surgery your doctor may not be able to tell you the exact stage until after the operation.
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T stages
There are 4 main T stages of mouth and oropharyngeal cancer
T1 means the tumour is contained within the tissue of the mouth or oropharynx and is no
larger than 2cm ( inch) T2 means the tumour is larger than 2cm, but smaller than 4cm (about 1 inches) T3 means the tumour is bigger than 4cm T4a means the tumour has grown further than the mouth or oropharynx and into nearby body tissues such as bone, tongue, the air cavities of the face (sinuses) or the skin T4b means the tumour has spread into nearby areas such as the space around and behind the jaws, the back of the upper jaw where the large jaw muscles attach, the base of the skull, or the area of the neck that surrounds the main arteries (carotid arteries)
N stages
There are 4 main lymph node stages in cancer of the mouth and oropharynx. One of these, stage N2, is broken down into 3 sub stages. The important points here are whether there is cancer in the lymph nodes in the neck and if so, the size of the node and which side of the neck it is on.
N0 means there are no cancer cells in the lymph nodes N1 means there are cancer cells in 1 lymph node on the same side of the neck as the
cancer, but the node is less than 3cm across N2a means there is cancer in 1 lymph node on the same side of the neck, and the node is more than 3cm across but less than 6cm across
N2b means there is cancer in more than 1 lymph node, but none of these nodes are more
than 6cm across. All the affected nodes are on the same side of the neck as the cancer. N2c means there is cancer in nodes on the other side of the neck, or in nodes on both sides, but none of these nodes are more than 6cm across N3 means that at least 1 node containing cancer is more than 6cm across
M stages
There are two M stages for cancers of the mouth and oropharynx
M0 means there is no cancer spread to other parts of the body M1 means the cancer has spread to other parts of the body, such as the lungs
Together, the T, N and M stages give a complete description of the stage of your cancer. For example, if you have a T2, N0, M0 cancer, you have a tumour larger than 2cm but not larger than 4cm. There are no cancer cells in the lymph nodes and there is no spread of your cancer to other parts of the body.
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Stage 1
This is the earliest stage of invasive cancer. It means that cancer has begun to grow through the tissues lining the mouth or oropharynx and into the deeper tissues underneath. The cancer is no more than 2 cm across and has not spread to nearby tissues, lymph nodes or other organs.
Stage 2
If you have stage 2 cancer, the tumour is larger than 2cm across, but less than 4cm. The cancer has not spread to lymph nodes or any other organs.
Stage 3
Having stage 3 mouth or oropharynx cancer can mean one of two things. Either the cancer is bigger than 4cm but has not spread to any lymph nodes or other parts of the body. Or the tumour is any size but has spread to one lymph node on the same side of the neck as the cancer. In this case the lymph node involved is no more than 3cm across.
Stage 4
Stage 4 means the cancer is advanced. It is divided into 3 stages
Stage 4a means the cancer has grown through the tissues around the lips and mouth
lymph nodes in the area may or may not contain cancer cells
Stage 4b means the cancer is any size and has spread to more than 1 lymph node on the
same side of the neck as the cancer, or to lymph nodes on both sides of the neck, or any lymph node is bigger than 6cm Stage 4c means the cancer has spread to other parts of the body such as the lungs or bones
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cells
Grade 2 (intermediate grade) the cancer cells look slightly different to normal mouth or
oropharyngeal cells Grade 3 (high grade) the cancer cells look very abnormal and not much like normal mouth or oropharyngeal cells Grade 4 (high grade) the cancer cells look very different to normal mouth or oropharyngeal cells Differentiation means how developed or mature (differentiated) a cell is. So doctors may describe grade 1 cancer cells as well differentiated. Grade 2 cancer cells are moderately differentiated. Grade 3 cancer cells are poorly differentiated. Grade 4 cells are undifferentiated.
