Oral Cancer: Chemotherapy

What is chemotherapy?

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

Chemo may stop cancer cell growth, slow cell growth, or kill the cancer cells.

When might chemotherapy be used for oral cancer?

Chemo might be used to treat oral cancer:

• Along with radiation after surgery. Chemo is sometimes given 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 by killing any cancer cells that may have been left behind after surgery. This is called adjuvant treatment.

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

• Alone or along with radiation to try to shrink large tumors before surgery. This is called neoadjuvant chemotherapy. In some cases, this makes it possible to remove less healthy tissue during surgery.

• If the cancer has spread to other parts of your body (metastasized). Chemo can't cure the cancer. But it may slow its growth to help you feel better and live longer. It may also help you swallow and can ease bone pain and reduce extreme tiredness (fatigue).

Your medical team will review the chemo choices that may work best for you. They will also talk with you about the goals of treatment.

How is chemotherapy given for oral cancer?

Most people with cancer get chemo in an outpatient part of the hospital or at the healthcare provider's office. Depending on the medicines used and your general health, you may need to stay in the hospital during treatment. You can get chemo right into your blood through an IV (a small tube that's put into a vein) or as a pill. Or you may get a combination of the two.

Chemotherapy for oral cancer often means taking more than one medicine. Combining medicines can help kill more cancer cells, but it can also mean more side effects. When more than one medicine is used, the medicines are usually given one after the other. They're then given again 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 kill more cancer cells. Rests in between treatment give healthy cells a chance to recover. Your healthcare provider will decide how often you need to get chemo. Treatment usually lasts many months, depending on how well it's working.

Here are the chemo medicines most often used for oral cancer:

• Cisplatin

• Fluorouracil (5-FU) 

• Carboplatin

• Paclitaxel

• Docetaxel

What are common side effects of chemotherapy?

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

The most common short-term side effects of chemo 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

• Mouth sores

• Nausea

• Vomiting

If you're getting radiation at the same time you are getting chemo, side effects may be worse.

Possible long-term side effects of chemo 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. There may even be things you can do to help prevent some of them. Most side effects go away over time after treatment ends.

Keep watch for infections

It's likely that your healthcare provider will take blood samples from you often while you're getting chemo to make sure you aren't having harmful reactions. Make sure you ask your healthcare provider what signs, if any, mean you should call right away. For instance, chemotherapy can make it easier for you to get infections. So call your healthcare provider if you have any of these signs of infection:

• Fever

• Shaking chills

• Sores in the mouth and throat that keep you from eating or drinking

• New cough or shortness of breath

• Burning during urination or changes in the way your urine smells or looks

• Confusion

Working with your healthcare provider

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

Talk with your healthcare providers about what symptoms to watch for and when to call them. For instance, chemo can make you more likely to get infections. You may be told to check your temperature and stay away from people who are sick. Make sure you know what number to call with questions. Is there a different number for evenings, holidays, 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.