Survival rates are often used by doctors as a standard way of discussing a person’s prognosis (outlook). Some patients with cancer may want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or may even not want to know them. If you don’t want to read about the survival statistics for oral cavity and oropharyngeal cancer, you don't have to..

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many of these people live much longer than 5 years.

Five-year relative survival rates, such as the numbers below, assume that some people will die of other causes and compares the observed survival of people with cancer with that expected for people without cancer. This is a more accurate way to describe the impact that a particular type and stage of cancer may have on survival.

To get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with these cancers.

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any individual’s case. Many other factors may affect a person’s outlook, such as the patient’s age and health, the treatment received, and how well the cancer responds to treatment. Your doctor can tell you how the numbers below may apply to you, because they are familiar with the aspects of your particular situation.

The following survival statistics come from the National Cancer Institute’s SEER program. They are based on large numbers of patients diagnosed between 2000 and 2014. SEER doesn’t provide recent statistics by AJCC stage. Instead, cancers are divided into the summary stages:

• Local: the cancer is only in the area where it started. This includes stages I and II, as well as some stage III cancers that haven’t spread to any lymph nodes.
• Regional: the cancer has spread to nearby tissues and/or lymph nodes. This includes some stage III cancers, as well as stage IV cancers that haven’t spread to distant sites
• Distant: the cancer has spread to distant sites

Also, these statistics are based on the stage of the cancer when it was first diagnosed. They do not apply to cancers that have come back or spread, for example.

Lip

Tongue

Floor of the mouth

Other cancers

For cancers of the oropharynx and tonsil, the relative 5-year survival rate was 66%, but survival by stage is not available.

For cancers of the gums and other parts of the mouth, the relative survival was 60%, but survival by stage is not available.

Research on oral and oropharyngeal cancers is taking place in many university hospitals, medical centers, and other institutions around the world. Each year, scientists find out more about what causes these diseases, how to prevent them, and how to better treat them. 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. The new and promising treatments discussed here are only available in clinical trials.

DNA changes

A great deal of research is being done to learn about the DNA changes that cause the cells in the oral cavity and oropharynx to become cancer.

One of the changes often found in DNA of oral cancer cells is a mutation of the TP53 gene. The protein produced by this gene (called p53) normally helps keep cells from growing too much and helps to destroy cells that are too damaged to be fixed. Changes in the TP53 gene can lead to increased growth of abnormal cells and cancer.

Some studies suggest that tests to find these gene changes might help find oral and oropharyngeal cancers early. These tests may also be used to better find cancer cells that might have been left behind after surgery and to determine which tumors are most likely to respond to chemo or radiation therapy. The use of p53 gene therapy as a treatment for these cancers is also being studied in early phase clinical trials.

Discoveries about how changes in the DNA of cells in the mouth and throat cause these cells to become cancer are also being applied to experimental treatments intended to reverse these changes. Another type of gene therapy boosts the immune system so it can better find and kill cancer cells. These forms of treatment are still in very early stages of study, so it will be several years before we know if any of them are effective.

Prevention

Some studies are looking at drugs that might help prevent oral cavity and oropharyngeal cancers in people at high risk for them, such as those with pre-cancerous conditions or a history of one of these cancers. Erlotinib (Tarceva^®), a drug that keeps the epidermal growth factor receptor (EGFR) from signaling cells to grow, is one drug being tested. Metformin, a drug already used to treat diabetes, is also under study. This drug may help keep pre-cancerous changes from turning into cancers.

Several other types of drugs are now being tested to help prevent these cancers. Some early research has found that certain extracts of black raspberries might even help prevent these cancers. All of these drugs and compounds need further study.

Treatment

Oral cavity and oropharyngeal cancers that are linked with HPV tend to have a better outcome than those that are HPV negative (HPV-). Clinical trials are starting to look at these HPV+ and HPV- cancers separately. For instance, studies are being done to see if HPV+ cancers can be treated with less chemo and radiation without reducing survival. Researchers are also working on treatments aimed at HPV infections or that target HPV-infected cancer cells. Studies are also looking for better ways to treat HPV- cancers, too, as well as the best ways to use the treatments we already have.

A great deal of research is focusing on improving results from chemotherapy (chemo) for people with these cancers. This includes figuring out which combinations of drugs work best and determining how best to use these drugs along with other forms of treatment. Researchers also continue to develop new chemo drugs that might be more effective against advanced oral and oropharyngeal cancers. They're also looking at whether drugs approved to treat other kinds of cancer might work for these cancers.

Doctors are always looking at newer ways of focusing radiation on tumors more precisely to help them get more radiation to the tumor while limiting side effects to nearby areas. This is especially important for head and neck tumors like oral cavity and oropharyngeal cancers, where there are often many important structures very close to the tumor.

Clinical trials are studying targeted therapies that might block the action of substances (such as growth factors and growth factor receptors) that cause head and neck cancers to grow and spread. Drugs that target the epidermal growth factor receptor (EGFR) may help treat oral and oropharyngeal cancers. For example, the drug erlotinib (Tarceva^®) has shown promising results in early phase trials. Drugs that block the growth of blood vessels tumors need to survive, such as bevacizumab (Avastin^®), are now being studied for use against these cancers as well.

