Treatment
Many people with oral cancer want to take an active part in making decisions
about their medical care. It is natural to want to learn all you can about your
disease and your treatment choices. However, shock and stress after the
diagnosis can make it hard to think of everything you want to ask the doctor.
It often helps to make a list of questions before an appointment. To help
remember what the doctor says, you may take notes or ask whether you may use a
tape recorder. You may also want to have a family member or friend with you
when you talk to the doctor—to take part in the discussion, to take notes, or
just to listen.
Your doctor may refer you to a specialist, or you may ask for a referral.
Specialists who treat oral cancer include
oral and maxillofacial surgeons,
otolaryngologists
(ear, nose, and throat doctors),
medical oncologists,
radiation oncologists,
and
plastic surgeons. You may be referred to a team that
includes specialists in
surgery,
radiation therapy,
or
chemotherapy. Other
health care professionals who may work with the specialists as a team include a
dentist,
speech pathologist,
nutritionist,
and
mental health counselor.
Before starting treatment, you might want a second opinion about the diagnosis
and the treatment plan. Some insurance companies require a second opinion;
others may cover a second opinion if you or your doctor requests it.
There are a number of ways to find a doctor for a second opinion:
-
Your doctor may refer you to one or more specialists. At cancer centers,
several specialists often work together as a team.
-
The Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby
treatment centers.
-
A local or state medical or dental society, a nearby hospital, or a medical or
dental school can usually provide the names of specialists in your area.
-
The American Board of Medical Specialties (ABMS)
has a list of doctors who have had training
and exams in their specialty. You can find this list
in the Official ABMS Directory of Board Certified Medical Specialists.
The directory is available in most public libraries. Or you can look
up doctors at
http://www.abms.org. (Click on
Who's Certified.)
-
The American Dental Association (ADA) Web site provides a list of dentists by
specialty and location. The ADA Member Directory is available on the Internet
at
http://www.ada.org/public/directory/index.html.
-
The NCI provides a helpful fact sheet on how to find a doctor called "How To
Find a Doctor or Treatment Facility If You Have Cancer." It is available on the
Internet at
http://www.cancer.gov/publications.
You may want to ask the doctor these questions before treatment begins:
- What is the stage of the disease? Has the cancer spread? If so, where?
- What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible
side effects
of each treatment? How will treatment affect my normal activities? Will I be given anything to control side effects?
- How long will treatment last?
- Will I have to stay in the hospital?
- What is the treatment likely to cost? Is this treatment covered by my insurance plan?
- Would a
clinical trial
(research study) be appropriate for me? (See
"The Promise of Cancer Research"
for more information about clinical trials.)
- Should I try to quit smoking?
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The choice of treatment depends mainly on your general health, where in your
mouth or oropharynx the cancer began, the size of the tumor, and whether the
cancer has spread. Your doctor can describe your treatment choices and the
expected results. You will want to consider how treatment may affect normal
activities such as swallowing and talking, and whether it will change the way
you look. You and your doctor can work together to develop a treatment plan
that meets your needs and personal values.
You do not need to ask all your questions or understand all the answers at
once. You will have other chances to ask your doctor to explain things that are
not clear and to ask for more information.
Oral cancer treatment may include surgery, radiation therapy, or chemotherapy.
Some patients have a combination of treatments.
At any stage of disease, people with oral cancer may have treatment to control
pain and other symptoms, to relieve the side effects of therapy, and to ease
emotional and practical problems. This kind of treatment is called
supportive care,
symptom management,
or
palliative care.
Information about supportive care
is available on NCI's Web site at http://www.cancer.gov and from NCI's Cancer
Information Service at 1-800-4-CANCER.
You may want to talk to the doctor about taking part in a clinical trial, a
research study of new treatment methods. The section on
"The Promise of Cancer
Research" has more information about clinical trials.
Surgery to remove the tumor in the mouth or throat is a common treatment for
oral cancer. Sometimes the
surgeon
also removes lymph nodes in the neck. Other
tissues in the mouth and neck may be removed as well. Patients may have surgery
alone or in combination with radiation therapy.
You may want to ask the doctor these questions before having surgery:
- What kind of operation do you recommend for me?
- Do I need any lymph nodes removed? Why?
- How will I feel after the operation? How long will I be in the hospital?
- What are the risks of surgery?
- Will I have trouble speaking, swallowing, or eating?
- Where will the scars be? What will they look like?
- Will I have any long-term effects?
- Will I look different?
- Will I need
reconstructive
or
plastic surgery?
When can that be done?
- Will I lose my teeth? Can they be replaced? How soon?
- Will I need to see a specialist for help with my speech?
- When can I get back to my normal activities?
- How often will I need checkups?
- Would a clinical trial be appropriate for me?
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Radiation therapy (also called
radiotherapy)
is a type of
local therapy. It
affects cells only in the treated area. Radiation therapy is used alone for
small tumors or for patients who cannot have surgery. It may be used before
surgery to kill cancer cells and shrink the tumor. It also may be used after
surgery to destroy cancer cells that may remain in the area.
Radiation therapy uses high-energy rays to kill cancer cells. Doctors use two
types of radiation therapy to treat oral cancer:
-
External radiation: The radiation comes from a machine. Patients go to the
hospital or clinic once or twice a day, generally 5 days a week for several
weeks.
-
Internal radiation
(implant radiation): The
radiation comes from
radioactive
material placed in seeds, needles, or thin plastic tubes put directly in the
tissue. The patient stays in the hospital. The implants remain in place for
several days. Usually they are removed before the patient goes home.
Some people with oral cancer have both kinds of radiation therapy.
You may want to ask the doctor these questions before having radiation therapy:
- Which type of radiation therapy do you recommend for me? Why do I need this treatment?
- When will the treatments begin? When will they end?
- Should I see my dentist before I start treatment? If I need dental treatment, how much time does my mouth need to heal before radiation therapy starts?
- What are the risks and side effects of this treatment? What can I do about them?
- How will I feel during therapy?
- What can I do to take care of myself during therapy?
- How will my mouth and face look afterward?
- Are there any long-term effects?
- Can I continue my normal activities?
- Will I need a special diet? For how long?
- How often will I need checkups?
- Would a clinical trial be appropriate for me?
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Chemotherapy uses anticancer drugs to kill cancer cells. It is called
systemic therapy
because it enters the bloodstream and can affect cancer cells
throughout the body.
Chemotherapy is usually given by injection. It may be given in an outpatient
part of the hospital, at the doctor's office, or at home. Rarely, a hospital
stay may be needed.
You may want to ask the doctor these questions before having chemotherapy:
- Why do I need this treatment?
- Which drug or drugs will I have?
- How do the drugs work?
- Should I see my dentist before I start chemotherapy? If I need dental treatment, how much time does my mouth need to heal before the chemotherapy begins?
- What are the expected benefits of the treatment?
- What are the risks and possible side effects of treatment? What can I do about them?
- When will treatment start? When will it end?
- Will I need to stay in the hospital? How long?
- How will treatment affect my normal activities?
- Would a clinical trial be appropriate for me?
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