Treatments for locally advanced oral cancer

The following are treatment options for locally advanced (stage 3, stage 4A and stage 4B) oral cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is usually the first treatment for locally advanced oral cancer. The type of surgery done will depend on where the cancer is in the mouth.

The following procedures are commonly used to treat locally advanced oral cancer.

A wide local excision removes the tumour and a small amount of healthy tissue with it (called the surgical margin). The size and depth of the surgical margin depends on the location of the tumour.

A glossectomy removes the tumour and part or all of the tongue.

A neck dissection removes lymph nodes from the neck. It may be done to check if the cancer has spread to the lymph nodes.

A sentinel lymph node biopsy (SLNB) finds and removes the first lymph node (or first few lymph nodes) in a group of lymph nodes to see if it contains cancer cells.

Reconstructive surgery may be needed to rebuild the part of the mouth where a large tumour has been removed. A skin graft (skin from another part of the body) or a flap (skin, muscle, bone or a combination of these from another part of the body) may be used in the reconstruction.

Find out more about surgery for oral cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Locally advanced oral cancer is usually treated with external radiation therapy, which uses a machine outside the body to direct a beam of radiation through the skin to a specific part of the body.

You may have radiation therapy after surgery that removes a locally advanced oral cancer.

Radiation therapy and chemotherapy may be given during the same time period to treat locally advanced oral cancer. This is called chemoradiation.

Find out more about radiation therapy for oral cancer.

Chemotherapy uses drugs to destroy cancer cells. Chemotherapy or chemoradiation may be offered for locally advanced oral cancer.

Find out more about chemotherapy for oral cancer.

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer.

Pembrolizumab (Keytruda) may be used to treat locally advanced oral cancer that can be removed by surgery (resectable). You may be offered pembrolizumab on its own or with chemotherapy or radiation therapy.

Find out more about immunotherapy for oral cancer.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer.

Cetuximab (Erbitux) may be given with radiation therapy to treat locally advanced oral cancer.

Find out more about targeted therapy for oral cancer.

Talk to your doctor about clinical trials open to people with oral cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.