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Advanced Cancer of the Oral Cavity

This information will help you understand advanced cancer of the oral cavity, including diagnosis, surgery, 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 gums

Cancer can occur in any part of the oral cavity. Advanced cancer of the oral cavity means more than one area is involved. It also involves nearby tissue, muscle, and bone. More aggressive cancer can spread to the lymph nodes in the neck.

Symptoms of Oral Cavity Cancer

  • 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 by a pathologist. It will take at least 5 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 that is made between the 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 sent to a pathologist for examination. It will take at least 1 week to get the results.

The surgery may cause swelling in your throat. A procedure called a tracheostomy may be done to make sure you can breathe well. Your surgeon will make a small incision on your neck into your trachea (windpipe). A tracheostomy tube will be placed in your trachea. This allows the air you breathe to go directly from your trachea to your lungs. Ask your nurse for the resource Tracheostomy, if you haven't already received it.

After Your Surgery

When you wake up after your surgery, you may not be able to talk because of the tracheostomy tube. You can communicate by writing. Your nurse will give you a pencil and paper. You will also be able to answer yes or no questions by shaking your head.

Your nurse will care for your tracheostomy. This will require suctioning it to keep it free of mucus, which 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.

You may have a feeding tube after surgery if it will be too difficult for you to swallow or eat. Depending on the extent of your surgery, you may not be able to eat until the week after your surgery.

You may 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 through a feeding tube. You will need less pain medication as you heal.

There will be drainage tubes in your neck if the lymph nodes in your neck were taken out. 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. All of these tubes will probably be removed before you are discharged from the hospital.

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. Your physical activity will increase slowly each day.

Your nurse will teach you how to use an oral irrigation kit to care for your mouth. This is a device that helps keep your mouth clean, promotes healing, and can help with pain control. 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.

It is very important that you not develop trismus (not able to open your mouth) while you are recovering from surgery. Your nurse will teach you the exercises described in the resource Trismus to prevent this side effect.

Most patients are in the hospital for 10 to 14 days. We cannot tell you when you will return to work and your normal activities. It 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 will be made for a visiting nurse or home health aid.

Follow-up Visits

You will need to see your head and neck surgeon 1 week after you are discharged from the hospital. 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 the sutures (stitches) will be removed during your first follow-up visit. You will also have a complete head and neck exam.

If it is ready, your head and neck surgeon will go over your pathology report 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 MSK, an appointment will be made for you. If you are going to have it done somewhere else, your surgeon will need to know what major hospitals are close to where you live. We can then 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. Your appointments will be spaced further apart over time.

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. You and your family will almost certainly have ups and downs. Many 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, please 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 they offer, call (646) 888-4740.

Depression can occur 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 and/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.

Treating the Risk Factors for Oral Cavity Cancer

The risk factors for oral cavity cancer include:

  • Smoking cigarettes
  • Chewing tobacco
  • Drinking alcohol

If any of these activities have been part of your lifestyle, you must stop them immediately. This is the only way to reduce your chances of a recurrence or of developing a new, second cancer.

We can refer you to a tobacco treatment program either here or in your community. You can contact the MSK Tobacco Treatment Program at (212) 610-0507.

If you have been a heavy drinker, there are programs that can help you stop drinking. Contact the MSK Counseling Center at (646) 888-0100 for more information on these programs.

Contact Your Doctor or Nurse if You Have:

  • A temperature of 101° F (38.3° C) or higher
  • Increasing redness around any incision sites
  • Increasing or foul smelling drainage
  • Increase in pain that is not controlled with your regular pain medication or acetaminophen (Tylenol®)