Introduction
The Mouth and Throat
Understanding Cancer
Oral Cancer: Who's at Risk?
Early Detection
Symptoms
Diagnosis
Staging
Treatment
Side Effects of Cancer Treatment
Nutrition
Reconstruction
Rehabilitation
Follow-up Care
Support for People with Oral Cancer
The Promise of Cancer Research
National Cancer Institute Information Resources
National Institute of Dental and Craniofacial Research Information Resources
Introduction
Each year in the United States, about 29,000 people learn they have
cancer* of the oral cavity (the
mouth and lips) or the oropharynx (the part of the throat at the back of the
mouth).
This National Cancer Institute (NCI) booklet (NIH Publication No. 03-1574) has important information to help people with oral cancer and their family and friends better understand this disease. It discusses possible causes, symptoms, diagnosis, and treatment of
the disease. It also has information about rehabilitation and about sources of
support to help patients cope with oral cancer.
Scientists are studying oral cancer to learn more about this disease, and
doctors are exploring new ways to treat it. This research keeps increasing our
knowledge about oral cancer. The NCI provides the most up-to-date information
by telephone and on the Internet:
-
Telephone (1-800-4-CANCER): Information Specialists at NCI's Cancer
Information Service can answer questions about cancer and can send materials
published by NCI.
-
Internet (http://www.cancer.gov): Cancer.gov is NCI's Web site. It has a
wide range of information that is updated regularly. People can ask questions
online and get immediate help through LiveHelp 1. Many NCI booklets and fact
sheets can be viewed at
http://www.cancer.gov/publications 2. People in the United
States and its territories may use this Web site to order publications. This
Web site also explains how people outside the United States can mail or fax
their requests for NCI publications.
*Words that may be new to readers appear in italics. The "Dictionary 3"
section explains these terms. Some words in the "Dictionary" have a
"sounds-like" spelling to show how to pronounce them.
The Mouth and Throat
This booklet is about cancers that occur in the mouth
(oral cavity) and the part
of the throat at the back of the mouth
(oropharynx).
The oral cavity and
oropharynx have many parts:
This picture shows the parts of the mouth and throat.
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This picture shows the area under the tongue.
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Understanding Cancer
Cancer begins in
cells,
the building blocks that make up
tissues. Tissues make
up the
organs
of the body.
Normally, cells grow and divide to form new cells as the body needs them. When
cells grow old, they die, and new cells take their place.
Sometimes this orderly process goes wrong. New cells form when the body does not
need them, and old cells do not die when they should. These extra cells can
form a mass of tissue called a growth or
tumor.
Tumors can be
benign
or
malignant:
-
Benign tumors are not cancer:
-
Benign tumors are rarely life-threatening.
-
Generally, benign tumors can be removed, and they usually do not grow back.
-
Cells from benign tumors do not invade the tissues around them.
-
Cells from benign tumors do not spread to other parts of the body.
-
Malignant tumors are cancer:
-
Malignant tumors are generally more serious than benign tumors. They may be
life-threatening.
-
Malignant tumors often can be removed, but sometimes they grow back.
-
Cells from malignant tumors can invade and damage nearby tissues and organs.
-
Cells from malignant tumors can spread to other parts of the body. The cells
spread by breaking away from the original cancer
(primary tumor)
and entering
the bloodstream or
lymphatic system.
They invade other organs, forming new
tumors and damaging these organs. The spread of cancer is called
metastasis.
Oral cancer is part of a group of cancers called
head and neck cancers. Oral
cancer can develop in any part of the oral cavity or oropharynx. Most oral
cancers begin in the tongue and in the floor of the mouth. Almost all oral
cancers begin in the flat cells
(squamous cells)
that cover the surfaces of the
mouth, tongue, and lips. These cancers are called
squamous cell carcinomas.
When oral cancer spreads (metastasizes), it usually travels through the
lymphatic system. Cancer cells that enter the lymphatic system are carried
along by
lymph,
a clear, watery fluid. The cancer cells often appear first in
nearby
lymph nodes
in the neck.
Cancer cells can also spread to other parts of the neck, the lungs, and other
parts of the body. When this happens, the new tumor has the same kind of
abnormal cells as the primary tumor. For example, if oral cancer spreads to the
lungs, the cancer cells in the lungs are actually oral cancer cells. The
disease is metastatic oral cancer, not lung cancer. It is treated as oral
cancer, not lung cancer. Doctors sometimes call the new tumor "distant" or
metastatic disease.