PDT or photodynamic therapy involves using a drug that the cancer cells absorb. The drug is then exposed to a special light which "turns it on" so it kills the cancer cells. This treatment has been used since the 1980s, but there's been a renewed research interest in how it might be used to treat oral and orophayngeal cancers. PDT is less damaging than surgery, and because there are many important structures very close to these tumors, it might be useful in early stage cancers and those that come back (recur) after treatment.

A doctor or dentist may find some oral cavity and oropharyngeal cancers or pre-cancers during a routine exam, but many of these cancers are found because of signs or symptoms a person is having. A dentist or doctor should examine the problem area. Then, if cancer is suspected, tests will be needed.

Exams by a doctor

Medical history and physical exam

As a first step, the doctor will ask you questions about symptoms, possible risk factors, and any other medical problems you may have.

The doctor will examine you to look for possible signs of mouth or throat cancer or pre-cancer. These could be bumps or other changed areas on your head, face or neck, or problems with the nerves of the face and mouth. The doctor will look at the entire inside of your mouth, and might feel around in it with a gloved finger. Other tests may be used to look for changed areas in your mouth or throat, or to get a better sense of what an abnormal area might be. Some of these tests are described in Can Oral Cavity and Oropharyngeal Cancers Be Found Early?

Complete head and neck exam

If there' is a reason to think you might have cancer, your doctor will refer you to a doctor who specializes in these cancers, such as an oral and maxillofacial surgeon or a head and neck surgeon (also known as an ear, nose, and throat [ENT] doctor or an otolaryngologist). This specialist will most likely do a complete head and neck exam, as well as other exams and tests.

During a complete head and neck exam, the specialist will pay special attention to the head and neck area, being sure to look and feel for any abnormal areas. This exam will include the lymph nodes in your neck, which will be felt carefully for any signs of cancer.

Because the oropharynx is part of the throat deep inside the neck, some parts are not easy to see. The doctor may use mirrors or special fiber-optic scopes to look at these areas. Both of these exams can be done in the doctor’s office. For either of them, the doctor may first spray the back of your throat with numbing medicine to help make the exam easier.

• Indirect pharyngoscopy and laryngoscopy: To do this, the doctor uses small mirrors on long, thin handles to look at your throat, the base of your tongue, and part of the larynx (voice box).
• Direct (flexible) pharyngoscopy and laryngoscopy: For this exam, the doctor puts a flexible fiber-optic scope (called an endoscope) in through your mouth or nose to look at areas that can’t easily be seen with mirrors, such as the region behind the nose (nasopharynx) and the larynx (voice box), or to get a clearer look at areas of change that were seen with the mirrors.

Panendoscopy

During a panendoscopy, the doctor uses different types of endoscopes passed down the mouth or nose to do a laryngoscopy, esophagoscopy, and (at times) bronchoscopy. This lets the doctor thoroughly examine the oral cavity, oropharynx, larynx (voice box), esophagus (tube leading to the stomach), and the trachea (windpipe) and bronchi (breathing passageways in the lungs).

This exam is usually done in an operating room while you are under general anesthesia (drugs that put you into a deep sleep). The doctor uses a laryngoscope to look for tumors in the throat and voice box. Other parts of your mouth, nose, and throat are examined, too. If a tumor is found that's large or seems likely to have spread, the doctor may also use an esophagoscope to look into the esophagus or a bronchoscope to look into the trachea and bronchi.

Your doctor will look at these areas through the scopes to find any tumors, see how big they are, and see how far they may have spread to nearby areas. A small piece of tissue from any tumors or other abnormal areas may be taken out (biopsied) to be looked at under a microscope to see if they contain cancer. Biopsies can be done with special tools that are used through the scopes.

Biopsy

In a biopsy, the doctor removes a smal piece of tissue, called a sample, to be looked at under a microscope. A biopsy is the only way to know for sure that oral cavity or oropharyngeal cancer is present. A sample of tissue or cells is always needed to confirm a cancer diagnosis before treatment is started. Several types of biopsies may be used, depending on each case.

Exfoliative cytology

To do this, the doctor scrapes the changed area and smears the collected tissue onto a glass slide. The sample is then stained with a dye so the cells can be seen under the microscope. If any of the cells look abnormal, the area can then be biopsied.

The advantage of this test is that it's easy, and even only slightly abnormal-looking areas can be checked. This can lead to an earlier diagnosis and a greater chance of cure if there is cancer. But this method doesn't show all cancers. And sometimes it’s not possible to tell the difference between cancer cells and abnormal cells that aren't cancer (dysplasia), so a biopsy would still be needed.

Incisional biopsy

For this type of biopsy, the doctor cuts a small piece of tissue from the area that looks abnormal. This is the most common type of biopsy used to check changes in the mouth or throat.

The biopsy can be done either in the doctor’s office or in the operating room, depending on where the tumor is and how easy it is to get a good tissue sample. If it can be done in the doctor’s office, the area around the tumor will be numbed before the biopsy is done. If the tumor is deep inside the mouth or throat, the biopsy might be done in the operating room while you are under general anesthesia (in a deep sleep). The surgeon uses special instruments through an endoscope to take out small tissue samples.

