. Treatment is individualized depending on various factors — such as where the tumour is (mouth, throat, larynx, etc.), how big it is, how far it has spread, the patient's general health, and whether functions such as speech or swallowing may be involved.
Let's divide it into 4 broad categories of treatment:
Surgery
Drug therapies
Radiation therapy
Maintenance therapy
1. Surgery
Surgery is usually the preference when the tumour can be operated on. The aim is to excise the tumour completely, sometimes with a border of normal tissue to make sure that no cancer cells are left behind.
Some of the common surgeries are:
Tumour Resection: The main tumour is removed surgically.
Neck Dissection: The lymph nodes in the neck are taken out if there is a possibility that the cancer has spread to them.
Endoscopic Surgery: A minimally invasive procedure employing a camera and instruments passed down the nose or mouth.
Transoral Robotic Surgery (TORS): Robotic instruments make their way through the mouth, with precision and minimal disturbance of surrounding tissues.
Laser Surgery: Employing intense beams of light to vaporize tiny tumours, especially in the voice box or throat.
Microsurgery: Needed when the area operated on is very delicate, such as nerves or blood vessels — employing microscopes to achieve precision.
Skull Base Surgery: In the case of tumours located deep close to the skull base.
Maxillectomy: Dissection of part or entire upper jaw, usually employed for hard palate or upper gum tumours.
Glossectomy: Dissection of part or entire tongue in the case of the presence of cancer of the tongue.
Mandibulectomy: Partial or complete jawbone removal if the cancer has invaded there.
Laryngectomy: Removal of the voice box — in these instances, the patient can breathe through a stoma created in the neck.
Pharyngectomy: Partial or complete removal of the throat or pharynx — usually followed by reconstructive surgery to regain function.
All of these procedures have their risks and recovery trajectory, and speech, swallow, or cosmetic rehabilitation may be required afterwards.
Surgery
2. Drug Therapies
Drug therapies are used to kill cancer cells or reduce their growth. These are used alone or in combination with surgery or radiation.
a. Chemotherapy (Chemo)
Chemotherapy involves the use of potent drugs that circulate through the bloodstream and kill rapidly dividing cancer cells.
It can be administered before a treatment (neoadjuvant) to shrink a big tumor.
Or after a treatment (adjuvant) to kill remaining cells.
It can also be combined with radiation for concurrent chemoradiation to enhance efficacy.
Chemotherapy is administered in cycles, generally 3–6 courses spanning several weeks.
b. Immunotherapy
It assists the body's immune system to identify and destroy cancer cells.
Checkpoint inhibitors such as nivolumab and pembrolizumab are standard drugs, particularly in the case of recurrent or metastatic Head and Neck cancer.
c. Targeted Therapy
Precision drugs that target specific molecules or pathways in cancer cells. For instance:
Cetuximab, which attacks the EGFR protein
Kinase inhibitors such as sorafenib and sunitinib inhibit pathways that encourage tumour growth and vessel formation
These therapies are generally more tolerated than chemo and are effective in many patients.
3. Radiation Therapy
Radiation kills or harms cancer cells by using high-energy beams. It is sometimes used with surgery or by itself when surgery cannot be done.
Types of radiation used most commonly are:
External Beam Radiation Therapy (EBRT): Most frequently used. Radiation is transmitted to the tumour from a machine outside the body.
Brachytherapy: Radioactive material is placed inside or alongside the tumour. It is usually applied for oral or oropharyngeal cancers.
Intraoperative Radiation Therapy (IORT): Radiation is given to the tumour bed directly, directly in the operating theatre — preserving as much healthy tissue as possible.
Radiation is usually given daily, in small fractions:
Conventional fractionation (5–6 weeks' worth of daily doses)
Hypofractionation (larger doses in fewer sessions)
Accelerated regimens (for aggressive tumours)
Side effects can occur in patients as temporary complaints such as dry mouth, sore throat, tiredness, or skin reactions, all of which are monitored closely by the clinical team.
4. Maintenance Therapy
Some patients remain on low-dose treatment even after extensive treatment ends to prevent cancer relapse.
Maintenance therapy involves:
Concurrent Chemoradiation – A combined treatment applied particularly in advanced-stage patients.
Cetuximab – A monoclonal antibody usually applied long-term to regulate tumour growth.
Targeted oral treatments – Such as sorafenib and sunitinib, followed on in selected patients based on tumour type and genetic markers.
Why is maintenance therapy necessary?
Because even on scans that appear clear, some cancer cells can still be lurking. This follow-up treatment decreases the likelihood of recurrence and improves survival in most patients.
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