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Advanced Cancer of the Oral Cavity

This information will help you understand advanced cancer of the oral cavity, including symptoms, diagnosis, and treatment. The oral cavity includes the:
 
  • Lips
  • Cheeks
  • Teeth
  • Front of the tongue
  • Roof of the mouth
  • Floor of the mouth
  • Upper and lower gum
Cancer can develop in any part of the oral cavity. Advanced cancer of the oral cavity means that more than one part is involved. It also usually involves nearby tissue, muscle, and bone. More aggressive cancer can spread to the lymph nodes in the neck.
 

Symptoms

  • A sore on the lip, mouth, or both that doesn’t heal
  • A lump on the lips, on the neck, or in the mouth that doesn’t go away
  • A white or red patch on the gums, tongue, or cheeks
  • Bleeding, pain, or numbness in the mouth that doesn’t go away
  • A sore throat that doesn’t go away
  • A sensation that something is caught in the throat
  • Difficulty or pain with chewing or swallowing
  • Swelling that causes dentures to fit poorly or become uncomfortable
  • A change in the voice
  • Pain in the ear
  • Not being able to open the mouth

Diagnosis

The first step is to see if your symptoms are caused by cancer. You will need to have a biopsy. This involves removing a small amount of tissue from the area where the cancer may be located. This tissue will be looked at under a microscope. It will take at least 5 business days to receive the results of the biopsy. At that time, your doctor will explain your diagnosis.
 
Your doctor may want you to have other tests, such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), or a positron emission tomography (PET) scan, to see if the cancer has spread to other areas of your body.
 

Surgery

Surgery is the most common treatment for advanced cancer of the oral cavity. The goal is to remove all of the cancer. Depending on your surgery, you may need to have tissue, muscle, and bone reconstruction. If so, a plastic surgeon will work with your head and neck surgeon.
 
Your head and neck surgeon may also want you to see a dental and maxillofacial surgeon. He or she will evaluate your teeth and have a prosthesis made if you need one. A prosthesis is something that replaces a part of the body that is removed.
 
The extent of your surgery will depend on how your head and neck surgeon removes the cancer.
 
  • Some tumors need to be removed through an incision (surgical cut) in the jaw. The incision is made betweennthe front 2 bottom teeth. The jaw is opened, the tumor is removed, and the jaw is put back together with a metal plate and screws.
  • If the cancer is close to or involves only a small piece of the jaw, just this part of the bone is removed.
  • If the cancer involves a lot of the bone, a whole section of the jaw will be removed.
  • Sometimes, tissue, muscle, bone, arteries, and veins will be taken from another part of the body to replace what was taken out. This is called a free flap.
  • The lymph nodes in your neck may need to be removed. The tumor and lymph nodes are examined under a microscope. It will take at least 1 week to get the results.

Tracheostomy

The surgery may cause swelling in your throat. Your surgeon may perform a tracheostomy to make sure you can breathe well. Your surgeon will make an opening into your neck. He or she will insert a tracheostomy tube through the opening and into your trachea (windpipe). This will allow you to breathe without difficulty. If you will have a tracheostomy, your nurse will give you the resource Caring for Your Tracheostomy (www.mskcc.org/cancer-care/patient-education/resources/caring-for-your-tracheostomy)

After Your Surgery

Communication

If you have a tracheostomy, you may not be able to talk when you first wake up. However, you can communicate by writing. Your nurse will give you a pencil and paper. You can also answer “yes or no” questions by nodding your head. You may also have the opportunity to communicate using a computer tablet. The tablet has an application (app) that can help you communicate your needs. Your nurse will teach you how to use the tablet.
 

Compression boots

While you are in bed, you will wear compression boots. These boots apply gentle pressure in your calves to help prevent blood clots from forming. They will be removed when you are able to get out of bed and walk. If you have not had free flaps, you will be out of bed and walking by the day after your surgery. If you do have free flaps, it may take longer, depending on where the free flaps are located. Your physical activity will increase slowly each day.
 

Tracheostomy

If you have a tracheostomy, your nurse will care for it. This will require suctioning it to keep it free of mucus. This suctioning may be uncomfortable for about a minute. However, it will make your breathing much easier and reduce your risk of pneumonia. The tracheostomy tube will be removed as soon as the swelling in your airway goes down and you are able to breathe normally. If you will go home with a tracheostomy, your nurse will teach you how to care for it.
 

Feeding tube

If it will be too difficult for you to eat and drink, you may have a feeding tube placed after surgery. Depending on the extent of your surgery, you may not be able to eat until the week after your surgery.
 

Managing your pain

You will have pain after your surgery. It is important to ask your nurse for pain medication. At first, you may receive it through your intravenous (IV) line. Later, you may get the medication orally (by mouth) or through your feeding tube, if you have one. You will need less pain medication as you heal.
 