Oral Cancer: Who's at Risk?
Doctors cannot always explain why one person develops oral cancer and another
does not. However, we do know that this disease is not contagious. You cannot
"catch" oral cancer from another person.
Research has shown that people with certain
risk factors
are more likely than
others to develop oral cancer. A risk factor is anything that increases your
chance of developing a disease.
The following are risk factors for oral cancer:
-
Tobacco: Tobacco use accounts for most oral cancers. Smoking cigarettes,
cigars, or pipes; using chewing tobacco; and dipping snuff are all linked to
oral cancer. The use of other tobacco products (such as
bidis
and
kreteks) may
also increase the risk of oral cancer. Heavy smokers who use tobacco for a long
time are most at risk. The risk is even higher for tobacco users who drink
alcohol heavily. In fact, three out of four oral cancers occur in people who
use alcohol, tobacco, or both alcohol and tobacco.
-
Alcohol: People who drink alcohol are more likely to develop oral cancer than
people who don't drink. The risk increases with the amount of alcohol that a
person consumes. The risk increases even more if the person both drinks alcohol
and uses tobacco.
-
Sun: Cancer of the lip can be caused by exposure to the sun. Using a lotion or
lip balm that has a sunscreen can reduce the risk. Wearing a hat with a brim
can also block the sun's harmful rays. The risk of cancer of the lip increases
if the person also smokes.
-
A personal history of head and neck cancer: People who have had head and neck
cancer are at increased risk of developing another primary head and neck
cancer. Smoking increases this risk.
Quitting tobacco reduces the risk of oral cancer. Also, quitting reduces the chance that a person with oral cancer will get a second cancer in the head and neck region. People who stop smoking can also reduce their risk of cancer of the lung, larynx, mouth, pancreas, bladder, and esophagus. There are many resources to help smokers quit:
- The Cancer Information Service at 1-800-4-CANCER can talk with callers about ways to quit smoking and about groups that offer help to smokers who want to quit. Groups offer counseling in person or by telephone.
- Also, your doctor or dentist can help you find a local smoking cessation program.
- Your doctor can tell you about medicine (bupropion) or about nicotine replacement therapy, which comes as a patch, gum, lozenges, nasal spray, or inhaler.
- The "National Cancer Institute Information Resources 4" section has information about the Federal Government's smoking cessation Web site, http://www.smokefree.gov.
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Some studies suggest that not eating enough fruits and vegetables may increase
the chance of getting oral cancer. Scientists also are studying whether
infections with certain
viruses
(such as the
human papillomavirus) are linked
to oral cancer.
If you think you may be at risk, you should discuss this concern with your
doctor or dentist. You may want to ask about an appropriate schedule for
checkups. Your health care team will probably tell you that not using tobacco
and limiting your use of alcohol are the most important things you can do to
prevent oral cancers. Also, if you spend a lot of time in the sun, using a lip
balm that contains sunscreen and wearing a hat with a brim will help protect
your lips.
Early Detection
Your regular checkup is a good time for your dentist or doctor to check your entire mouth for signs of cancer. Regular checkups can detect the early stages of oral cancer or conditions that may lead to oral cancer. Ask your doctor or dentist about checking the tissues in your mouth as part of your routine exam.
Symptoms
Common symptoms of oral cancer include:
- Patches inside your mouth or on your lips that are white, a mixture of red and white, or red
- White patches (leukoplakia) are the most common. White patches sometimes become malignant.
- Mixed red and white patches
(erythroleukoplakia) are more likely than white patches to become malignant.
- Red patches (erythroplakia) are brightly colored, smooth areas that often become malignant.
- A sore on your lip or in your mouth that won't heal
- Bleeding in your mouth
- Loose teeth
- Difficulty or pain when swallowing
- Difficulty wearing dentures
- A lump in your neck
- An earache
Anyone with these symptoms should see a doctor or dentist so that any problem can be diagnosed and treated as early as possible. Most often, these symptoms do not mean cancer. An infection or another problem can cause the same symptoms.
