Oral and Oropharyngeal Cancer

ON THI S PAGE: You will find a drawing of the main body parts affected by oral and oropharyngeal cancers. Use the menu to see other pages.

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The next section in this guide is Risk Factors and Prevention . It describes the factors that may increase the chance of developing oral or oropharyngeal cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for oral and oropharyngeal cancers. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

• Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

• Lower the number of people who develop the disease

Learn more about the basics of cancer screening .

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.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

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 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, pharyngoscopy 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, simple 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 is 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 of 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 videofluoroscopy, 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. 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 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.

The next section in this guide is Stages and Grades . It explains the system doctors use to describe the extent of the cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use to treat people with oral or oropharyngeal cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for oral and oropharyngeal cancers. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How oral and oropharyngeal cancers are treated

Oral and oropharyngeal cancers can often be cured, especially if the cancer is found at an early stage. Although curing the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. When doctors plan treatment, they consider how treatment might affect a person’s quality of life, such as how the person feels, looks, talks, eats, and breathes.

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 dentist or oral oncologist: 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.

• Physical therapist: 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 means 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 to 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 muscle 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 to the area. Talk with your surgeon about the possible side effects from 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 .

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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 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 to the head due to nerve damage or 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 .

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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 often is 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 with 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 a 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, 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 .

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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 .

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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 .

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Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the 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 or type and 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.

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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.

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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 .

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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 near the end of life. 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 .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about oral and oropharyngeal cancers and how to treat them. Use the menu to see other pages.

Doctors are working to learn more about oral and oropharyngeal cancers, ways to prevent them, how to best treat them, and how to provide the best care to people diagnosed with these diseases. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• New drug therapies. Many new treatments have become available as doctors and researchers have learned more about the biology of head and neck cancers. Some of these treatments, including immunotherapy and targeted therapy , are available through clinical trials. As described in Types of Treatment , immunotherapy uses the body's natural defenses to fight cancer by improving your immune system's ability to attack cancer cells. Therapies being researched include tyrosine kinase inhibitors; antiangiogenic therapy , which prevents the growth of blood vessels needed for tumor growth; immune modulating approaches; and drugs that trigger cancer cell death. These and other treatment approaches are in various stages of research.

• Radiofrequency thermal ablation (RFA). RFA uses heat to destroy cancer cells. It is a minimally invasive treatment option that may be useful for treating a localized tumor that cannot be removed with surgery.

• Less intense treatment for HPV-related cancer. Many patients with HPV-related oropharyngeal cancer have an excellent prognosis after treatment. Providing these patients with less intense treatment can reduce long-term side effects without affecting survival. However, research is ongoing in this area and less intensive treatment is only recommended as part of a clinical trial. Learn more about ASCO’s clinical opinion on less intense treatment for HPV-related oropharyngeal cancer.

• Palliative care/supportive care. Clinical trials are underway to find better methods of reducing the symptoms and side effects of current oral and oropharyngeal cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding oral and oropharyngeal cancers, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now .

• Visit the Cancer.Net Blog to review research and coping topics related to head and neck cancers.

• Listen to podcasts from ASCO experts discussing head and neck cancer research highlights from scientific meetings in 2022 and 2020 .

• Visit the website of Conquer Cancer, the ASCO Foundation to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. A common follow-up schedule is every 2 months for the first year, every 4 months for the second year, every 6 months for the third year, and once a year after that.

People treated for oral or oropharyngeal cancer have a higher risk of developing a secondary cancer . If you smoke, you should be monitored for possible secondary cancers in the lung, esophagus, and the head and neck area. Researchers are studying the use of chemotherapy to prevent second cancers from developing, called chemoprevention . This may become a part of regular follow-up care for those treated for oral or oropharyngeal cancer.

Learn more about the importance of follow-up care .

Cancer rehabilitation

Rehabilitation is a major part of follow-up care after treatment for head and neck cancer. People may need physical therapy and speech and swallowing therapy. Palliative and supportive care to manage symptoms and maintain good nutrition during and after treatment may be recommended.

Depending on the size and location of the tumor and the type of cancer treatment used, a person may have problems with their ability to chew and move food through the digestive system. People who have been treated for oral or oropharyngeal cancer can have long-term swallowing problems. It is important that they continue to swallow their saliva and as much food as they are able throughout treatment to prevent these problems from developing. Special nutritional care and support is often needed during and immediately following treatment. Some people may need to learn new ways to eat or prepare foods differently. Working with a speech-language pathologist and a registered dietitian can help with these challenges. Listen to a podcast about managing eating challenges after treatment.

If the cancer treatment changes the oral cavity structures or limits movement, a patient’s ability to speak will be affected. Speech-language pathologists can help people work toward regaining their speech and swallowing functions.

People treated for oral or oropharyngeal cancer may look different, feel tired, and be unable to talk or eat the way they did before treatment. They may experience swelling in the area, called lymphedema . Some people experience depression . Be sure to talk with members of your health care team about your physical and emotional side effects regularly. They can help you adjust and connect you with support services.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

People treated for oral or oropharyngeal cancer should receive regular follow-up medical and dental examinations to check for signs of recurrent cancer or a new type of cancer. Most recurrences of oral and oropharyngeal cancer happen within the first 2 to 3 years after diagnosis, so follow-up visits will be more frequent in the years right after treatment.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Surgery and radiation therapy used to treat oral and oropharyngeal cancers can affect a person’s thyroid gland. If your thyroid gland could have been affected by treatment, then thyroid function tests should be part of your follow-up care to find out if thyroid hormone medication is needed. Special dental care may also be needed to manage or avoid long-term dental problems.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of oral or oropharyngeal cancer do I have? Where exactly is it located?

• Is HPV a factor in my cancer?

• Can you explain my pathology report (laboratory test results) to me?

• What is the stage and grade of the cancer? What does this mean?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What clinical trials are available for me? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• Should I get a second opinion about my treatment plan?

• If I am a smoker, will quitting help this treatment work better? Can you help me quit?

• What are the possible side effects of each treatment, both in the short term and the long term?

• What can be done to prevent or treat side effects?

• How could this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• What problems with speech, swallowing, or shoulder motion will likely occur? What rehabilitation services are available? Can you provide a referral?

• If my treatment will affect my ability to eat the foods I am used to, how will I receive proper nutrition? Should I talk with a registered dietitian?

• Can you recommend an oncologic dentist who I can see before treatment begins?

• Can you recommend an oncologic speech language pathologist who I can see before treatment begins?

• Should I see other specialists before treatment? Should I talk with a radiation oncologist, medical oncologist, or a reconstructive/plastic surgeon?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before treatment begins?

• If I'm worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about having surgery

• What type of surgery will I have? Will lymph nodes be removed?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term effects of having this surgery?

• Will I need major reconstruction after surgery? If so, how will this affect my ability to speak and eat?

• Will there be a need for a neck dissection (removal of lymph nodes)? If so, what type of dissection will be done? What does this mean?

• Will this surgery affect my appearance in any way? If so, what can I expect?

• How likely is it that I will lose my voice box (larynx)? If this is necessary, what are the options available for voice/speech rehabilitation?

• Can you refer me to an experienced speech-language pathologist to help with my recovery?

Questions to ask about having radiation therapy

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• What side effects can I expect during treatment? Loss of saliva? Loss of taste? Difficulty swallowing?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about having therapies using medication

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

• What will rehabilitation after treatment consist of for me?

• What are the chances of developing a secondary cancer?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.