Treatment Options for Oral Cavity and Oropharyngeal Cancer by Stage
This information is based on AJCC Staging systems prior to 2018 which were primarily based on tumor size and lymph node status. Since the updated staging system for oropharyngeal cancer now also includes the p16 status of the tumor, the stages may be higher or lower than previous staging systems. Whether or not treatment strategies will change with this new staging system are yet to be determined. You should discuss your stage and treatment options with your physician.
The type of treatment your doctor will recommend depends on where the tumor is and how far the cancer has spread. Here are common ways to treat different stages of oral cavity and oropharyngeal cancer. But each situation is different. Your doctor may have reasons for suggesting a treatment option not mentioned here.
Most experts agree that treatment in a clinical trial should be considered for any type or stage of cancer in the head and neck areas. This way people can get the best treatment available now and may also get the new treatments that are thought to be even better.
Stage 0 (carcinoma in situ)
Although cancer in this stage is on the surface layer and has not started to grow into deeper layers of tissue, it can do so if not treated. The usual treatment is surgery (usually Mohs surgery, surgical stripping, or thin resection) to remove the top layers of tissue along with a small margin (edge) of normal tissue. Close follow-up is important to watch for signs that the cancer has come back. Carcinoma in situ that keeps coming back after surgery may need to be treated with radiation therapy.
Nearly all people with this stage survive a long time without the need for more intense treatment. Still, it's important to note that continuing to smoke increases the risk that a new cancer will develop.
Stages I and II
Most patients with stage I or II oral cavity and oropharyngeal cancer do well when treated with surgery and/or radiation therapy. Chemotherapy (chemo) given along with radiation (called chemoradiation) is another option. It can be used alone, but it's most often used after surgery to treat any cancer cells that may be left behind. Both surgery and radiation work well in treating these cancers. The choice depends on your preferences and the expected side effects, including how the treatment might affect how you look and how you swallow and speak.
Lip
Surgery is preferred for small cancers that can be removed. Radiation alone may also be used as the first treatment. In this case, surgery might be needed later if radiation doesn’t completely get rid of the tumor.
Large or deep cancers often require surgery. If needed, reconstructive surgery can help correct the defect in the lip.
If the tumor is thick, it increases the risk that the cancer might have spread to lymph nodes in the neck, so the surgeon may remove them (called lymph node dissection) so they can be checked for cancer spread.