Diagnosis
If you have symptoms that suggest oral cancer, the doctor or dentist checks
your mouth and throat for red or white patches, lumps, swelling, or other
problems. This exam includes looking carefully at the roof of the mouth, back
of the throat, and insides of the cheeks and lips. The doctor or dentist also
gently pulls out your tongue so it can be checked on the sides and underneath.
The floor of your mouth and lymph nodes in your neck also are checked.
If an exam shows an abnormal area, a small sample of tissue may be removed.
Removing tissue to look for cancer cells is called a
biopsy. Usually, a biopsy
is done with
local anesthesia.
Sometimes, it is done under
general anesthesia.
A
pathologist
then looks at the tissue under a microscope to check for cancer
cells. A biopsy is the only sure way to know if the abnormal area is cancerous.
If you need a biopsy, you may want to ask the doctor or dentist some of the following questions:
- Why do I need a biopsy?
- How much tissue do you expect to remove?
- How long will it take? Will I be awake? Will it hurt?
- How soon will I know the results?
- Are there any risks? What are the chances of infection or bleeding after the biopsy?
- How should I care for the biopsy site afterward? How long will it take to heal?
- Will I be able to eat and drink normally after the biopsy?
- If I do have cancer, who will talk with me about treatment? When?
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Staging
If the biopsy shows that cancer is present, your doctor needs to know the
stage
(extent) of your disease to plan the best treatment. The stage is based on the
size of the tumor, whether the cancer has spread and, if so, to what parts of
the body.
Staging
may require lab tests. It also may involve
endoscopy.
The doctor uses a
thin, lighted tube
(endoscope)
to check your throat, windpipe, and lungs. The
doctor inserts the endoscope through your nose or mouth. Local anesthesia is
used to ease your discomfort and prevent you from gagging. Some people also may
have a mild sedative. Sometimes the doctor uses general anesthesia to put a
person to sleep. This exam may be done in a doctor's office, an outpatient
clinic, or a hospital.
The doctor may order one or more
imaging
tests to learn whether the cancer has
spread:
-
Dental x-rays: An x-ray of your entire mouth can show whether cancer has spread
to the jaw.
-
Chest x-rays: Images of your chest and lungs can show whether cancer has spread
to these areas.
-
CT scan:
An x-ray machine linked to a computer takes a series of detailed
pictures of your body. You may receive an injection of dye. Tumors in the
mouth, throat, neck, or elsewhere in the body show up on the CT scan.
-
MRI: A powerful magnet linked to a computer is used to make detailed pictures
of your body. The doctor can view these pictures on a monitor and can print
them on film. An MRI can show whether oral cancer has spread.
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 5"
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 5" 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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Side Effects of Cancer Treatment
Because treatment often damages healthy cells and tissues, unwanted side
effects are common. These side effects depend mainly on the location of the
tumor and the type and extent of the treatment. Side effects may not be the
same for each person, and they may even change from one treatment session to
the next. Before treatment starts, your health care team will explain possible
side effects and suggest ways to help you manage them.
The NCI provides helpful booklets about cancer treatments and coping with side
effects. Booklets such as
Radiation Therapy and You 6,
Chemotherapy and You 7,
and
Eating Hints for Cancer Patients 8 may be viewed, downloaded, and ordered from
http://www.cancer.gov/publications. These materials also may be ordered by calling
the Cancer Information Service at 1-800-4-CANCER.
The National Institute of Dental and Craniofacial Research (NIDCR) also
provides helpful materials. Head and Neck Radiation Treatment and Your Mouth,
Chemotherapy and Your Mouth, and other booklets are available from NIDCR. See
"National Institute of Dental and Craniofacial Research Information Resources 9"
for a list of publications.
It takes time to heal after surgery, and the time needed to recover is
different for each person. You may be uncomfortable for the first few days
after surgery. However, medicine can usually control the pain. Before surgery,
you should discuss the plan for pain relief with your doctor or nurse. After
surgery, your doctor can adjust the plan if you need more pain relief.
It is common to feel tired or weak for a while. Also, surgery may cause tissues
in your face to swell. This swelling usually goes away within a few weeks.
However, removing lymph nodes can result in swelling that lasts a long time.
Surgery to remove a small tumor in the mouth may not cause any lasting
problems. For a larger tumor, however, the surgeon may remove part of the
palate, tongue, or jaw. This surgery may change your ability to chew, swallow,
or talk. Also, your face may look different after surgery. Reconstructive or
plastic surgery may be done to rebuild the bones or tissues of the mouth. (See
"Reconstruction 10.")