Fine needle aspiration (FNA) biopsy

For this test, the doctor uses a very thin, hollow needle attached to a syringe to pull out (aspirate) some cells from a tumor or lump. These cells are then looked at under a microscope to see if cancer is present.

FNA biopsy is not used to sample abnormal areas in the mouth or throat, but it's sometimes used for a neck lump (mass) that can be felt or seen on a CT scan. FNA can be helpful in several situations, such as:

• Finding the cause of a new neck mass: An FNA biopsy is sometimes used as the first test for someone with a newly found neck lump. It may show that the lump is a benign (not cancer) lymph node that has grown because of a nearby infection, such as a sinus or tooth infection. In this case, treatment of the infection is all that's needed. Or the FNA may find a benign, fluid-filled cyst that can be cured by surgery. But even when the FNA results are benign, if symptoms suggest cancer, more tests (such as pharyngoscopy and panendoscopy) are needed.
  If the FNA finds cancer, the doctor looking at the sample can usually tell what type of cancer it is. If the cells look like a squamous cell cancer, more exams will be done to search for the source of the cancer in the mouth and throat. If the FNA shows a different type of cancer, such as lymphoma or a cancer that has spread to a lymph node in the neck from another organ (like the thyroid, stomach, or lungs) more tests will be done to find it, and treatment for that type of cancer will be given.
• Learning the extent of a known cancer: FNA is often done after oral or oropharyngeal cancer has been diagnosed to find out if the cancer has spread to lymph nodes in the neck. This information will help the doctor decide the best treatment for the cancer.
• Seeing if cancer has come back after treatment: FNA may be used for people whose cancer has been treated by surgery and/or radiation therapy, to find out if a new neck mass in the treated area is scar tissue or cancer that has come back.

Lab tests of biopsy samples

All biopsy samples are sent to a lab to be checked under a microscope by a pathologist, a doctor who is specially trained to diagnose cancer with lab tests. The doctor can usually tell cancer cells from normal cells, as well as what type of cancer it is, by the way the cells look. In some cases, the doctor may need to coat the cells with special stains to help tell what type of cancer it is.

HPV testing

For cancers of the throat, doctors have the biopsy samples tested to see if HPV infection is present. This is a key part of staging (finding out the extent of the cancer) and is considered when making treatment decisions. This information can also help the doctor predict the probable course of the cancer, because people whose cancers are linked to HPV tend to do better than those whose cancers are not.

Imaging tests

Imaging tests use x-rays, magnetic fields, or radioactive substances to create pictures of the inside of your body. Imaging tests are not used to diagnose oral cavity or oropharyngeal cancers, but they may be done for a number of reasons both before and after a cancer diagnosis, including:

• To help look for a tumor if one is suspected
• To learn how far cancer may have spread
• To find out if treatment is working
• To look for possible signs that the cancer has come back (recurred) after treatment

Chest x-ray

After diagnosis, an x-ray of your chest may be done to see if the cancer has spread to your lungs.

Computed tomography (CT)

A CT scan uses x-rays to make detailed, cross-sectional images of your body. Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues and organs in the body. It can help your doctor see the size and location of a tumor, if it's growing into nearby tissues, and if it has spread to lymph nodes in the neck. The test also may be done to look for spread of cancer to the lungs.

Magnetic resonance imaging (MRI)

Like CT scans, MRI scans show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. Because it provides a very detailed picture, an MRI scan may be done to look for spread of the cancer in the neck. These scans can also be very useful in looking at other areas of the body, too, especially the brain and spinal cord.

Positron emission tomography (PET)

For a PET scan, a form of radioactive sugar is put into the blood. Cancer cells use sugar at a higher rate than normal cells, so they will absorb more of the radioactive sugar. After about an hour, you will be moved onto a table in the PET scanner. A special camera is used to create pictures of areas of radioactivity in your body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your whole body.

If you have already been diagnosed with cancer, your doctor might use this test to see if the cancer has spread to lymph nodes or other parts of the body. A PET scan can also be useful if your doctor thinks the cancer may have spread but doesn’t know where.

A PET scan is often combined with a CT scan using a machine that can perform both scans at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET with the more detailed appearance of that area on the CT.

Barium swallow

A barium swallow can be used to see the lining of the upper part of the digestive system, especially the esophagus (the tube that connects the throat to the stomach). In this test, you drink a chalky liquid called barium which coats the walls of your throat and esophagus. A series of x-rays is taken as you swallow. Because people with oral and oropharyngeal cancers are at risk for cancer of the esophagus, your doctor may order this test to check for this cancer. It's also useful to see if the cancer is causing problems with normal swallowing.

Other tests

Other tests may be done as part of a work-up if a patient has been diagnosed with oral cavity or oropharyngeal cancer. These tests are not used to diagnose the cancer, but they may be done for other reasons, such as to see if a person is healthy enough for treatments such as surgery, radiation therapy, or chemotherapy.

