Oral squamous cell carcinoma (OSCC) is a type of cancer that arises from the squamous cells lining the oral cavity. Treating OSCC involves multiple approaches depending on the stage, location, and overall health of the patient. The main treatments include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy, often used in combination to improve outcomes.
**Surgery** is typically the first line of treatment, especially for early-stage OSCC. The goal is to remove the tumor completely along with a margin of healthy tissue to reduce the risk of recurrence. Surgical procedures can vary from removing small lesions to more extensive operations such as glossectomy (removal of part or all of the tongue), neck dissection (removal of lymph nodes in the neck), or resection of parts of the jaw or oral floor. Surgery may also involve reconstructive techniques to restore function and appearance, which is crucial for speech, chewing, and swallowing.
**Radiation therapy** uses high-energy beams to kill cancer cells and is often employed after surgery to eliminate residual cancer cells or as a primary treatment when surgery is not feasible. Different forms of radiation therapy exist, including intensity-modulated radiation therapy (IMRT), which precisely targets the tumor while sparing surrounding healthy tissues. Radiation can cause side effects such as skin irritation, mucositis (inflammation of the mucous membranes), dry mouth, and potential long-term effects on thyroid and pituitary function. Managing these side effects is an important part of care.
**Chemotherapy** involves the use of drugs to kill cancer cells or stop their growth. It is often used in advanced stages of OSCC or when the cancer has spread beyond the oral cavity. Chemotherapy can be given before surgery (neoadjuvant) to shrink tumors, after surgery (adjuvant) to reduce recurrence risk, or alongside radiation therapy (chemoradiation) to enhance the effectiveness of radiation. Common chemotherapy agents include cisplatin, carboplatin, paclitaxel, docetaxel, and 5-fluorouracil. These drugs can have side effects like nausea, fatigue, lowered immunity, and kidney or nerve damage, requiring careful monitoring.
**Targeted therapy** focuses on specific molecules involved in cancer growth. For OSCC, drugs like cetuximab target the epidermal growth factor receptor (EGFR), which is often overexpressed in these tumors. Targeted therapies can be used alone or with chemotherapy and radiation to improve treatment response. They tend to have different side effect profiles compared to traditional chemotherapy, often including skin rash and infusion reactions.
**Immunotherapy** is an emerging treatment that helps the body’s immune system recognize and attack cancer cells. Immune checkpoint inhibitors, such as those targeting PD-1 or PD-L1 proteins, have shown promise in treating recurrent or metastatic OSCC that does not respond to conventional therapies. Immunotherapy can lead to durable responses but may also cause immune-related side effects affecting various organs.
In addition to these main treatments, ongoing research explores novel approaches such as nanoparticle-based drug delivery, modulation of long non-coding RNAs involved in tumor progression and drug resistance, and combination therapies tailored to the tumor’s molecular profile. These advances aim to overcome challenges like drug resistance and improve survival rates.
Treatment choice depends on multiple factors including tumor size, location, lymph node involvement, metastasis, patient’s general health, and preferences. Early detection significantly improves the chances of successful treatment. Multidisciplinary care involving surgeons, radiation oncologists, medical oncologists, dentists, speech therapists, and nutritionists is essential to optimize outcomes and quality of life for patients with oral squamous cell carcinoma.