Almost all patients who have radiation therapy to the head and neck area
develop oral side effects. That is why it is important to get the mouth in good
condition before cancer treatment begins. Seeing a dentist two weeks before
cancer treatment begins gives the mouth time to heal after dental work.
The side effects of radiation therapy depend mainly on the amount of radiation
given. Some side effects in the mouth go away after radiation treatment ends,
while others last a long time. A few side effects (such as dry mouth) may never
go away.
Radiation therapy may cause some or all of these side effects:
-
Dry mouth: Dry mouth can make it hard for you to eat, talk, and swallow. It can
also lead to tooth decay. You may find it helpful to drink lots of water, suck
ice chips or sugar-free hard candy, and use a saliva substitute to moisten your
mouth.
-
Tooth decay: Radiation can cause major tooth decay problems. Good mouth care
can help you keep your teeth and gums healthy and can help you feel better.
-
Doctors usually suggest that people gently brush their teeth, gums, and tongue
with an extra-soft toothbrush and
fluoride
toothpaste after every meal and
before bed. If brushing hurts, you can soften the bristles in warm water.
-
Your dentist may suggest that you use fluoride gel before, during, and after
radiation treatment.
-
It also helps to rinse your mouth several times a day with a solution made from
1/4 teaspoon baking soda and 1/8 teaspoon salt in one cup of warm water. After
you rinse with this solution, follow with a plain water rinse.
-
Sore throat or mouth: Radiation therapy can cause painful ulcers and
inflammation. Your doctor can suggest medicines to help control the pain. Your
doctor also may suggest special rinses to numb the throat and mouth to help
relieve the soreness. If your pain continues, you can ask your doctor about
stronger medicines.
-
Sore or bleeding gums: It is important to brush and floss teeth gently. You may
want to avoid areas that are sore or bleeding. To protect your gums from
damage, it is a good idea to avoid the use of toothpicks.
-
Infection: Dry mouth and damage to the lining of the mouth from radiation
therapy can cause infection to develop. It helps to check your mouth every day
for sores or other changes and to tell your doctor or nurse about any mouth
problems.
-
Delayed healing after dental care: Radiation treatment may make it hard for
tissues in the mouth to heal. It helps to have a thorough dental exam and
complete all needed dental treatment well before radiation therapy begins.
-
Jaw stiffness: Radiation can affect the chewing muscles and make it difficult
for you to open your mouth. You can prevent or reduce jaw stiffness by
exercising your jaw muscles. Health care providers often suggest opening and
closing the mouth as far as possible (without causing pain) 20 times in a row,
3 times a day.
-
Denture problems: Radiation therapy can change the tissues in your mouth so
that dentures do not fit anymore. Because of soreness and dry mouth, some
people may not be able to wear dentures for as long as one year after radiation
therapy. After the tissues heal completely and your mouth is no longer sore,
your dentist may need to refit or replace your dentures.
-
Changes in the sense of taste and smell: During radiation therapy, food may
taste or smell different.
-
Changes in voice quality: Your voice may be weak at the end of the day. It may
also be affected by changes in the weather. Radiation directed at the neck may
cause your
larynx
to swell, causing voice changes and the feeling of a lump in
your throat. Your doctor may suggest medicine to reduce this swelling.
-
Changes in the
thyroid:
Radiation treatment can affect your thyroid (an organ
in your neck beneath the voice box). If your thyroid does not make enough
thyroid hormone, you may feel tired, gain weight, feel cold, and have dry skin
and hair. Your doctor can check the level of thyroid hormone with a blood test.
If the level is low, you may need to take thyroid hormone pills.
-
Skin changes in the treated area: The skin in the treated area may become red
or dry. Good skin care is important at this time. It is helpful to expose this
area to the air while protecting it from the sun. Also, avoid wearing clothes
that rub the treated area, and do not shave the treated area. You should not
use lotions or creams in the treated area without your doctor's advice.
-
Fatigue: You may become very tired, especially in the later weeks of radiation
therapy. Resting is important, but doctors usually advise their patients to
stay as active as they can.
Although the side effects of radiation therapy can be distressing, your doctor
can usually treat or control them. It helps to report any problems that you are
having so that your doctor can work with you to relieve them.
