Head & Neck Oncology Program

Lip and Oral Cavity Cancer

Stages and Treatment Options

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If cancer of the lip or oral cavity is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This process is called staging, and it helps the doctor plan the patient’s treatment. The following stages are used for cancer of the lip and oral cavity:

Stage I: The cancer is no more than two centimeters (about one inch) and has not spread to lymph nodes in the area. (Lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells.)

Stage II: The cancer is more than two centimeters but less than four centimeters (less than two inches) and has not spread to lymph nodes in the area.

Stage III: Either of the following may be true:

The cancer is more than four centimeters.
The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than three centimeters (just over one inch).

Stage IV: Either of the following may be true:

The cancer has spread to tissues around the lip and oral cavity. The lymph nodes in the area may or may not contain cancer.
The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer or to lymph nodes on one or both sides of the neck or to any lymph node that measures more than six centimeters (over two inches).
The cancer has spread to other parts of the body.

Recurrent: Recurrent cancer is cancer that has come back (recurred) after it has been treated. It may come back in the lip or oral cavity or in another part of the body.

For specific cancers in the lip and oral cavity, the following treatments may be used:

Lip Cancer

Stage I: Treatment may be surgery, radiation therapy, or a clinical trial testing micrographic surgery followed by radiation therapy.
Stage II: Treatment may be surgery, external and/or internal radiation therapy, or a clinical trial testing micrographic surgery followed by radiation therapy.
Stage III: Treatment may be one of the following:
- Surgery to remove the cancer, plus internal or external radiation therapy
- Radiation therapy
- A clinical trial of chemotherapy followed by surgery or radiation therapy
- A clinical trial of surgery followed by chemotherapy
- A clinical trial of surgery, radiation therapy, and chemotherapy
- A clinical trial of a new radiation therapy technique (superfractionated)
Stage IV: Treatment may be one of the following:
- Surgery to remove the cancer plus internal or external radiation therapy
- A clinical trial of radiation therapy
- A clinical trial of chemotherapy combined with radiation therapy
- A clinical trial of fractionated (smaller doses) radiation therapy
Recurrent: Treatment depends on the type of treatment the patient had previously. If the patient was treated with radiation therapy, he or she may have surgery. If the previous treatment was surgery, the patient may have more surgery, radiation therapy, or both. Patients may want to consider taking part in a clinical trial of chemotherapy or hyperthermia.

Tongue Cancer

Stage I: Treatment may be surgery, surgery followed by radiation therapy to the neck, radiation therapy to the mouth and neck, or a clinical trial testing micrographic surgery followed by radiation therapy.
Stage II: Treatment may be radiation therapy, surgery and radiation therapy, a clinical trial testing micrographic surgery followed by radiation therapy.
Stage III: Treatment may be external beam radiation with or without internal radiation therapy or surgery followed by radiation therapy.
Stage IV: Treatment may be one of the following:
- Surgery to remove the tongue and the voicebox (larynx) below it followed by radiation therapy
- Radiation therapy to relieve symptoms
- A clinical trial of chemotherapy combined with radiation therapy
- A clinical trial of fractionated (smaller doses) radiation therapy
Recurrent: Treatment depends on the type of treatment the patient had previously. If the patient was treated with radiation therapy, he or she may have surgery. If the previous treatment was surgery, the patient may have more surgery, radiation therapy, or both. Patients may want to consider taking part in a clinical trial of chemotherapy or hyperthermia.

Buccal Mucosa Cancer

The buccal mucosa is the lining of the inside of the cheeks and lips.

