Treatments for recurrent or metastatic oral cancer

Recurrent oral cancer means that the cancer has come back after it has been treated. Most recurrences come back in the same place that the cancer first started (called a local recurrence) or in the tissues or lymph nodes close to where it first started (called a regional recurrence).

Sometimes, the cancer can come back in another part of the body. This spread is metastatic cancer. It can also be called distant metastasis or distant recurrence. Metastatic oral cancer (stage 4C) is treated like recurrent oral cancer.

Your healthcare team will work with you to develop a treatment plan. They will suggest treatments based on:

• what treatments were used before
• where the cancer comes back
• your needs and wants

You may be offered the following treatments for recurrent oral cancer or metastatic oral cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Recurrent or metastatic oral cancer is sometimes 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 if you haven't already had it and you can't have surgery.

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

Radiation therapy may be used to relieve pain or control symptoms (called palliative radiation therapy).

Find out more about radiation therapy for oral cancer.

Chemotherapy uses drugs to destroy cancer cells.

You may have chemotherapy or chemoradiation if you haven't already had it and you can't have surgery.

Chemotherapy may also be used alone to relieve pain or symptoms (called palliative chemotherapy).

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 as a first-line therapy to treat recurrent oral cancer or metastatic oral cancer that cannot be removed by surgery (unresectable). You may be offered pembrolizumab on its own or with chemotherapy.

Nivolumab (Opdivo) may be used to treat recurrent oral cancer or metastatic oral cancer that stops responding to chemotherapy drugs such as cisplatin or carboplatin.

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 metastatic oral cancer.

Find out more about targeted therapy for oral cancer.

Surgery is sometimes offered for recurrent or metastatic oral cancer.

It may be used to remove a tumour that comes back (recurs) in the same place that the cancer first started (called a local recurrence) or in the tissues or lymph nodes close to where it first started (called a regional recurrence).

It may also be used to relieve pain or control symptoms (called palliative surgery).

Find out more about surgery 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.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.