Chemotherapy and radiation therapy can cause some of the same side effects,
including painful mouth and gums, dry mouth, infection, and changes in taste.
Some anticancer drugs can also cause bleeding in the mouth and a deep pain that
feels like a toothache. The problems you have depend on the type and amount of
anticancer drugs you receive, and how your body reacts to them. You may have
these problems only during treatment or for a short time after treatment ends.
Generally, anticancer drugs affect cells that divide rapidly. In addition to
cancer cells, these rapidly dividing cells include the following:
-
Blood cells: These cells fight infection, help your blood to clot, and carry
oxygen to all parts of the body. When drugs affect your blood cells, you are
more likely to get infections, bruise or bleed easily, and feel very weak and
tired.
-
Cells in hair roots: Chemotherapy can lead to hair loss. The hair grows back,
but sometimes the new hair is somewhat different in color and texture.
-
Cells that line the digestive tract: Chemotherapy can cause poor appetite,
nausea and vomiting, diarrhea, or mouth and lip sores. Many of these side
effects can be controlled with drugs.
Nutrition
Eating well during cancer treatment means getting enough calories and protein
to prevent weight loss, regain strength, and rebuild healthy tissues. But
eating well may be difficult after treatment for oral cancer. Some people with
cancer find it hard to eat because they lose their appetite. They may not feel
like eating because they are uncomfortable or tired. A dry or sore mouth or
changes in smell and taste also may make eating difficult.
If your mouth is dry, you may find that soft foods moistened with sauces or
gravies are easier to eat. Thick soups, puddings, and milkshakes often are
easier to swallow. Nurses and dietitians can help you choose the right foods.
Also, the National Cancer Institute booklet
Eating Hints for Cancer Patients 8
contains many useful ideas and recipes. The "National Cancer Institute
Information Resources 4" section tells how to get this publication.
After surgery or radiation therapy for oral cancer, some people need a feeding
tube. A feeding tube is a flexible plastic tube that is passed into the stomach
through an incision in the abdomen. In almost all cases, the tube is temporary.
Most people gradually return to a regular diet.
To protect your mouth during cancer treatment, it helps to avoid:
-
Sharp, crunchy foods like taco chips
-
Foods that are hot, spicy, or high in acid like citrus fruits and juices
-
Sugary foods that can cause cavities
-
Alcoholic drinks
Reconstruction
Some people with oral cancer may need to have plastic or reconstructive surgery
to rebuild the bones or tissues of the mouth. Research has led to many advances
in the way bones and tissues can be replaced.
Some people may need
dental implants.
Or they may need to have
grafts
(tissue
moved from another part of the body). Skin, muscle, and bone can be moved to
the oral cavity from the chest, arm, or leg. The plastic surgeon uses this
tissue for repair.
If you are thinking about reconstruction, you may wish to consult with a
plastic or
reconstructive surgeon
before your treatment begins. You can have
reconstructive surgery at the same time as you have the cancer removed, or you
can have it later on. Talk with your doctor about which approach is right for
you.
Rehabilitation
The health care team will help you return to normal activities as soon as
possible. The goals of rehabilitation depend on the extent of the disease and
type of treatment. Rehabilitation may include being fitted with a dental
prosthesis
(an artificial dental device) and having dental implants. It also
may involve speech therapy, dietary counseling, or other services.
Sometimes surgery to rebuild the bones or tissues of the mouth is not possible.
A dentist with special training (a
prosthodontist) may be able to make you a
prosthesis to help you eat and talk normally. You may need special training to
learn to use it.
If oral cancer or its treatment leads to problems with talking, speech therapy
will generally begin as soon as possible. A speech therapist may see you in the
hospital to plan therapy and teach speech exercises. Often speech therapy
continues after you return home.
Follow-up Care
Follow-up care after treatment for oral cancer is important. Even when the
cancer seems to have been completely removed or destroyed, the disease
sometimes returns because undetected cancer cells remained in the body after
treatment. The doctor monitors your recovery and checks for recurrence of
cancer. Checkups help ensure that any changes in your health are noted. Your
doctor will probably encourage you to inspect your mouth regularly and continue
to have exams when you visit your dentist. It is important to report any
changes in your mouth right away.
