Mouth cancer treatment often involves surgery. However, in earlier cancer stages, it may be treatable with nonsurgical options, such as radiation.

With an early diagnosis of mouth cancer, the condition may only require radiation therapy as treatment. However, most people require surgery. Doctors may also recommend nonsurgical treatments, such as radiation and chemotherapy, in combination with surgery.

This article discusses nonsurgical treatment options for mouth cancer.

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Radiation therapy uses a high-energy, targeted beam of X-ray radiation to kill cancer cells or slow their spread. Doctors may recommend radiation in the following circumstances:

  • as the first and main treatment for people with smaller mouth cancers or those who are unsuitable candidates for surgery
  • as an added therapy after surgery to destroy any remaining cancer cells that were not visible during a surgical procedure and reduce the risk of cancer returning in that area
  • as an added therapy before surgery to shrink larger tumors and reduce the extent of surgery necessary
  • to treat cancers that have come back after a different treatment
  • alongside targeted therapy in people with more advanced cancer who cannot have chemotherapy
  • to soothe advanced cancer symptoms, including pain, bleeding, swallowing difficulties, and the effects of cancer spreading to the bones and lungs

The type of radiation that doctors most commonly use to treat mouth cancers is called external beam radiation therapy. An external source similar to an X-ray machine focuses the radiation onto the target area. The procedure lasts only a few minutes and typically involves no pain.

Over time, this treatment can make it difficult to eat and drink. Radiation can also damage the salivary glands, causing ongoing dry mouth.

Chemotherapy involves anticancer drugs that kill cancer cells.

According to the National Cancer Institute, chemotherapy is not a standard treatment option for mouth or oral cancer.

Generally, a person only receives this treatment without surgery for mouth cancer that is too advanced for surgical procedures to be effective. It can help slow the growth and make symptoms easier to manage.

Otherwise, a healthcare professional may prescribe chemotherapy before or after surgery as an additional therapy.

Courses of chemotherapy often last 3–6 months, depending on the effectiveness of the treatment and the severity of side effects.

It is important for individuals who smoke to stop smoking before the start of chemotherapy treatments. Smoking during treatment can worsen side effects, reduce the effectiveness of treatment, and increase the risk of infection.

This type of mouth cancer treatment uses drugs that target specific proteins in cancer cells. These proteins support longer life, faster growth, and a wider spread. The goal of targeted therapy is to slow this growth and spread and to destroy the cancer cells.

Healthcare professionals may use cetuximab (Erbitux), a type of drug doctors refer to as a monoclonal antibody, to treat mouth cancer. Monoclonal antibodies are artificial antibodies that work like immune system cells. Cetuximab targets a protein called epidermal growth factor receptor that sits on the surface of mouth cancer cells.

Cancer care teams sometimes combine this with radiation therapy for cancers in earlier stages. They might use cetuximab in combination with chemotherapy or in isolation for more advanced mouth cancer.

This type of treatment empowers the immune system to target and kill cancer cells.

It is possible to treat mouth cancer with a type of immunotherapy called a PD-1 inhibitor.

PD-1 is a protein in some immune system cells that usually prevents them from attacking other cells. PD-1 inhibitors, such as pembrolizumab and nivolumab, “switch off” PD-1 to activate the immune system against cancer cells. This may slow the growth of tumors or even shrink them.

A cancer doctor might recommend these drugs if chemotherapy becomes ineffective in treating cancer or if the disease comes back or spreads to other areas of the body. Some people whose mouth cancer has returned or who cannot receive surgery may use pembrolizumab (Keytruda) alone as a treatment.

This involves giving chemotherapy and radiation therapy at the same time. It is useful for those who have cancer in one part of the mouth that is too advanced to benefit from surgery. It can also shrink mouth tumors more than chemotherapy or radiation therapy alone.

People may receive the chemotherapy drug cisplatin every 3 weeks during radiation therapy. Other drugs or treatment schedules may apply.

The following are some questions people frequently ask about mouth cancer.

How long can a person live with untreated mouth cancer?

In a 2018 study using the National Cancer Database, people who did not receive treatment for early stage mouth cancer had a 31.1% five-year survival rate. This reduced to 12.6% in people with late-stage mouth cancer.

What is the best treatment for oral cancer?

The best treatment for oral cancer depends on the type, spread, location, and stage of the cancer. However, most people receive surgery to remove the cancerous tissue from the mouth area.

How long does oral cancer take to spread?

The spread of oral cancer depends on tumor size and cancer stage. The rate of spread can vary from person to person.

Some people cannot undergo surgery for mouth cancer. This may be because the tumor is too large or advanced. In those cases, they can receive radiation therapy or targeted therapy.

However, most individuals need surgery to remove cancerous tissue from the mouth and neck area. Many will also have reconstructive surgery to restore the function or appearance of the original tongue, jaw, voice box, or neck.

Chemotherapy and immunotherapy are also available to support mouth cancer treatment. A healthcare professional can recommend the most effective way to treat the cancer depending on the location, size, and spread.