After determining a diagnosis of mandibular cancer and completing a full pre-treatment evaluation, doctors will recommend a course of treatment for their patients. In general, your care team can treat mandibular cancers with three different options: surgery, radiation and chemotherapy. They can administer these treatments in combination or independent of the others.
Surgery
For mandibular 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. Mandibular cancers are often treated with a mandibulectomy and a 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. In addition, reconstruction of the oral cavity following cancer removal is an important means to restore the patient’s function and appearance. A thorough discussion of this aspect of the surgical plan is vital to the patient’s understanding of what life will be like after cancer treatment.
Radiation
The most common use of radiation for the treatment of mandibular 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.
- 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.
External Beam Radiation
In some cases, complete surgical removal of a mandibular 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 to treat mandibular cancer. In some cases, it is used in combination with radiation as additional treatment following surgery. Chemotherapy is usually only added to adjuvant radiation therapy if there is extranodal extension from cancerous lymph nodes in the neck (meaning that the cancer has grown outside of the lymph node), or if there is cancer left behind during surgery.
General Treatment Options for Mandibular Cancer
Treatment Options depend on your 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 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 a 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 removed).
- 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.