Drainage tubes

If the lymph nodes in your neck were removed, you will have drainage tubes in your neck. You may also have them in the area of your free flap, if you had one. The drainage tubes are usually removed when the amount of drainage has decreased to a safe level. All of these tubes will most likely be removed before you are discharged from the hospital. If you go home with a tube(s) in place, your nurse will teach you how to care for it.
 

Oral hygiene

Your nurse will teach you how to use an oral irrigation kit to care for your mouth. This kit helps keep your mouth clean, promotes healing, and can help control your pain. You will need to keep rinsing your mouth with the irrigation kit after you are discharged from the hospital. It is especially important for you to rinse your mouth after meals. There should be no food left inside your mouth after you are finished eating.
 

Preventing trismus

It is very important to prevent trismus (not being able to open your mouth) while you are recovering from surgery. Your nurse will teach you the exercises described in the resource Trismus (www.mskcc.org/cancer-care/patient-education/resources/trismus) to prevent this side effect.
 

Discharge

Most people are in the hospital for 10 to 14 days. Your surgeon will tell you when you can return to work and your normal activities. This depends on the extent of your surgery and how you recover.
 

 

Most people can manage at home without additional help, but your nurse will talk with you about this before you leave the hospital. If you need help, arrangements can be made for a visiting nurse or home health aide.
 
Contact your surgeon if you have any of the following signs or symptoms of infection:
 
  • A temperature of 101° F (38.3° C) or higher
  • Increased redness around any incisions
  • Increased or foul smelling drainage from any incisions
  • Increased pain that is not controlled with your prescribed pain medication or acetaminophen (Tylenol®)

Follow-up Visits

You will need to see your head and neck surgeon 1 week after your discharge. If a plastic surgeon was involved in your surgery, you will also need to see him or her. Call each office to make the appointments. Depending on how you are healing, some or all of your stitches will be removed during your first follow-up visit. You will also have a complete head and neck exam.
 
If your test results are ready, your head and neck surgeon will go over them with you. You will learn whether you need any further treatment. Most patients with advanced cancer of the oral cavity will need radiation therapy. If you are going to have it done at Memorial Sloan Kettering Cancer Center (MSK), an appointment will be made for you. If you are going to have it done somewhere else, we can help you choose a radiation oncologist. All your records will be sent to the doctor who will be treating you.
 
It is very important to keep all of your follow-up appointments so that any recurrence or new cancer is found early. Over time, your appointments will be spaced further apart.
 

Recovery

The diagnosis and treatment of cancer can be a very stressful and overwhelming event. Each person who receives a diagnosis of cancer copes in his or her own way. Many people say it helps to concentrate on the small improvements you will see as the days and weeks go by, such as:
 
  • The swelling will slowly disappear.
  • Your face will begin to look more natural and the scars will become less noticeable.
  • You will be able to talk more easily and eat many of the foods you like. A dietitian can help you find the best ways to prepare your favorite foods while you regain your ability to chew and swallow.
  • You will have more energy to do the activities you enjoy.
There are many resources to help you and your family during your recovery. Some are here at MSK and others are in your community. Ask your doctor, nurse, or social worker about options.
 
You may find it comforting to speak with a head and neck cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers. To learn more about this program, call (212) 639-5007.
 
The MSK Resources for Life After Cancer (RLAC) Program provides support and education for people who are finished with treatment. To learn more about this group and the programs offered, call (646) 888-4740 or go to: www.mskcc.org/cancer-care/survivorship/cancer-care/survivorship/services-survivors
 

Emotional health

Depression can develop at any time when you have a serious illness. It is important to recognize the symptoms. Help is available to treat and manage it. The signs of depression include:
 
  • Feelings of helplessness and sadness
  • Not being able to concentrate or carry out normal activities
  • Changes in mood
  • Changes in sleep pattern (sleeping more or less than usual)
  • Increase or decrease in appetite
If you have any of these symptoms and they last more than 2 weeks, tell your doctor or nurse. To speak with a counselor, contact the MSK Counseling Center at (646) 888-0100.
 

Tobacco and alcohol use

The risk factors for oral cavity cancer include:
 
  • Smoking cigarettes or other tobacco products
  • Chewing tobacco
  • Drinking alcohol
Stopping these activities will help reduce your chances of a recurrence or of developing a new, second cancer. If you want to stop using tobacco, we can refer you to a tobacco treatment program either here or in your community. For more information, contact the MSK Tobacco Treatment Program at (212) 610-0507 or go to: www.mskcc.org/cancer-care/counseling-support/tobacco-treatmentIf you want to stop drinking alcohol, there are programs that can help you. Contact the MSK Counseling Center at (646) 888-0100 for more information.