Blood tests

No blood tests can diagnose cancer in the oral cavity or oropharynx. Still, your doctor may order routine blood tests to get an idea of your overall health, especially before treatment. Such tests can help diagnose malnutrition, low red blood cell counts (anemia), liver disease, and kidney disease. Blood tests may also suggest the cancer has spread to the liver or bone. When this happens, more tests are needed.

Other tests before surgery

If surgery is planned, you might also have an electrocardiogram (EKG) to make sure your heart is working well. Some people having surgery also may need tests of their lung function. These are called pulmonary function tests (PFTs).

Dental exam

If radiation therapy will be used as part of the treatment, you'll be asked to see a dentist before starting. The dentist will help with preventive dental care and may remove teeth, if needed, before radiation treatment is started.

If the cancer is in your jaw or the roof of your mouth, a dentist with special training (called a prosthodontist) might be asked to evaluate you. This dentist can make replacements for missing teeth or other structures of the oral cavity to help restore your appearance; comfort; and ability to chew, swallow, and speak after treatment. If part of the jaw or roof of the mouth (palate) will be removed with the tumor, the prosthodontist will work to ensure that the replacement artificial teeth and the remaining natural teeth fit together correctly. This can be done with dentures, other types of prostheses, or dental implants.

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.

Oral cavity

For cancers of the floor of the mouth, front of the tongue, inside of the cheek, gums, and hard palate, surgery is the main treatment. Lymph nodes in the neck may be removed (called lymph node dissection) to check them for cancer spread. If it looks like the cancer hasn't been completely removed or if it has a high risk of coming back based on how the cancer cells look under the microscope (grade), radiation (often combined with chemo) may be added.

Radiation can be used instead of surgery as the main treatment for some people. This is most often done for people who can’t have surgery because of other medical problems.

Oropharynx

For cancers of the back of the tongue, soft palate, and tonsils, the main treatment is radiation therapy aimed at the cancer and the lymph nodes in the neck. Surgery can be used as the main treatment (instead of radiation). This would include removing lymph nodes in the neck (lymph node dissection). If any cancer remains after surgery, chemoradiation is often used.

Stages III, IV, and IVA

Oral cavity cancers

These stage III and IVA cancers in the floor of the mouth, front of the tongue, inside of the cheek, gums, and hard palate include bigger cancers, those that have grown into nearby tissues, and/or those that have spread to nearby lymph nodes in the neck. They're often treated with a combination of surgery and radiation. Surgery is often done first and includes taking out some of the neck lymph nodes (lymph node dissection).

Oropharyngeal cancers

These are cancers in the back of the tongue, soft palate, and tonsils that are larger cancers, have grown into nearby tissues, and/or have spread to nearby lymph nodes in the neck. These cancers are often treated with chemoradiation, although radiation and cetuximab may be used in some cases. The effect of combining radiation with both chemo and cetuximab is also being studied. Any cancer that remains after chemoradiation is removed with surgery. If the cancer has spread to neck lymph nodes, they may also need to be removed (a lymph node dissection) after chemoradiation is done.

Another option is to treat first with surgery to remove the cancer and neck lymph nodes. This is often followed by radiation or chemoradiation to lower the chance of the cancer coming back.

The choice of treatment is influenced by where the cancer is, how much it has spread, the expected side effects, patient preferences, and the patient’s current health status.

Some doctors give chemo as the first treatment, followed by chemoradiation, and then surgery if needed. Not all doctors agree with this approach, though.

Stages IVB and IVC

These are HPV-negative cancers that have already spread into nearby tissues, structures, and maybe lymph nodes. Stage IVC cancers have spread to other parts of the body, such as the lungs. These cancers are usually treated with chemo, cetuximab, or both. Other treatments such as radiation may also be used to help relieve symptoms from the cancer or to help prevent new problems.

Clinical trials are looking at different ways of combining radiation and chemo with or without cetuximab or other new agents to improve survival and quality of life, and reduce the need for radical or deforming surgery to treat these advanced cancers in the mouth and throat.

Recurrent oral cavity or oropharyngeal cancer

When cancer come backs after treatment, it's called recurrent cancer. Recurrence can be local (in or near the same place the cancer first started), regional (in nearby lymph nodes), or distant (spread to other organs such as the lungs or bone). Treatment options for recurrent cancers depend on the location and size of the cancer, what treatments have already been used, and the person’s general health.

If the cancer comes back in the same area and radiation therapy was used as the first treatment, surgery is often the next treatment, if the cancer can be removed completely and the patient is healthy enough for surgery. Usually, external beam radiation therapy cannot be repeated in the same site except in certain cases. But internal radiation (brachytherapy) can often be used to control the cancer if it has come back in the place it started. If surgery was used first, more surgery, radiation therapy, chemo, cetuximab, or a combination of these may be options.

If the cancer comes back in the lymph nodes in the neck, the nodes are often removed with surgery (lymph node dissection). This may be followed by radiation.

If the cancer comes back in a distant area, chemo (and/or cetuximab) is the preferred treatment. This may shrink or slow the growth of some cancers for a while and help relieve symptoms, but these cancers are very hard to cure.

If chemo is no longer working, a newer option might be treatment with an immunotherapy drug such as pembrolizumab (Keytruda) or nivolumab (Opdivo). These drugs can help the body’s own immune system attack the cancer. 