This page has information about treatments for mouth or oropharyngealcancer. You can find out about
A quick guide to what's on this page Head and neck cancer treatment teams How your doctor decides on your treatment Choosing your treatment Surgery Radiotherapy Chemotherapy Chemoradiation Biological therapy Treating cancer that has spread
the team will still have got together with your test results and case notes to discuss the best treatment options for you. The MDT includes a variety of doctors and other health professionals who specialise in different aspects of treatment, such as
Head and neck surgeons Medical oncologists specialists in treatment with cancer drugs Clinical oncologists specialists in radiotherapy treatment Restorative dentistry consultant Head and neck clinical nurse specialist Other health professionals
Medical oncologist
A medical oncologist is a doctor who specialises in treating cancer with cancer drugs such as chemotherapy or biological therapies.
Clinical oncologist
A clinical oncologist treats cancer with radiotherapy. They work closely with a team of people to plan and give the treatment.
teeth during and after your treatment, and they may send you to a dental hygienist for more help. It is important to keep your teeth and mouth clean to reduce the risk of infection. The dentist will help to plan your recovery with your surgeon, so that you can speak and eat as well as possible afterwards. They may suggest using special false teeth, or a replacement part (prosthesis) for missing teeth or any structure in the mouth. For example, some people with mouth cancer need to have surgery to remove part of their jawbone. The consultant rebuilds the missing piece with a piece of bone from another part of the body. A restorative dentist can fit a prosthesis with teeth to attach to the new jaw bone using dental implants. A prosthesis will also help to make yourfacial appearance as normal as possible after major surgery.
For advanced cancer you may have biological therapy in combination with chemotherapy. You may have one of these treatments alone or a combination of treatments. Your doctor will plan your treatment according to
The type of mouth or oropharyngeal cancer you have Whether the cancer has spread (the stage) What the cells look like under a microscope (the grade) The impact your treatment will have on your speech, chewing and swallowing Your general health and fitness
There is detailed information about surgery, radiotherapy for mouth cancer, chemotherapy for mouth cancer, chemoradiation for mouth and oropharyngeal cancer and biological therapy for mouth cancerin this section. Surgery alone cures some tumours, but others respond better to radiotherapy, or radiotherapy with chemotherapy or biological therapy. A Cochrane review in 2010 found that adding chemotherapy to surgery or radiotherapy for oropharyngeal cancer works better than just one of these treatments on their own. On the next page, there are links to descriptions of the most common treatments for each type and stage of mouth and oropharyngeal cancer.
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Surgery
Surgery is a common treatment for mouth and oropharyngeal tumours. How much surgery you have depends on the size and depth of the cancer when it is found. It also depends on whether there is a risk that the cancer has spread into lymph nodes around your mouth or in your neck. You are most likely to have an operation under general anaesthetic. Surgery works very well for early stage mouth cancer.
For some very early stage cancers of the mouth and oropharynx, you may be able to have laser surgery under local or general anaesthetic, although this is not common. In laser surgery, the surgeon uses a narrow, intense beam of light to cut out the cancer. The laser beam works like a surgical knife (scalpel). But if you have an early cancer, your specialist team may recommend that you have radiotherapy instead of surgery. For information about specific operations that you may have, you can look in the surgery for mouth and oropharyngeal cancer section.
Radiotherapy
Radiotherapy alone is used to treat some types of mouth and oropharyngeal cancers that have not spread.
If you have surgery your doctor may recommend that you have radiotherapy afterwards. The treatment aims to kill off any cancer cells that might have been left behind. This lowers the risk of the cancer coming back. Radiotherapy may be combined with chemotherapy for people whose cancer has spread into surrounding areas (locally advanced cancer). There is detailed information about radiotherapy and side effects to the mouth and oropharyx area in this section.
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Chemotherapy
You may have chemotherapy in the following situations
If your cancer has come back after surgery and radiotherapy To treat a mouth and oropharyngeal cancer that is locally advanced or has spread to other
parts of the body There is information about chemotherapy and the different chemotherapy drugs and side effects in this section.
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Chemoradiation
Chemotherapy may be combined with radiotherapy and is called chemoradiation. It may be used instead of surgery for some oropharyngeal cancers that have spread into surrounding tissues or into nearby lymph nodes. For some people this may get rid of the cancer completely. This treatment may also be used for very small mouth cancers but this is rare. We have detailed information about chemoradiation for mouth and oropharyngeal cancers in this section.
