After determining a diagnosis and completing a full pre-treatment evaluation, doctors will recommend a course of treatment for their patients. In general, there are three different options for the treatment of lip cancers that can be used alone or in combination.
Surgery
For lip 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. Lip cancers may be treated with a soft tissue resection, primary closure, and/or a local skin flap. Surgery often includes a neck dissection, where some of the lymph nodes in the neck are removed and checked for cancer. The surgery that a doctor recommends will depend on what part of the lip, and how much of the lip is involved by the cancer.
In some instances, Mohs micrographic surgery, a technique commonly utilized for surgical removal of head and neck skin cancers, may be advisable for the removal of a lip cancer. This technique is generally performed by a dermatologist, and aims to maximize the chances of removing the entire cancer, while preserving as much normal tissue as possible. In experienced hands, Mohs surgery may be able to minimize the amount of deformity and the functional impact of surgery for lip cancer.
One of the most challenging parts of surgery performed on the lip is the surgical reconstruction after the cancer has been removed. A variety of different forms of reconstruction have been developed to restore both the appearance and the function of the lips after surgery. By and large, the type of reconstruction will depend on the amount of the lip that has to be removed in order to completely remove the cancer. 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 lip cancer is called adjuvant radiation, which is radiation given after surgery in order to decrease the chances that the tumor will come back.
Reasons Radiation May Be Needed
A doctor may recommend this type of post-surgical radiation for a few reasons, among others.
- If the tumor was not completely removed.
- 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.
In some cases, complete surgical removal of a lip 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 lip cancer. In rare 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 Lip Cancer
These options depend on T and N stages.
T1-2, N0
- The preferred treatment is surgical removal of the cancer.
- A sentinel lymph node biopsy 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 is left after the initial radiation.
T3, N0; T1-3, N1-3; or T4a, any N
- The initial treatment is surgical removal of the cancer with a neck dissection(s).
- Cancers on the upper lip may require the removal of additional lymph nodes from around the parotid gland.
- 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.