If further treatment is recommended, it’s important to talk to your doctor so that you understand what the goal of treatment is — whether it's to try to cure the cancer or to keep it under control for as long as possible and relieve symptoms. This can help you weigh the pros and cons of each treatment. Because these cancers are hard to treat, clinical trials of newer treatments may be a good option for some people.

Chemotherapy (chemo) is the use of anti-cancer drugs to treat cancer. For oral cavity and oropharyngeal cancers, the drugs are given into a vein or taken by mouth, which allows them to enter the bloodstream and reach cancer that has spread throughout the body.

How is chemo used to treat oral cavity and oropharyngeal cancers?

Chemo may be used in several different situations:

• Chemo (typically combined with radiation therapy) may be used instead of surgery as the main treatment for some cancers. (This is called chemoradiation.)
• Chemo (combined with radiation therapy) may be given after surgery to try to kill any small deposits of cancer cells that may have been left behind. This is known as adjuvant chemotherapy.
• Chemo (sometimes with radiation therapy) may be used to try to shrink some larger cancers before surgery. This is called neoadjuvant or induction chemotherapy. In some cases this makes it possible to use less radical surgery and remove less tissue. This can lead to fewer serious side effects from surgery.
• Chemo (with or without radiation therapy) can be used to treat cancers that are too large or have spread too far to be removed by surgery. The goal is to slow the growth of the cancer for as long as possible and to help relieve any symptoms the cancer is causing.

Which chemo drugs are used?

The chemo drugs used most often for cancers of the oral cavity and oropharynx are:

• Cisplatin
• Carboplatin
• 5-fluorouracil (5-FU)
• Paclitaxel (Taxol^®)
• Docetaxel (Taxotere^®)
• Hydroxyurea

Other drugs that are used less often include

• Methotrexate
• Bleomycin
• Capecitabine

A chemo drug may be used alone or combined with other drugs. Combining drugs can often shrink tumors better, but tend to cause more side effects. A commonly used combination is cisplatin and 5-FU. This combination works better than either drug alone in shrinking cancers of the oral cavity and oropharynx. Another combination often used is cisplatin, 5-FU, plus docetaxel.

Doctors give chemotherapy in cycles, with each treatment followed by a rest period to allow the body time to recover. Each chemo cycle lasts for a few weeks.

For cancers of the head and neck (such as oral cavity and oropharyngeal cancers), chemo is often given at the same time as radiation (called chemoradiation). Cisplatin alone is the preferred chemo drug when given along with radiation. Some doctors prefer to give the radiation and chemo before surgery. But for some people, the side effects can be too severe.

For people whose cancers are too advanced for surgery but not widespread, getting chemo and radiation together might produce a better outcome than radiation alone. But this combined approach can be hard to tolerate, especially for people in poor health.

Possible side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles divide quickly and are also affected. This can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Low blood counts

Chemo can affect the blood-producing cells of the bone marrow, leading to low blood cell counts. This can lead to:

• Increased chance of infections (due to low white blood cell counts)
• Easy bruising or bleeding (due to low blood platelet counts)
• Fatigue (due to low red blood cell counts)

Along with the risks above, some side effects are seen more often with certain chemo drugs. For example, 5-FU often causes diarrhea. This might need to be treated with drugs like loperamide. Cisplatin, docetaxel, and paclitaxel can cause nerve damage (called neuropathy). This can lead to numbness and tingling in the hands and feet. This often improves once treatment is stopped, but for some people it can last a long time. Cisplatin can also kidney damage. To help prevent this, intravenous (IV) fluid is given before and after each dose.

Although most side effects get better over time once treatment is stopped, some can last a long time or even be permanent. If your doctor plans treatment with chemo be sure to discuss the drugs that will be used and the possible side effects. Once chemo is started, tell your health care team if you notice any changes or have any side effects. There are ways to prevent or treat many of the side effects of chemo. For example, many drugs are available to help prevent or treat nausea and vomiting.

Cancer survivors can be affected by a number of health problems, but often their greatest concern is facing cancer again. If oral cavity or oropharyngeal cancer comes back after treatment it is called a recurrence. But some cancer survivors may develop a new, unrelated cancer later. This is called a second cancer. No matter what type of cancer you have had, it's still possible to get another (new) cancer, even after surviving the first.

Being treated for cancer doesn’t mean you can’t get another cancer. People who have had cancer can still get the same types of cancers that other people get. In fact, some types of cancer and cancer treatments can be linked to a higher risk of certain second cancers.

