After determining a diagnosis of buccal cancer and completing a full pre-treatment evaluation, doctors will recommend a treatment plan for their patients. In general, there are three different options for the treatment of buccal cancers that can be used alone or in combination.
Surgery
For buccal cancer, complete surgical removal of the tumor is almost always the first treatment, unless a doctor decides that it is not possible or safe to proceed with surgery. Buccal cancers may be treated with a soft tissue resection, mandibulotomy, mandibulectomy, neck dissection, and/or a regional or free flap.
The surgery that a doctor recommends will depend on the location of the cancer, as well as the stage. Patients and their care teams should discuss the types of surgeries that may be required for the treatment of their cancer.
Radiation
The most common use of radiation for the treatment of buccal cancer is called adjuvant radiation, which is radiation given after surgery in order to decrease the chances that the tumor will come back.
Reasons for Post-Surgical Radiation
A doctor may recommend post-surgical radiation in a few scenarios.
- If the tumor was not completely removed or if the surgical margins were positive for cancer.
- If the type of cancer was determined to be aggressive or of a high grade or T-stage.
- If the cancer had spread to lymph nodes or other structures, such as nerves or vessels.
In some cases, complete surgical removal of a buccal cancer may be impossible or unsafe, and a doctor may recommend radiation therapy as the primary treatment. In this type of treatment, an external beam of radiation is directed at the tumor in order to destroy the rapidly dividing cancer cells.
Chemotherapy
Chemotherapy is not commonly used alone to treat buccal cancer. In some cases, it is used in combination with radiation as a primary treatment instead of surgery. Chemotherapy can also be added to adjuvant radiation therapy if there is extranodal extension from cancerous lymph nodes in the neck, or if there is cancer left behind during surgery.
General Treatment Options for Buccal Cancer
These options depend on T and N stages.
T1-2, N0
- The preferred treatment is surgical removal of the cancer, with or without a neck dissection, depending on the location of the tumor and on how thick the tumor is.
- A sentinel lymph node biopsy (a procedure to see if the cancer has spread to the lymphatic system) may also be performed, and may be followed by a neck dissection, depending on the results of the biopsy.
- Surgery will sometimes be followed by radiation, additional surgeries, and/or chemotherapy with radiation, depending on the outcome of the primary surgery.
- Radiation alone is also a primary treatment option.
- Radiation could be followed by surgery, depending on whether any disease remained after the initial radiation.
T3, N0; T1-3, N1-3; or T4a, any N
- The initial treatment is surgical removal of the cancer with neck dissection(s).
- Surgery will sometimes be followed by radiation, additional surgeries, and/or chemotherapy with radiation, depending on the outcome of the primary surgery.
- Factors that will guide additional treatment include:
- Positive margins (the presence of cancer cells at the edge of the tissue that was resected).
- Spread of cancer beyond the lymph nodes in the neck (extranodal extension).
- T3 or T4 tumors based on pathologic evaluation.
- N2 or N3 disease in the neck lymph nodes.
- Cancerous lymph nodes in unusual parts of the neck.
- Tumor invasion into or around nerves (perineural invasion).
- Tumor invasion into blood vessels (lymphovascular invasion).
T4b, any N; unresectable neck disease; or patients unfit for surgery
In cases that are very advanced, or in patients who are extremely sick, patients should have an extensive discussion with their doctor in order to consider the possibility of palliative therapy or hospice care.
