Radiation Therapy for Mouth (Oral) Cancer
Overview
Radiation therapy for mouth cancer works by using high-energy X-rays to kill cancer cells. MSK offers precise radiation therapy that kills mouth cancer cells with fewer side effects from radiation. This keeps the healthy tissue safe.
Mouth cancer often is treated with surgery. Some people may have radiotherapy after surgery, or radiotherapy alone.
You may have radiation therapy along with chemotherapy. This is called chemoradiation.
MSK is the only center to offer weekly magnetic resonance imaging (MRI) at no cost to you. This lets us make quick changes to your radiation treatment, if needed.
To understand how oral cancer radiation fits into your treatment, this is a good place to start.
Talk with an MSK Care Advisor. We're here 24 hours a day, 7 days a week.
How is radiation therapy used to treat mouth cancer?
Radiation therapy for mouth cancer uses very precise, powerful, high-energy beams to kill cancer cells.
Your doctor may recommend radiation therapy:
- After surgery for mouth cancer, to lower the chance that the cancer will come back.
- To treat mouth cancers that cannot be removed by surgery.
- To treat mouth cancers that come back after surgery.
Your doctor may recommend chemotherapy as part of your radiation therapy. This is called chemoradiation. It may help the tumor respond better to treatment.
Radiation oncologists are cancer doctors with special training in using radiation to treat cancer. MSK’s radiation therapy experts deliver radiation to the tumor while keeping nearby healthy tissue safe. Radiation therapy aims to kill off mouth cancer cells with as few side effects as possible.
Mouth cancer may not respond to surgery or chemotherapy. If so, we use radiation therapy to relieve symptoms and improve your quality of life.
Types of radiation therapy for oral cancer
There are 2 basic kinds of radiation therapy, external and internal. It’s rare to use internal radiation to treat mouth tumors.
External radiation therapy is delivered from outside your body. This kind of therapy uses high-energy rays to harm cancer cells so they can no longer grow.
External beam radiation therapy (EBRT) is the most common type of radiation therapy for oral cancer. EBRT uses a treatment machine called a linear accelerator to aim beams of radiation right at the tumor.
The beams pass through your body and harm cancer cells in their path. You will not see or feel the radiation.
Most energy rays used for EBRT are photons (X-rays or gamma rays). Another type of EBRT is proton therapy, which uses proton rays.
Doctors at MSK are national experts in all methods of radiation therapy. They’ll recommend which is best for you, based on the cancer and your preferences.
External beam radiation therapy
IGRT can treat oral cancer tumors with even more accuracy than regular radiation therapy. This method gives a very precise dose of radiation right to the tumor.
Image-guided means we take images to help guide the radiation beams. Imaging can include PET, MRI, and CT scans to locate the tumor before and during radiation therapy.
Most often, you’ll have IGRT 5 days a week for a few weeks. You may have as few as 3 treatments. You’ll have more imaging scans during IGRT to track changes in the tumor’s size or shape.
MSK is one of only a few hospitals to offer the most advanced proton therapy in New York City. MSK uses proton therapy, also called proton beam therapy, for some cases of oral cancer.
This type of radiation therapy uses charged particles called protons to kill cancer cells. A device called a cyclotron sends tiny, high-energy beams of protons to the tumor.
With proton therapy, the beams do not go past the tumor. It can cause fewer side effects because healthy tissue near the tumor is more likely to be safe.
Intensity-modulated radiation therapy (IMRT) lets us change the radiation beams’ power during treatment using a special computer program. It lets us make a dose plan that can deliver high doses of radiation more precisely to the tumor area.
IMRT can have fewer side effects for some people because it’s so accurate.
You’ll have a CT scan before IMRT to make a 3D map of the tumor. Most treatment sessions take 10 to 30 minutes. You’ll have them 5 days a week for a few weeks.
The total number of treatments depends on things like the tumor’s size and location. You also may have chemotherapy to make radiation work better.
Chemotherapy with radiation (chemoradiation) for mouth cancer
Chemoradiation is when chemotherapy is given together with radiation. It’s also called chemoradiotherapy.
Radiation alone can work very well on some cancers, but chemotherapy can help the radiation work better.
Chemoradiation works by using chemotherapy to first weaken cancer cells. Chemo makes the tumor more sensitive to radiation treatment, so radiation harms the tumor more easily.
Chemotherapy also can treat very tiny cancer cells that may have spread outside the area where the cancer started.
Side effects of radiation for mouth cancer
What are the short-term side effects of radiation therapy?
Radiation treatments are very precise and cause little harm to healthy tissues. Radiation for mouth cancer does not cause hair loss, and many people report few lasting side effects.
In general, you can keep doing your daily activities or keep working through treatment.
Some people do have side effects during or shortly after radiation for mouth cancer. They include:
- Changes in your skin that look like a sunburn.
- A hoarse (low, raspy) voice.
- Changes in taste.
- Dry mouth.
- Weak teeth (tooth decay and dental problems).
- Pain, sores, or redness in the mouth.