Checkups include exams of the mouth, throat, and neck. From time to time, your
doctor may do a complete physical exam, order blood tests, and take x-rays.
People who have had oral cancer have a chance of developing a new cancer in the
mouth, throat, or other areas of the head and neck. This is especially true for
those who use tobacco or who drink alcohol heavily. Doctors strongly urge their
patients to stop using tobacco and drinking to cut down the risk of a new
cancer and other health problems.
The NCI has prepared a booklet for people who have completed their treatment to
help answer questions about follow-up care and other concerns.
Facing Forward Series: Life After Cancer Treatment 11
provides tips for making the best use of
medical visits. It describes how to talk to your health care team about
creating a plan of action for recovery and future health.
Support for People with Oral Cancer
Living with a serious disease such as oral cancer is not easy. You may worry
about caring for your family, keeping your job, or continuing daily activities.
You may have concerns about treatments and managing side effects, hospital
stays, and medical bills. Doctors, nurses, and other members of the health care
team can answer your questions about treatment, working, or other activities.
Meeting with a social worker, counselor, or member of the clergy can be helpful
if you want to talk about your feelings or discuss your concerns. Often, a
social worker can suggest resources for financial aid, transportation, home
care, or emotional support.
Support groups also can help. In these groups, patients or their family members
meet with other patients or their families to share what they have learned
about coping with the disease and the effects of treatment. Groups may offer
support in person, over the telephone, or on the Internet. You may want to talk
with a member of your health care team about finding a support group. The NCI's
fact sheets
"Cancer Support Groups: Questions and Answers" and "National
Organizations That Offer Services to People With Cancer and Their Families"
tell how to find a support group. See
"National Cancer Institute Information
Resources 4" for ordering information.
The Cancer Information Service can provide information to help patients and
their families locate programs, services, and publications.
The Promise of Cancer Research
Doctors all over the country are conducting many types of clinical trials.
These are research studies in which people volunteer to take part. In clinical
trials, doctors are testing new ways to treat oral cancer. Research has already
led to advances, and researchers continue to search for more effective
approaches.
People who join clinical trials may be among the first to benefit if a new
approach is shown to be effective. And if participants do not benefit directly,
they still make an important contribution to medical science by helping doctors
learn more about the disease and how to control it. Although clinical trials
may pose some risks, researchers do all they can to protect their patients.
Researchers are testing anticancer drugs and combinations of drugs. They are
studying radiation therapy combined with drugs and other treatments. They also
are testing drugs that prevent or reduce the side effects of radiation therapy.
If you are interested in learning more about joining a clinical trial, you may
want to talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies 12. It explains how clinical trials are carried out and explains their possible benefits and risks. NCI's Web site includes a
section on clinical trials at
http://www.cancer.gov/clinicaltrials with general
information about clinical trials and detailed information about specific
studies. The Cancer Information Service at
1-800-4-CANCER or at LiveHelp 1
at http://www.cancer.gov can answer questions and
provide information about clinical trials. Another source of information about
clinical trials is http://clinicaltrials.gov.
National Cancer Institute Information Resources
You may want more information for yourself, your family, and your doctor. The
following National Cancer Institute (NCI) services are available to help you.
Telephone
Cancer Information Service (CIS)
Provides accurate, up-to-date information on cancer to patients and their
families, health professionals, and the general public. Information Specialists
translate the latest scientific information into understandable language and
respond in English, Spanish, or on TTY equipment.
Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615
Internet
http://www.cancer.gov
The NCI's Cancer.gov Web site provides information from numerous NCI
sources. It offers current information on cancer prevention, screening,
diagnosis, treatment, genetics, supportive care, and ongoing clinical trials.
It also provides information about NCI's research programs and funding
opportunities, cancer statistics, and the Institute itself. Cancer.gov provides
live, online assistance through LiveHelp 1.
Cancer.gov is at http://www.cancer.gov on the Internet.
http://www.smokefree.gov
The Tobacco Control Research Branch of NCI, in collaboration with the Centers
for Disease Control and Prevention and the American Cancer Society, created a
smoking cessation Web site. It offers online quitting advice through NCI's
LiveHelp 1 service. It also provides national and state telephone quitline
numbers and access to printed materials about quitting tobacco. It is located
on the Internet at http://www.smokefree.gov.