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Biological therapy
Biological therapies are treatments made from naturally occurring body substances or that affect how cancer cells divide and grow. A biological therapy called cetuximab (also known as Erbitux) is used for some mouth and oropharyngeal cancers. It may be used alongside radiotherapy for locally
advanced squamous mouth or oropharyngeal cancer. It is also used in clinical trials in combination with platinum based chemotherapy or radiotherapy. There is information about biological therapies for mouth and oropharyngeal cancer in this section.
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Treatments that are still in development may be an option for you. This will mean taking part in aclinical trial. There is information about new treatments in the section about mouth and oropharyngeal cancer research. If your cancer has spread your doctor is likely to refer you to a palliative care team. Palliative care is treatment aimed at improving your symptoms and making life easier for you. Some people feel very upset when their doctor suggests this. They assume that it must mean that their doctors cant do any more for them, but this isnt the case. Palliative care involves helping to
Control any symptoms such as pain, sickness or breathing problems Support you with your diet and physical care Rehabilitate you you may just need some time to get your strength back before going
home from hospital Palliative care also includes looking after people in the terminal stages of their illness.
This page describes the treatment for particular stages of cancer of the mouth and oropharynx. You can read about
A quick guide to what's on this page About the information on this page Treating stage 0 mouth cancers (CIS) Treating stage 1 and 2 mouth cancers Treating stage 3 and 4 mouth cancers Treating advanced mouth cancer that is unlikely to get better (palliative treatment)
If you have surgery it will usually include removing some of the lymph nodes in the neck during an operation called a neck dissection. This is because there is a high risk that the cancer has spread to the lymph nodes. If the cancer has spread into the nodes, you will usually also have radiotherapy to the neck after your surgery. This is to try and kill off any remaining cancer cells. Researchers and doctors are looking into giving chemotherapy, radiotherapy or both of these before surgery. Doctors call this neoadjuvant therapy. The aim is to shrink the tumour before you have your surgery. The idea is that you will then be able to have a smaller operation and so the after effects of the operation will be less severe. If your cancer is too big or cannot be removed using surgery you are most likely to have radiotherapy. Your doctors may recommend chemotherapy or biological therapy alongside the radiotherapy. Researchers are developing more drugs for these types of cancer. So you may have new chemotherapy drugs or biological therapies as part of a clinical trial. There are different ways of giving radiotherapy to people with stage 3 and 4 cancers. You can haveinternal radiotherapy or external radiotherapy depending on the part of the body involved.
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Treating advanced mouth cancer that is unlikely to get better (palliative treatment)
Palliative treatment aims to control symptoms caused by a disease. The treatment won't cure your cancer but it may slow its growth or shrink it for a while. For example, if your mouth or oropharyngeal tumour is large and beginning to block your airway, your doctor may recommend surgery to remove all or part of the tumour to make breathing easier. They may also suggest
Surgery combined with radiotherapy Chemotherapy alone or with radiotherapy (chemoradiation)
Treatments that are still in development may be another option for you. This will mean taking part in aclinical trial. There is information about new treatments under development in the section about mouth and oropharyngeal cancer research. If your cancer has spread, your doctor is also likely to refer you to a palliative care team to help control your symptoms and support you.
about 7 weeks. If there are still signs of cancer after the chemotherapy treatment, you will have surgery to remove it. Side effects of chemoradiation The side effects of chemoradiation will be the same as those with radiotherapy and chemotherapy. But having both treatments, at the same time, means the side effects can be more severe. You may get very tired, and have a very sore mouth. If your mouth is very sore, it is important to tell your doctor or nurse, so that you can have the right painkillers. For some people, the mouth is so sore that it is difficult to swallow. If this happens to you, you are likely to need to have liquid food through a tube into your stomach or bloodstream so that you can get enough liquid and calories. It is important that you do not get an infection in your mouth. Your nurse will explain what you need to do to keep your mouth clean and avoid an infection.
You can view and print the quick guides for all the pages in the treating mouth cancer section.