Radiation for mouth cancer can affect how well you can swallow. It can weaken the muscles and structures that help you swallow. This can make it harder to eat and drink. Whether this happens depends on the size and location of the tumor.
Having trouble swallowing is called dysphagia (dis-FAY-jee-uh).
Radiation therapy can cause:
- Pain when you swallow
- Mucositis (myoo-koh-SY-tis), which are painful areas or sores in your mouth or throat
- Dry mouth
- Thicker saliva
- Swelling in your mouth, throat, or both
- Changes in taste
These symptoms often start 1 to 2 weeks after your first radiation therapy session. They may get worse during treatment. Most symptoms start to get better about 2 to 4 weeks after your treatment ends.
What are long-term side effects of oral cancer radiation therapy?
Side effects can start months or years after mouth cancer radiation treatment ends. These are called long-term or late effects. Late effects of mouth cancer radiation are not common, but can include:
- Inflammation in the mouth, most often with people who also had chemotherapy or immunotherapy.
- Injury to the mouth if there was a lot of exposure from radiation.
- Trismus, also known as lockjaw, which is when you have trouble opening your mouth all the way. Trismus can happen anytime during, right after, or even years after head and neck radiation therapy. Learn more about how to manage trismus.
It’s important to get enough nutrition before, during, and after head and neck cancer treatment. We have information about how to manage side effects during radiation therapy and chemotherapy. Watch this video to learn how to get enough nutrition during radiation treatment for head and neck cancer.
Radiation therapy can also cause fibrosis (fy-BROH-sis), which is tissue scarring that’s permanent (does not go away). The effects of radiation scarring depend on the mouth area that was treated, and include:
- Trismus, or lock jaw, which is when you have trouble opening your mouth all the way.
- Your salivary glands may not make enough saliva. This can make it hard to swallow because your mouth is too dry.
- The muscles in your tongue and the back of your throat may not move as well. This can make it harder to eat and drink.
- The muscles that help protect your airway when you swallow may weaken. They may not be strong enough to keep foods or liquids from going down your airway. You have a higher risk for choking.
- Your esophagus (food pipe) may narrow (get smaller). This can cause food to get stuck in the back of your throat.
MSK experts will help you manage problems with swallowing after radiation therapy.
How does MSK limit your exposure to radiation during treatment?
MSK’s radiation experts do everything possible to lower the chances of radiation harming your body and causing side effects. They use the most precise ways to deliver radiation right to mouth tumors instead of nearby healthy tissue.
For safety, we can take images each day to see the bones or tumor and keep healthy tissue safe. These methods limit how much radiation healthy tissue gets.
More than 8 out of every 10 people get xerostomia (dry mouth) after radiation for head and neck cancers. Dry mouth, or cotton mouth, can hurt. But it also can lead to infections, cavities, tooth decay, and poor nutrition. Learn about dry mouth symptoms and natural treatments for dry mouth.
We manage side effects to help you recover fast from radiation for mouth cancer.
Our Integrative Medicine and Wellness Service offers acupuncture, meditation, massage therapy, yoga, and exercise. Integrative medicine is also called complementary, natural, or holistic therapies. Without using prescription drugs, integrative therapies can help improve and control side effects of cancer treatment.
Our dental and rehabilitation experts can also help manage side effects. They can keep your throat working as it should, for eating, swallowing, and speaking.
During and after treatment, you’ll have exercises to prevent side effects. We’ll watch for any problems with swallowing. And we’ll make sure you keep the range of motion in your tongue, jaw, and neck.
Common questions
Before you start radiation therapy for mouth cancer, you’ll have a treatment planning procedure called a simulation. A radiation simulation is done to make sure that:
- Your treatment site is mapped so the radiation is precise and targeted.
- You get the right dose (amount) of radiation.
- Nearby tissue gets the lowest amount of radiation possible.
Your radiation therapy simulation will take about 4 hours. You’ll have imaging scans, including a PET-CT scan for some people.
Your skin will be marked with little tattoo dots that tell us which area to treat. These tattoos are permanent (do not come off).
You’ll be lying in one position for a long time.
Your radiation oncologist and care team will carefully plan and check the angles and shapes of the radiation beams.
Radiation treatments take place Monday through Friday, for about 7 weeks.
Your radiation therapy team will tell you what to expect for your treatment schedules. You may have chemotherapy and radiation on the same day.
You must come to every appointment. Treatment may not work as well if you skip or miss appointments. If you need to change your schedule, talk with your radiation therapist.
Learn more about the set-up procedure and treatments.
Before your appointment, it’s helpful to write down questions you want to ask. Here are some examples. Write down the answers during your appointment so you can review them later.
- How will radiation make my mouth feel?
- What kind of radiation therapy will I get?
- How many radiation treatments will I get?
- What side effects should I expect during radiation therapy?
- Will these side effects go away after I finish radiation therapy?
- What kind of late side effects should I expect after radiation therapy?
- What kind of follow-up care will I need after radiation therapy ends?