Stage I: Treatment may be one of the following surgery, radiation therapy, or a clinical trial testing micrographic surgery followed by radiation therapy.
Stage II: Treatment may be radiation therapy, surgery and radiation therapy, or a clinical trial testing micrographic surgery followed by radiation therapy.
Stage III: Treatment may be one of the following:
- Surgery to remove the cancer and the tissue around it
- Radiation therapy
- Surgery plus radiation therapy
- A clinical trial of chemotherapy followed by surgery or radiation therapy
- A clinical trial of surgery followed by chemotherapy
- A clinical trial of surgery, radiation therapy, and chemotherapy
Stage IV: Treatment may be one of the following:
- Surgery to remove the cancer and the tissue around it
- Radiation therapy
- Surgery plus radiation therapy
- A clinical trial of chemotherapy combined with radiation therapy
- A clinical trial of fractionated (smaller doses) radiation therapy
Recurrent: Treatment depends on the type of treatment the patient had previously. If the patient was treated with radiation therapy, he or she may have surgery. If the previous treatment was surgery, the patient may have more surgery, radiation therapy, or both. Patients may want to consider taking part in a clinical trial of chemotherapy or hyperthermia.

Floor of the Mouth Cancer

Stage I: Treatment may be surgery, radiation therapy, or a clinical trial testing micrographic surgery followed by radiation therapy.
Stage II: Treatment may be surgery, radiation therapy, surgery followed by internal or external radiation therapy, or a clinical trial testing micrographic surgery followed by radiation therapy.
Stage III: Treatment may be one of the following:
- Surgery to remove the cancer and lymph nodes in the neck. Part of the jawbone may also be removed if necessary.
- External beam therapy with or without internal radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
Stage IV: Treatment may be one of the following:
- Surgery to remove the cancer followed by radiation therapy
- Radiation therapy followed by surgery
- A clinical trial of chemotherapy combined with radiation therapy
- A clinical trial of fractionated (smaller doses) radiation therapy
Recurrent: Treatment depends on the type of treatment the patient had previously. If the patient was treated with radiation therapy, he or she may have surgery. If the previous treatment was surgery, the patient may have more surgery, radiation therapy, or both. Patients may want to consider taking part in a clinical trial of chemotherapy or hyperthermia.

Lower Gum Cancer

Stage I: Treatment may be surgery, radiation therapy, or a clinical trial testing micrographic surgery followed by radiation therapy.
Stage II: Treatment may be surgery, radiation therapy, or a clinical trial testing micrographic surgery followed by radiation therapy.
Stage III: Treatment will probably be radiation therapy given before or after surgery to remove the cancer. Also, patients may want to consider clinical trials testing chemotherapy combined with radiation therapy.
Stage IV: Treatment may be one of the following:
- Surgery, radiation therapy, or both
- A clinical trial of chemotherapy combined with radiation therapy
- A clinical trial of fractionated (smaller doses) radiation therapy
Recurrent: Treatment depends on the type of treatment the patient had previously. If the patient was treated with radiation therapy, he or she may have surgery. If the previous treatment was surgery, the patient may have more surgery, radiation therapy, or both. Patients may want to consider taking part in a clinical trial of chemotherapy or hyperthermia.

Retromolar Trigone Cancer

The retromolar trigone is the small area behind the wisdom teeth.

Stage I: Treatment may be surgery to remove part of the jawbone, radiation therapy followed (if needed) by surgery, a clinical trial testing micrographic surgery followed by radiation therapy.
Stage II: Treatment may be surgery to remove part of the jawbone, radiation therapy followed (if needed) by surgery or a clinical trial testing micrographic surgery followed by radiation therapy.
Stage III: Treatment may be one of the following:
- Surgery followed by radiation therapy
- A clinical trial of chemotherapy followed by surgery or radiation therapy
- A clinical trial of surgery followed by chemotherapy
- A clinical trial of fractionated (smaller doses) radiation therapy
Stage IV: Treatment may be one of the following:
- Surgery followed by radiation therapy
- A clinical trial of chemotherapy combined with radiation therapy
- A clinical trial of fractionated (smaller doses) radiation therapy
Recurrent: Treatment depends on the type of treatment the patient had previously. If the patient was treated with radiation therapy, he or she may have surgery. If the previous treatment was surgery, the patient may have more surgery, radiation therapy, or both. Patients may want to consider taking part in a clinical trial of chemotherapy or hyperthermia.