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Combination treatment
Having chemotherapy and radiotherapy at the same time is called chemoradiation or synchronous therapy. Researchers have found that chemoradiation works better than radiotherapy alone for people whose oropharyngeal cancer has grown beyond the place where it first started. It may also be used instead of surgery for small mouth cancers but this is not common. Some chemotherapy drugs help to make the cells more sensitive to the radiotherapy. The most common drug used is cisplatin. You have it during the radiotherapy course, usually every 3 or 4 weeks, or sometimes weekly. Chemoradiation can be quite tough treatment to get through. You will need to have some tests to see if you are fit enough to cope with it. Your exact treatment plan will depend on what your doctor thinks is best for you. The radiotherapy course usually lasts about 7 weeks. Although it is usual to avoid delay, occasionally you may need to stop the treatment for a short time because of the side effects. But treatment can usually start again after a few days rest. Research has found that a short delay doesnt affect how well the treatment works.
If there are still signs of cancer after the chemotherapy treatment, you will have surgery to remove it. If the cancer comes back in the future, you may be able to have surgery to remove it then. Some other drugs are being researched in combination with radiotherapy and you may have them as part of clinical trials.
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Combination treatment
Having chemotherapy and radiotherapy at the same time is called chemoradiation or synchronous therapy. Researchers have found that chemoradiation works better than radiotherapy alone for people whose oropharyngeal cancer has grown beyond the place where it first started. It may also be used instead of surgery for small mouth cancers but this is not common. Some chemotherapy drugs help to make the cells more sensitive to the radiotherapy. The most common drug used is cisplatin. You have it during the radiotherapy course, usually every 3 or 4 weeks, or sometimes weekly. Chemoradiation can be quite tough treatment to get through. You will need to have some tests to see if you are fit enough to cope with it. Your exact treatment plan will depend on what your doctor thinks is best for you. The radiotherapy course usually lasts about 7 weeks. Although it is usual to avoid delay, occasionally you may need to stop the treatment for a short time because of the side effects. But treatment can usually start again after a few days rest. Research has found that a short delay doesnt affect how well the treatment works. If there are still signs of cancer after the chemotherapy treatment, you will have surgery to remove it. If the cancer comes back in the future, you may be able to have surgery to remove it then. Some other drugs are being researched in combination with radiotherapy and you may have them as part of clinical trials.
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We have more information on this website about radiotherapy and chemotherapy treatments. You can ask your doctor or specialist nurse for written information. You can also phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. Our mouth cancer organisations page has details of people who can give information about chemoradiation. Some organisations can put you in touch with a cancer support group. Our mouth cancer reading list has information about books and leaflets about mouth cancer treatments. If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or you can go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.
This page is about biological therapies for mouth and oropharyngeal cancer. There is information about
A quick guide to what's on this page What biological therapy is Cetuximab (Erbitux) Other biological therapies Side effects of biological therapies More information about biological therapy
Cetuximab (Erbitux)
Cetuximab (Erbitux) is a type of biological therapy known as a monoclonal antibody. It is designed to block areas on the surface of cancer cells that can trigger growth. These are called epidermal growth factor receptors (EGFR). Blocking these receptors can stop the signals that tell the cancer to grow. Trials have shown that cetuximab combined with radiotherapy can help people with locally advanced head and neck cancer to live longer than radiotherapy on its own. The National Institute for Health and Clinical Excellence (NICE) and the Scottish Medicines Consortium (SMC) have approved the use of cetuximab, with radiotherapy, for locally advanced squamous cell head and neck cancer. They have approved it for people when platinum based chemotherapy (such as cisplatin or carboplatin) is not working, or cannot be used. Locally advanced cancer means cancer that has spread into the areas close to the mouth or oropharynx. But the cancer has not spread to other areas of the body such as the bone or distant lymph nodes. Cetuximab is also used in combination with platinum based chemotherapy. It is for people with squamous cell head and neck cancer that has come back or has spread. The decision to approve cetuximab in this situation was based on the results of a large international trial called EXTREME. The trial compared cetuximab and chemotherapy to chemotherapy alone. Patients on this trial hadn't been treated before with chemotherapy. The results suggested that adding cetuximab to chemotherapy helped people to live between 2 and 3 months longer than if they just had chemotherapy on its own. But the SMC in Scotland and NICE in England decided not to recommend cetuximab for this group of patients on the NHS because it is not cost effective, so it is not widely used.