Second cancers linked to oropharyngeal cancer

Patients who have had cancers of the oropharynx can get any type of second cancer, but they have an increased risk of:

• Lung cancer
• Esophagus cancer
• Cancers of the larynx and hypopharynx
• Cancer of the oral cavity (including tongue and mouth)
• Another cancer of the oropharynx (this is different than the first cancer coming back)
• Pancreas cancer
• Cancer of the bile ducts
• Anal cancer
• Cancer of the cervix
• Colon cancer
• Rectal cancer
• Stomach cancer
• Chronic myeloid leukemia (CML)
• Hodgkin lymphoma
• Thyroid cancer

Second cancers linked to oral cancer

Survivors of cancer of the oral cavity can get any second cancer, but they have an increased risk of:

• Lung cancer
• Esophagus cancer
• Cancers of the larynx and hypopharynx
• Another cancer of the oral cavity (this is different than the first cancer coming back)
• Cancer of the oropharynx
• Stomach cancer
• Liver cancer
• Colon cancer
• Rectal cancer
• Cancer of the cervix

What you can do

Quit smoking

Many of these cancers are linked to tobacco use. In fact, lung cancer, a cancer strongly linked to smoking tobacco, is the most common second cancer in those with a history of mouth or throat cancer.

While it's not easy to do, quitting tobacco can decrease your risk of many health problems, including another cancer. Smokers who quit have a lower risk of lung, esophagus, larynx, hypopharynx, and oral cavity and oropharynx than those who continue to smoke.

See Stay Away from Tobacco to learn more about quitting tobacco.

Follow-up after treatment

After completing treatment for cancer of the oral cavity or oropharynx, you should still see your doctor regularly. Your doctor may order tests to look for signs that the cancer has come back or spread. These tests are also useful in finding some second cancers, particularly a new lung cancer or cancer in the mouth or throat. Experts don’t recommend any other tests to look for second cancers in people who don’t have symptoms. Let your doctor know about any changes or problems you notice, because they could be caused by the cancer coming back or by a new disease or second cancer.

Survivors of oral cavity and oropharyngeal cancers should follow the American Cancer Society guidelines for the early detection of cancer.

To be in good health, survivors should also:

• Get to and stay at a healthy weight
• Adopt a physically active lifestyle
• Eat a healthy diet, with an focus on plant foods
• Limit alcohol to no more than 1 drink per day for women or 2 per day for men

These steps can also lower the risk of some cancers.

See Second Cancers in Adults to learn more about the causes of second cancers.

Doctors and scientists can’t say for sure what causes each case of oral cavity or oropharyngeal cancer. But they do know many of the risk factors and how some of them may lead to cells becoming cancerous.

Scientists believe that some risk factors, such as tobacco or heavy alcohol use, may cause these cancers by damaging the DNA of cells that line the inside of the mouth and throat.

DNA is the chemical in each of our cells that makes up our genes — the instructions for how our cells function. We usually look like our parents because they are the source of our DNA. However, DNA affects more than how we look. Some genes called proto-oncogenes can help control when cells grow and divide. DNA changes can change these into genes that promote cell division that are called oncogenes. Some genes that slow down cell division or make cells die at the right time and are called tumor suppressor genes. DNA changes can turn off tumor suppressor genes, and lead to cells growing out of control. Cancers can be caused by DNA changes that create oncogenes or turn off tumor suppressor genes.

When tobacco and alcohol damage the cells lining the mouth and throat, the cells in this layer must grow more rapidly to repair this damage. The more often cells need to divide, the more chances there are for them to make mistakes when copying their DNA, which may increase their chances of becoming cancer.

Many of the chemicals found in tobacco can damage DNA directly. Scientists are not sure whether alcohol directly damages DNA, but they have shown that alcohol helps many DNA-damaging chemicals get into cells more easily. This may be why the combination of tobacco and alcohol damages DNA far more than tobacco alone.

This damage can cause certain genes (for example, those in charge of starting or stopping cell growth) to malfunction. Abnormal cells can begin to build up, forming a tumor. With additional damage, the cells may begin to spread into nearby tissue and to distant organs.

In human papillomavirus (HPV) infections, the virus causes cells to make 2 proteins known as E6 and E7. When these are made, they turn off some genes that normally help keep cell growth in check. Uncontrolled cell growth may in some cases lead to cancer. When HPV DNA is found in the tumor cells, especially in non-smokers who drink little or no alcohol, HPV is thought to be the likely cause of the cancer.

Some people inherit DNA mutations (changes) from their parents that increase their risk for developing certain cancers. But inherited oncogene or tumor suppressor gene mutations are not believed to cause very many cancers of the oral cavity or oropharynx.

Some oral cavity and oropharyngeal cancers have no clear cause. Some of these cancers may be linked to other, as of yet unknown risk factors. Others may have no external cause — they may just occur because of random DNA changes (mutations) inside a cell.

Avoid risk factors

Not all cases of oral cavity and oropharyngeal cancer can be prevented, but the risk of developing these cancers can be greatly reduced by avoiding certain risk factors.

Limit smoking and drinking

Tobacco and alcohol are among the most important risk factors for these cancers. Not starting to smoke is the best way to limit the risk of getting these cancers. Quitting tobacco also greatly lowers your risk of developing these cancers, even after many years of use. The same is true of heavy drinking. Limit how much alcohol you drink, if you drink at all.

Avoid HPV infection

The risk of infection of the mouth and throat with the human papillomavirus (HPV) is increased in those who have oral sex and multiple sex partners. But HPV is very common and rarely causes symptoms, so having sex with even one other person can put you at risk.

These infections are also more common in smokers, which may be because the smoke damages their immune system or the cells that line the oral cavity.