Upper Gums and Hard Palate Cancer

The upper gums are also called the gingiva. The hard palate is the top bony part of the mouth.

Stage I: Treatment may be surgery, surgery followed by radiation therapy, a clinical trial testing micrographic surgery followed by radiation therapy.
Stage II: Treatment will probably be surgery followed by radiation therapy. Also, patients may want to consider a clinical trial testing micrographic surgery followed by radiation therapy.
Stage III: Treatment may be radiation therapy, surgery plus radiation therapy, or a clinical trial testing chemotherapy combined with radiation therapy.
Stage IV: Treatment may be surgery plus radiation therapy, a clinical trial of chemotherapy combined with radiation therapy, a clinical trial of fractionated (smaller doses) radiation therapy.
Recurrent: Treatment depends on the type of treatment the patient had previously. If the patient was treated with radiation therapy, he or she may have surgery. If the previous treatment was surgery, the patient may have more surgery, radiation therapy, or both. Patients may want to consider taking part in a clinical trial of chemotherapy or hyperthermia.

About the Treatments and Side Effects

There are two primary treatments for patients with cancer of the lip and oral cavity:

surgery
radiation therapy

Chemotherapy is being tested in clinical trials. Hyperthermia is a new treatment used for some patients.

Because the lips and mouth are needed to eat and talk, patients may need special help adjusting to the side effects of the cancer and its treatment. The doctor will consult with several kinds of doctors who can help determine the best treatment for the patient. Trained medical staff can also help the patient recover from treatment and adjust to new ways of eating and talking. The patient may need plastic surgery or help learning to eat and speak if a large part of the lip or mouth is taken out.

Surgery

Surgery is a common treatment for cancer of the lip and oral cavity. The doctor may remove the cancer and some of the healthy tissue around the cancer. The doctor may also remove the lymph nodes in the neck (lymph node dissection).

A new type of surgery called micrographic surgery is being tested for early cancers of the lip and oral cavity. During this surgery, the doctor removes the cancer and then uses a microscope to look at the area to make sure there are no cancer cells left. This allows the doctor to target the cancer while leaving as much normal tissue as possible in place.

Side effects of surgery: The side effects of surgery depend on the location of the tumor and the type of operation, among other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can usually be controlled with medicine. The recovery period after an operation varies from patient to patient.

Radiation Therapy

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy). If the patients stops smoking before starting radiation therapy, he or she will have a better chance of surviving longer.

Side effects of radiation therapy: The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: A treatment period is followed by a recovery period, then another treatment period, and so on.

If a doctor removes all the cancer that is visible at the time of the operation, the patient may be given chemotherapy after surgery to kill any remaining cells. Chemotherapy that is given after surgery to remove the cancer is called adjuvant chemotherapy. Chemotherapy given before surgery to try to shrink the cancer so it can be removed is called neoadjuvant chemotherapy.

Side effects of chemotherapy: Chemotherapy drugs generally fight rapidly dividing cells in the body. Cells that divide rapidly include both the targeted cancer cells and healthy cells in the blood, digestive tract, and hair follicles. Depending on which anticancer drugs a patient receives, he or she may experience symptoms when healthy cells are damaged along with the cancer cells. If healthy blood cells are destroyed by chemotherapy, the patient may be more susceptible to infections, bruising or bleeding, and fatigue. When cells in the hair roots or digestive tract are affected by anticancer drugs, the patient may have hair loss, nausea, vomiting, or mouth sores. Not all chemotherapy patients develop all of these side effects, and the symptoms usually go away during the recovery period or after the treatments are done. Doctors can prescribe medicines and other treatments to control most of the symptoms.

Hyperthermia
Hyperthermia is a new treatment being tested in certain patients. It uses a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the cancer shrinks.

This page was last updated on: May 14, 2009.