National Cancer Institute

at the National Institutes of Health

Lip and Oral Cavity Cancer Treatment (PDQ®)

Patient Version

Last Modified: 10/21/2011

Treatment Options by Stage

Stage I Lip and Oral Cavity Cancer
Stage II Lip and Oral Cavity Cancer
Stage III Lip and Oral Cavity Cancer
Stage IV Lip and Oral Cavity Cancer

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Stage I Lip and Oral Cavity Cancer

Treatment of stage I lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

Surgery (wide local excision).
Internal radiation therapy with or without external radiation therapy.

Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

Surgery (wide local excision).
Internal radiation therapy with or without external radiation therapy.
Radiation therapy to lymph nodes in the neck.

Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include the following:

Surgery (wide local excision) for tumors smaller than 1 centimeter, with or without internal and/or external radiation therapy.
Surgery (wide local excision with skin graft) or radiation therapy for larger tumors.

Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

Surgery (wide local excision) for tumors smaller than ½ centimeter.
Surgery (wide local excision) or radiation therapy for larger tumors.

Lower gingiva

If cancer is in the lower gingiva (gums), treatment may include the following:

Surgery (wide local excision, which may include removing part of the jawbone, and skin graft).
Radiation therapy with or without surgery.

Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

Surgery (wide local excision, which may include removing part of the jawbone.)
Radiation therapy with or without surgery.

Upper gingiva or hard palate

If cancer is in the upper gingiva (gums) or the hard palate (the roof of the mouth), treatment is usually surgery (wide local excision) with or without radiation therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I lip and oral cavity cancer ¹. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ².

Stage II Lip and Oral Cavity Cancer

Treatment of stage II lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

Surgery (wide local excision).
External radiation therapy and/or internal radiation therapy.

Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

Radiation therapy and/or surgery (wide local excision).
Internal radiation therapy with surgery (neck dissection).

Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include the following:

Radiation therapy for tumors that are 3 centimeters or smaller.
Surgery (wide local excision) and/or radiation therapy for larger tumors.

Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

Surgery (wide local excision).
Radiation therapy.
Surgery (wide local excision) followed by external radiation therapy, with or without internal radiation therapy, for large tumors.

Lower gingiva

If cancer is in the lower gingiva (gums), treatment may include the following:

Surgery (wide local excision, which may include removing part of the jawbone, and a skin graft).
Radiation therapy alone or after surgery.

Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

Surgery (wide local excision, which includes removing part of the jawbone).
Radiation therapy with or without surgery.

Upper gingiva or hard palate

If cancer is in the upper gingiva (gums) or the hard palate (the roof of the mouth), treatment may include the following:

Surgery (wide local excision) with or without radiation therapy.
Radiation therapy alone.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II lip and oral cavity cancer ³. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ².

Stage III Lip and Oral Cavity Cancer

Treatment of stage III lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

Surgery and external radiation therapy with or without internal radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of hyperfractionated radiation therapy.

Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

External radiation therapy with or without internal radiation therapy.
Surgery (wide local excision) followed by radiation therapy.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of hyperfractionated radiation therapy.

Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include the following:

Surgery (wide local excision) with or without radiation therapy.
Radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of hyperfractionated radiation therapy.

Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

Surgery (wide local excision, which may include removing part of the jawbone, with or without neck dissection).
External radiation therapy with or without internal radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of hyperfractionated radiation therapy.

Lower gingiva

If cancer is in the lower gingiva (gums), treatment may include the following:

Surgery (wide local excision) with or without radiation therapy. Radiation may be given before or after surgery.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of hyperfractionated radiation therapy.

Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

Surgery to remove the tumor, lymph nodes, and part of the jawbone, with or without radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of hyperfractionated radiation therapy.

Upper gingiva

If cancer is in the upper gingiva (gums), treatment may include the following:

Radiation therapy.
Surgery (wide local excision) and radiation therapy.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of hyperfractionated radiation therapy.

Hard palate

If cancer is in the hard palate (the roof of the mouth), treatment may include the following:

Radiation therapy.
Surgery (wide local excision) with or without radiation therapy.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of hyperfractionated radiation therapy.

Lymph nodes

For cancer that may have spread to lymph nodes, treatment may include the following:

Radiation therapy and/or surgery (neck dissection).
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of hyperfractionated radiation therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III lip and oral cavity cancer ⁴. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ².

Stage IV Lip and Oral Cavity Cancer

Treatment of stage IV lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

Surgery and external radiation therapy with or without internal radiation therapy.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of hyperfractionated radiation therapy.

Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

Surgery to remove the tongue and sometimes the larynx (voice box) with or without radiation therapy.
Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of hyperfractionated radiation therapy.

Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include the following:

Surgery (wide local excision) and/or radiation therapy.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of hyperfractionated radiation therapy.

Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

Surgery before or after radiation therapy.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of hyperfractionated radiation therapy.

Lower gingiva

If cancer is in the lower gingiva (gums), treatment may include the following:

Surgery and/or radiation therapy.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of hyperfractionated radiation therapy.

Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

Surgery to remove the tumor, lymph nodes, and part of the jawbone, followed by radiation therapy.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of hyperfractionated radiation therapy.