Although HPV infection is linked to most cases of oropharyngeal cancer, most people with HPV infections of the mouth and throat do not go on to develop this cancer.

In recent years, vaccines that reduce the risk of infection with certain types of HPV have become available. These vaccines were originally meant to lower the risk of cervical cancer, but they have been shown to lower the risk of other cancers linked to HPV as well, such as cancers of the penis, anus, vulva, and vagina. HPV vaccination also likely lowers the risk of mouth and throat cancers, but this has not yet been proven.

Since these vaccines are only effective if given before someone is infected with HPV, they're given when a person is young, before they're likely to become sexually active.

See our HPV information to learn more.

Limit exposure to ultraviolet (UV) light

Ultraviolet radiation is an important and avoidable risk factor for cancer of the lips, as well as for skin cancer. If possible, limit the time you spend outdoors during the middle of the day, when the sun’s UV rays are strongest. If you are out in the sun, wear a wide-brimmed hat and use sunscreen and lip balm with a sun protection factor (SPF) of at least 30.

Eat a healthy diet

A poor diet has been linked to oral cavity and oropharyngeal cancers, although it’s not exactly clear what substances in healthy foods might be responsible for reducing the risk of these cancers.

In general, eating a healthy diet is much better than adding vitamin supplements to an otherwise unhealthy diet. The American Cancer Society recommends a healthy diet that emphasizes plant foods. This includes eating at least 2½ cups of vegetables and fruits every day. Choosing whole-grain breads, pastas, and cereals instead of refined grains, and eating fish, poultry, or beans instead of processed meat and red meat may also help lower your risk of cancer. See the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention for our full guidelines.

Wear properly fitted dentures

Avoiding sources of oral irritation (such as dentures that don’t fit properly) may help lower your risk for oral cancer.

Treat pre-cancerous growths

Areas of leukoplakia or erythroplakia in the mouth sometimes progress to cancer. Doctors often remove these areas, especially if a biopsy shows they contain areas of dysplasia (abnormal growth) when looked at under a microscope.

But removing areas of leukoplakia or erythroplakia doesn't always keep someone from getting oral cavity cancer. Studies have found that even when these areas are completely removed, people with certain types of erythroplakia and leukoplakia still have a higher chance of developing a cancer in some other area of their mouth.

This may be because the whole lining of the mouth has probably been exposed to the same cancer-causing agents that led to these pre-cancers (like tobacco). This means that the entire area may already have early changes that can lead to cancer. This concept is called field cancerization.

It's important for people who have had these areas removed to continue having check-ups to look for cancer and new areas of leukoplakia or erythroplakia.

There's no routine screening test or plan for oral cavity and oropharyngeal cancers. Still, many pre-cancers and cancers in these areas can be found early (when they're small) during routine screening exams by a dentist, doctor, dental hygienist, or by self-exam.

Some early cancers have symptoms that cause people to seek medical or dental attention. But a lot of these cancers don't cause symptoms until they’ve grown or spread to other tissues. Or, they may cause symptoms much like those caused by problems other than cancer, such as a toothache or ear pain.

Some dentists and doctors recommend that you look at your mouth in a mirror every month to check for any changes, like white patches, sores, or lumps. This is very important if you use or have used tobacco, and/or if you routinely drink alcohol, as these put you at much higher risk for these cancers.

Regular dental check-ups that include an exam of the entire mouth are important in finding oral and oropharyngeal cancers (and pre-cancers) early.

Along with a clinical exam of the mouth and throat, some dentists and doctors may use special dyes and/or lights to look for abnormal areas, especially if you are at higher risk for these cancers. If an abnormal area is spotted, tests may also be used to help decide if they might be cancers (and need to be biopsied) or to choose the best spot to take tissue from for a biopsy. (See Tests for Oral Cavity and Oropharyngeal Cancers to learn more about biopsies.) Here are some of the tests most often used:

• One method uses a dye called toluidine blue. If the dye is spread over an abnormal area, it will turn blue.
• Another method uses laser light. When the light is reflected off abnormal tissue, it looks different from the light reflected off normal tissue.
• Another system uses a special light to look at the changed area after the mouth has been rinsed with a solution of acetic acid (the acid in vinegar).
• If an abnormal area is found, sometimes it can be tested by exfoliative cytology. To do this, the change tissue is scraped with a stiff brush (brush biopsy). The cells from the scraping are sent to a lab where they're checked under the microscope to see if there are pre-cancer or cancer cells.

As you cope with cancer and cancer treatment, we encourage you to have honest, open discussions with your doctor. Ask any question, no matter how small it might seem. Nurses, social workers, and other members of your treatment team may also be able to answer many of your questions. Here are some questions to get you started.

• What kind of oral cavity or oropharyngeal cancer do I have?
• Where is my cancer located?
• Has my cancer spread beyond the main (primary) site?
• What is the stage of my cancer? What does the stage mean?
• Will I need other tests before we can decide on treatment?
• Are there other doctors I need to see?
• How much experience do you have treating this type of cancer?
• What are my treatment choices? Which do you recommend? Why?
• What's the goal of the treatment?
• What are the chances my cancer be cured with treatment?
• How quickly do we need to decide on treatment?
• What should I do to be ready for treatment?
• How long will treatment last? What will it be like? Where will it be done?
• How would treatment affect my daily activities?
• What risks and side effects can I expect? How long are they likely to last?
• Will this treatment affect the way I look? If so, what are my options for reconstruction?
• What are our options if the treatment doesn’t work or if the cancer comes back (recurs)?
• What type of follow-up will I need after treatment?
• Where can I find more information and support?