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Skin changes (rashes or discolouration) rashes may be severe for some people A sore mouth Loss of appetite Low blood counts Swelling of parts of the body, due to fluid build up
Tell your doctor or nurse if you have any of these effects. You can have medicines to help to control them.
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This page is about the factors that are known to play a part in causing mouth and oropharyngeal cancers. There is information below about
A quick guide to what's on this page How common mouth cancer is Smoking and alcohol Chewing tobacco or betel quid Diet
Human papilloma virus (HPV) Low immunity Sunlight and sunbeds Previous cancer Family history Mouth conditions Genetic conditions
Drinking alcohol increases the risk of oropharyngeal cancer and may increase mouth cancer risk when combined with smoking. A large Cancer Research UK study looking at lifestyle factors that cause cancer found that about a third of cancers of the mouth and throat (30%) were caused by drinking alcohol. Current guidelines in the UK suggest that people should drink no more than 21 units of alcohol per week for men, and 14 units per week for women. Cigarettes and alcohol contain nitrosamines and other chemicals that are known to cause cancer. The nitrosamines in alcohol pass over the mouth, throat and top of the larynx (the epiglottis) as you swallow. When you smoke, the smoke passes through your mouth, throat and the larynx on its way to your lungs. Your risk increases the longer you smoke. Remember that if you smoke, you are much more likely to develop cancer of the mouth or oropharynx. If you smoke and regularly drink more than the recommended amounts your risk is especially high. Cancers of the mouth or oropharynx do sometimes occur in people who have never smoked or drunk much but this is rare. There is more about cancer risk and smoking and about cancer risk and alcohol on our News and Resources website.
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Diet
A poor diet may increase your risk of certain types of mouth and oropharyngeal cancer. This may be due to a lack of zinc, or other vitamins and minerals. If you eat a well balanced diet, with plenty of protein, you are unlikely to be short of zinc. A diet high in fresh fruit and vegetables seems to reduce the risk of developing cancer of the mouth. This may be because these foods contain a lot of antioxidant vitamins and other substances that help prevent damage to body cells. Vitamin A deficiency increases your risk of developing cancer of the mouth and oropharynx. Poor eating patterns are common in people who drink a lot of alcohol. Poor diet in people who drink heavily may help to explain why alcohol increases the risk of some cancers.
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Low immunity
Research has found that people have an increased risk of mouth cancer if they have a reduced immunity due to HIV or AIDS. Taking medicines to suppress immunity after organ transplants also gives a higher risk of mouth cancer than in the general population.
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Previous cancer
People who have had mouth or oropharyngeal cancer have an increased risk of getting a second one. Women have a higher risk of a second oral cancer than men. People who have had some other types of cancer also have an increased risk of mouth cancer. These include
Cancer of the food pipe (oesophagus) Squamous cell skin cancer Cervical, anal or genital cancer in women Cancer of the back passage (rectum) in men
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Family history
People often worry that they are at a higher risk of cancer because someone in their family has it. There does seem to be a slightly higher risk of getting mouth cancer if you have a close relative (a parent, brother, sister or child) who has had mouth cancer. We don't know the reason for this.
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Mouth conditions
Sometimes changes can happen in the cells of the lining of the mouth and they cause red or white patches to appear. These changes are called leukoplakia and erythroplakia. In some people these changes may develop into cancer over some years. Dentists can see these changes during dental checks so it is important to have regular dental appointments to find these changes early.
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Genetic conditions
People with certain syndromes caused by inherited changes (mutations) in particular genes have a high risk of mouth and throat cancer. These include
Fanconi anaemia a genetic disorder that can affect children and adults from any ethnic
background. It is also called Fanconi's syndrome. People with Fanconi anaemia are short, have bone changes, and are at risk of developing cancers, leukaemia, and bone marrow failure (aplastic anemia) Dyskeratosis congenita a genetic syndrome that can cause aplastic anaemia, skin rashes, and abnormally shaped fingernails and toenails. People with this syndrome have a high risk of developing cancer of the mouth and throat when they are young