Upper gingiva or hard palate

If cancer is in the upper gingiva (gums) or hard palate (the roof of the mouth), treatment may include the following:

Surgery with radiation therapy.
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of hyperfractionated radiation therapy.

Lymph nodes

For cancer that may have spread to lymph nodes, treatment may include the following:

Radiation therapy and/or surgery (neck dissection).
A clinical trial of chemotherapy and radiation therapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of hyperfractionated radiation therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV lip and oral cavity cancer ⁵. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ².

Glossary Terms

buccal mucosa (BUH-kul myoo-KOH-suh)

The inner lining of the cheeks.

cancer (KAN-ser)

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

centimeter (SEN-tih-MEE-ter)

A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.

chemotherapy (KEE-moh-THAYR-uh-pee)

Treatment with drugs that kill cancer cells.

clinical trial (KLIH-nih-kul TRY-ul)

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

external radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee)

A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.

gingiva (JIN-jih-vuh)

The tissue of the upper and lower jaws that surrounds the base of the teeth. Also called gums.

hard palate (... PAL-et)

The front, bony part of the roof of the mouth.

hyperfractionated radiation therapy (HY-per-FRAK-shuh-NAY-ted RAY-dee-AY-shun THAYR-uh-pee)

Radiation treatment in which the total dose of radiation is divided into small doses and treatments are given more than once a day. Also called hyperfractionation and superfractionated radiation therapy.

internal radiation therapy (in-TER-nul RAY-dee-AY-shun THAYR-uh-pee)

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.

larynx (LAYR-inx)

The area of the throat containing the vocal cords and used for breathing, swallowing, and talking. Also called voice box.

lymph node (limf node)

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

neck dissection (... dy-SEK-shun)

Surgery to remove lymph nodes and other tissues in the neck.

oral cavity (OR-ul KA-vih-tee)

Refers to the mouth. It includes the lips, the lining inside the cheeks and lips, the front two thirds of the tongue, the upper and lower gums, the floor of the mouth under the tongue, the bony roof of the mouth, and the small area behind the wisdom teeth.

palliative therapy (PA-lee-uh-tiv THAYR-uh-pee)

Treatment given to relieve the symptoms and reduce the suffering caused by cancer and other life-threatening diseases. Palliative cancer therapies are given together with other cancer treatments, from the time of diagnosis, through treatment, survivorship, recurrent or advanced disease, and at the end of life.

quality of life (KWAH-lih-tee ... life)

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

retromolar trigone (reh-troh-MOH-ler TRY-gone)

The small area behind the wisdom teeth.

skin graft (skin graft)

Skin that is moved from one part of the body to another.

stage (stayj)

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

stage I lip and oral cavity cancer (... OR-ul KA-vih-tee KAN-ser)

The tumor is 2 centimeters or smaller. Cancer has not spread to lymph nodes.

stage II lip and oral cavity cancer (... OR-ul KA-vih-tee KAN-ser)

The tumor is larger than 2 centimeters but not larger than 4 centimeters, and cancer has not spread to lymph nodes.

stage III lip and oral cavity cancer (... OR-ul KA-vih-tee KAN-ser)

The tumor may be any size and has spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the tumor; or the tumor is larger than 4 centimeters.

stage IV lip and oral cavity cancer (... OR-ul KA-vih-tee KAN-ser)

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVA, (1) the tumor has spread through tissue in the lip or oral cavity into nearby tissue and/or bone (jaw, tongue, floor of mouth, maxillary sinus, or skin of chin or nose); cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the tumor; or (2) the tumor is any size or has spread through tissue in the lip or oral cavity into nearby tissue and/or bone (jaw, tongue, floor of mouth, maxillary sinus, or skin of chin or nose). Cancer has spread to one lymph node on the same side of the neck as the tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters, or to more than one lymph node on the same side of the neck as the tumor and the lymph nodes are not larger than 6 centimeters, or to lymph nodes on the opposite side of the neck as the tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters. In stage IVB, (1) the tumor may be any size and has spread to one or more lymph nodes that are larger than 6 centimeters; or (2) the tumor has spread further into the muscles or bones in the oral cavity, or to the base of the skull and/or the carotid artery. Cancer may have spread to one or more lymph nodes anywhere in the neck. In stage IVC, the tumor has spread beyond the lip or oral cavity to distant parts of the body, such as the lungs. The tumor may be any size and may have spread to lymph nodes.

surgery (SER-juh-ree)

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

symptom (SIMP-tum)

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

tumor (TOO-mer)

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

wide local excision (…LOH-kul ek-SIH-zhun)

Surgery to cut out the cancer and some healthy tissue around it.

Table of Links
¹	http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?Diagnosis=40092&tt=1&a mp;format=1&cn=1
²	http://www.cancer.gov/clinicaltrials
³	http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?Diagnosis=40093&tt=1&a mp;format=1&cn=1
⁴	http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?Diagnosis=40094&tt=1&a mp;format=1&cn=1
⁵	http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?Diagnosis=40095&tt=1&a mp;format=1&cn=1

National Cancer Institute

at the National Institutes of Health

Lip and Oral Cavity Cancer Treatment (PDQ®)

Treatment Options by Stage

Glossary Terms

Table of Links