Print Materials
You can order National Cancer Institute (NCI) publications by writing to the
address below:
Publications Ordering Service
National Cancer Institute
Suite 3036A
6116 Executive Boulevard, MSC 8322
Bethesda, MD 20892-8322
Some NCI publications can be viewed, downloaded, and ordered from
http://www.cancer.gov/publications on the Internet. If you are in the United States
or one of its territories, you may order these and other NCI booklets by
calling the Cancer Information Service at 1-800-4-CANCER.
Booklets About Cancer Treatment
Radiation Therapy and You: A Guide
to Self-Help During Treatment 6
Chemotherapy and You: A Guide to
Self-Help During Treatment 7
Helping Yourself During
Chemotherapy: 4 Steps for Patients 13
Eating Hints for Cancer Patients 8
Understanding Cancer Pain 14
Pain Control: A Guide for People with Cancer and
Their Families 15
Get Relief From
Cancer Pain 16
Taking Part in Cancer Treatment Research Studies 12
La quimioterapia y usted: una guía de autoayuda durante el
tratamiento del cáncer (Chemotherapy and You: A Guide to Self-Help
During Cancer Treatment) 17
El dolor relacionado con el cáncer (Understanding Cancer Pain) 18
La radioterapia y usted: una guía de autoayuda durante el
tratamiento del cáncer (Radiation Therapy and You: A Guide to Self-Help
During Cancer Treatment) 19
Booklets About Living With Cancer
Advanced Cancer: Living Each Day 20
Facing Forward Series: Life After Cancer Treatment 11
Facing Forward Series: Ways You Can Make a Difference in Cancer 21
Taking Time: Support for People With Cancer and the People Who Care About
Them 22
When Cancer Recurs: Meeting the Challenge 23
Siga adelante: la vida después del tratamiento del cáncer
(Facing Forward Series: Life After Cancer Treatment) 24
Booklets About Quitting Smoking and Spit Tobacco
Clearing the Air: Quit Smoking Today 25
You Can Quit Smoking: A 5-Day Plan To Get Ready 26
You Can Quit Smoking: Consumer Guide 27
Smoking Facts and Tips for Quitting 28
Smoking Facts and Quitting Tips for African Americans 29
Spit Tobacco: A Guide for Quitting 30
Datos y consejos para dejar de fumar (Smoking Facts and Tips for Quitting) 31
Usted puede dejar de fumar (You Can Quit Smoking) 32
Guía para dejar de fumar: no lo deje para mañana, deje de
fumar hoy (Guide for Quitting Smoking: Don't Leave It for Tomorrow, Quit Today) 33
Fact Sheets
"Questions and Answers About Smoking Cessation" 34
"How To Find a Doctor or Treatment Facility If You Have Cancer" 35
"Cancer Support Groups: Questions and Answers" 36
"National Organizations That Offer Services to People With Cancer and
Their Families" 37
National Institute of Dental and Craniofacial Research Information Resources
The National Oral Health Information Clearinghouse
This Clearinghouse is a service of the Federal Government's National Institute of Dental and Craniofacial Research (NIDCR). NIDCR's mission is to promote the general health of the American people by improving their oral, dental, and craniofacial health. Through the conduct and support of research and the training of researchers, the NIDCR aims to promote health, prevent diseases and conditions, and develop new diagnostics and therapies.
NIDCR directs the health awareness campaign,
Oral Health, Cancer Care, and You: Fitting the Pieces Together. The campaign addresses the importance of preventing and managing the oral side effects of cancer treatments. It is a partnership among NIDCR, NCI, National Institute of Nursing Research, and Centers for Disease Control and Prevention.
NIDCR can supply free information about oral cancer and taking care of your mouth during cancer treatment. Booklets are available in English and Spanish:
Chemotherapy and Your Mouth
Head and Neck Radiation Treatment and Your Mouth
Quimioterapia y la Boca (Chemotherapy and Your Mouth)
Su Boca y el Tratamiento de Radiación en la Cabeza y el Cuello (Head and Neck
Radiation and Your Mouth)
Materials may be obtained by contacting the Clearinghouse:
National Institute of Dental and Craniofacial Research
National Oral Health Information Clearinghouse
Attn: OCCT
1 NOHIC Way
Bethesda, MD 20892-3500
Tel: 301-402-7364
Materials are also available online at
http://www.nidcr.nih.gov under "health information."
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