Along with these sample questions, be sure to write down some of your own. For instance, you might want more information about recovery times so you can plan your work or activity schedule. Or you may want to ask about second opinions or about clinical trials for which you may qualify. You can find more information about communicating with your health care team in The Doctor-Patient Relationship.

For many people with oral cavity or oropharyngeal cancer cancer, treatment can remove or destroy the cancer. The end of treatment can be both stressful and exciting. You may be relieved to finish treatment, but yet it’s hard not to worry about cancer coming back. This is very common if you’ve had cancer.

For other people, the cancer might never go away completely. Some people may get regular treatment with chemotherapy or targeted therapy or other treatments to try and help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. 

Life after cancer means returning to some familiar things and also making some new choices.

Follow-up care

After you have completed treatment, your doctors will still want to watch you closely. It's very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you are having and will examine you. Your doctor may also order lab tests or imaging tests (such as MRI or CT scans) to look for signs of cancer return (called cancer recurrence). Your health care team will discuss which tests should be done and how often based on the type and stage of your cancer, the type of treatment you had, and the response to that treatment.

People with cancer of the oral cavity or oropharynx may develop recurrences or new cancers in the head and neck area or the lungs. With improvements in surgery and radiation therapy, the ability to control the main (primary) cancer has greatly improved. But development of second cancers in the head and neck or lungs remains an important risk. Because of this, you will be followed closely after treatment. Recurrences happen most often in the first 2 years after treatment, so you will be examined every few months during the first 2 years and then less often after that.

If you were treated with radiation to the neck, blood tests to look at thyroid function may be needed about every 6 months.

Many studies have found that some people's quality of life tends to get worse in the first few months after treatment. But after that, for people who have given up smoking and drinking alcohol, things tend to get better. Within a year, many people are feeling reasonably well and happy.

Almost any cancer treatment can have side effects. Some may last for a few weeks to several months, but others can last the rest of your life. Don’t hesitate to tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them. Keep in mind that it's very important to report any new symptoms to your doctor right away, because they may prompt your doctor to do tests that could help find recurrent cancer as early as possible, when the likelihood of successful treatment is greatest.

Problems with eating and nutrition

Cancers of the mouth and throat and their treatments can sometimes cause problems such as loss or change in taste, dry mouth, or even loss of teeth. This can make it hard to eat, which can lead to weight loss and weakness due to poor nutrition.

Some people may need to adjust what they eat during and after treatment. Some may even need a feeding tube placed into the stomach, at least for a short time during and after treatment. You may want to consult with a nutritionist to help find ways to meet your nutritional needs. If a dry mouth is making it hard to eat, your doctor may recommend a saliva substitute. This can help you maintain your weight and nutritional intake. Again, talk to your doctor about any problems you're having. There are often ways to help.

Speech and swallowing therapy

Oral cavity or oropharyngeal cancers and their treatments may affect a person’s speech and ability to swallow. A speech therapist can often help with these. These experts are knowledgeable about speech and swallowing problems. They can help you learn to manage these problems and do the things you want and need to do.

Ask your doctor for a survivorship care plan

Talk with your doctor about developing a survivorship care plan for you. This plan might include: 

• A suggested schedule for follow-up exams and tests
• A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
• A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
• Diet and physical activity suggestions
• Reminders to keep your appointments with your primary care provider (PCP), who will monitor your general health care 

Keeping health insurance and copies of your medical records

Even after treatment, it’s very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history. It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.

Can I lower my risk of oral cavity or oropharyngeal cancer progressing or coming back?

If you have (or have had) oral cavity or oropharyngeal cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Unfortunately, it’s not yet clear if there are things you can do that will help.

Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure. However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of oral cavity or oropharyngeal cancer or other cancers.

About dietary supplements

So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of oral cavity or oropharyngeal cancer progressing or coming back. This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.

Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do. If you’re thinking about taking any type of nutritional supplement, talk to your health care team. They can help you decide which ones you can use safely while avoiding those that might be harmful.

If the cancer comes back

If the cancer does come back (recur) at some point, your treatment options will depend on where the cancer is located, what treatments you’ve had before, and your health. For more information on how recurrent cancer is treated, see Treatment Options for Oral Cavity and Oropharyngeal Cancer by Stage.

For more general information, you may also want to see Understanding Recurrence.

Could I get a second cancer after treatment?

People who’ve had oral cavity or oropharyngeal cancer can still get other cancers. In fact, oral cavity or oropharyngeal cancer survivors are at higher risk for getting some other types of cancer. Learn more in Second Cancers After Oral Cavity or Oropharyngeal Cancer.

Getting emotional support

Some amount of feeling depressed, anxious, or worried is normal when cancer is a part of your life. Some people are affected more than others. But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others. Learn more in Life After Cancer.