Oral Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

The medicines travel all through your body in your bloodstream. They may stop cancer cell growth, slow cell growth, or kill the cancer cells.

When might chemotherapy be used for oral cancer?

Your doctor may suggest chemotherapy to treat oral cancer in any of these situations:

  • You’re having radiation after surgery for oral cancer. Chemotherapy is sometimes given along with radiation to help the radiation work better. This is called radiosensitization. The goal of this treatment is to reduce the chance that the cancer will come back in the future by killing any cancer cells that may have been left behind after surgery. This is called adjuvant treatment.

  • All the cancer can't be removed by surgery. In this case, chemotherapy may be used as the main treatment. It can be given before radiation. This is called neoadjuvant or induction chemotherapy. Or the chemo may be used at the same time as radiation to help the radiation work better. Sometimes it's used before and during radiation. The goal of this treatment is often to control and maybe even cure the cancer, even if it can't be removed by surgery.

  • To shrink larger tumors before surgery. Chemo, sometimes together with radiation, may be used to try to shrink some larger cancers before surgery. This is called neoadjuvant chemotherapy. In some cases this makes it possible to remove less tissue during surgery.

  • You have metastatic oral cancer. This means the cancer has spread to other parts of your body. Chemotherapy can't cure this cancer. But it may slow its growth to help you feel better and live longer. It may also help you swallow, can ease bone pain, and reduce extreme tiredness (fatigue).

Your medical team will review the chemotherapy optionsthat may work best for you and talk with you about treatment goals. 

How is chemotherapy given for oral cancer?

Most people with cancer get chemotherapy in an outpatient part of the hospital or at the doctor's office. Depending on the medicines you take and your general health, you may need to stay in the hospital during treatment. You may receive these medicines by IV (into a vein) or in pill form. Or you may get a combination of the two.

Chemotherapy for oral cancer can mean taking more than 1 medicine. Combining medicines can help tumors shrink more, but can also mean more side effects. When more than 1 medicine is used, the medicines are usually given 1 after the other, and then given again as a treatment course every 2 to 3 weeks. You'll have a rest period between each treatment. Each period of treatment and rest is called a cycle. These cycles reduce damage to healthy cells. Rests in between treatment give cells a chance to recover. Your doctor will decide if you need to get chemotherapy daily, weekly, every few weeks, or monthly. Your treatment will usually continue for 2 to 6 months, depending on how well it's working.

Here are some common chemotherapy medicines for oral cancer:

  • Cisplatin

  • Fluorouracil (5-FU) 

  • Carboplatin

  • Paclitaxel

  • Docetaxel

What are common side effects of chemotherapy?

Chemotherapy medicines are designed to attack and kill cells that grow quickly, including cancer cells. These medicines can also affect normal cells that grow quickly. These include hair follicles, intestines,  the lining of your mouth and throat, and your bone marrow (where your blood cells are made). The side effects of chemotherapy are different for everyone. They usually go away over time when the treatment ends.

The most common short-term side effects of chemotherapy include:

  • Low red blood cell levels (anemia)

  • Appetite loss

  • A change in how food and drink tastes

  • Bloating, from water retention

  • Bruising or bleeding easily

  • Chewing, swallowing, and talking problems

  • Constipation

  • Dehydration

  • Diarrhea

  • Extreme tiredness (fatigue) 

  • Hair loss

  • Increased risk of infections

  • Less energy during and for a while after treatment

  • Mouth sores

  • Nerve damage that causes tingling and numbness in your hands and feet (peripheral neuropathy)

  • Nausea

  • Vomiting

If you are getting radiation at the same time you are getting chemotherapy, the side effects you have may be worse. These may include mouth sores, trouble swallowing, and a persistently dry mouth.

Possible long-term side effects of chemotherapy include:

  • Tingling or numbness in hands and feet (peripheral neuropathy)

  • Being unable to have children (infertility)

  • Kidney damage

  • Trouble with thinking, concentrating, and memory (chemo brain)

Talk to your healthcare team about any side effects you have. There are ways to prevent or treat many of the side effects of chemo.

Keep watch for infections

It's likely that your doctor will take blood samples from you often during the  time you are getting chemotherapy to make sure you aren't having harmful reactions. Make sure you ask your doctor what signs, if any, mean you should call immediately. For instance, chemotherapy can make it easier for you to get infections. So call your doctor if you have any of these signs of infection:

  • Fever

  • Shaking, chills

  • Sores in the mouth and throat

  • New cough or shortness of breath

  • Burning during urination

  • Flu-like symptoms (aches, weariness, nausea, diarrhea)

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what signs to look for and when to call them. For example, chemotherapy can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.