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RGCIRC, Niti Bagh
Oral Cancer Treatment at RGCIRC
An oral cancer diagnosis often brings concerns about treatment as well as its possible impact on speaking, eating, swallowing and appearance. Since oral cancer may develop in different areas of the mouth, including the tongue, gums, inner cheeks, lips, floor of the mouth and palate, treatment needs to consider the exact location and extent of the disease.
At Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), oral cancer treatment is planned by a multidisciplinary Head & Neck Cancer team. Specialists assess the tumour site, stage, lymph-node involvement, overall health and the need to preserve or restore important functions before recommending treatment. Depending on the diagnosis, treatment may include surgery, reconstructive surgery, radiation therapy, chemotherapy, targeted therapy or immunotherapy. Speech, swallowing, nutrition and rehabilitation support also form an important part of care, helping patients regain the ability to speak, eat and swallow as comfortably as possible after treatment.
Understanding Oral Cancer and Its Types
Oral cancer, also called mouth cancer, develops in the tissues of the oral cavity. The oral cavity includes several areas of the mouth, and knowing exactly where the cancer begins is important because the location influences staging, surgery and reconstruction.
Oral cancer may develop in:
- The lips
- The front two-thirds of the tongue
- The gums
- The inner lining of the cheeks and lips
- The floor of the mouth under the tongue
- The hard palate, or the bony roof of the mouth
- The area behind the wisdom teeth, known as the retromolar trigone
What are the Main Types of Oral Cancer?
Most oral cancers are squamous cell carcinomas. These cancers begin in the thin, flat squamous cells that line the inside of the mouth and lips.
Less common cancers may arise from other tissues in or around the oral cavity, including the minor salivary glands.
The exact location and type of cancer matter because they influence how the disease behaves, how it is staged and which treatment approach is most suitable. A tumour on the tongue, for example, may require a different surgical and reconstructive plan from one involving the jaw, cheek or hard palate.
Early Signs and Symptoms of Oral Cancer
Oral cancer does not always cause pain in its early stages. A small ulcer, patch or swelling may seem harmless at first, especially when it resembles a common mouth sore. What matters is whether the change heals normally or continues to persist.
Common signs and symptoms of oral cancer include:
- A mouth ulcer that does not heal
- A red or white patch inside the mouth
- A lump, swelling or thickened area on the tongue, gums, cheek or lip
- Unexplained bleeding from the mouth
- Persistent pain or tenderness
- Numbness in the tongue, lip or another part of the mouth
- Difficulty chewing or swallowing
- Difficulty moving the tongue or opening the mouth fully
- A tooth becoming loose without an obvious dental reason
- Changes in speech
- A lump or swelling in the neck
RGCIRC also lists non-healing ulcers, bleeding, loose teeth, difficulty opening the jaw, swallowing problems, white or red patches and neck swelling among the common warning signs of mouth cancer.
When Should a Mouth Ulcer or Other Change Be Checked?
Most mouth ulcers heal on their own and are not cancerous. Still, an ulcer, patch, lump or other unexplained change that does not heal or continues to worsen deserves medical evaluation. The same applies when it occurs along with persistent pain, bleeding, numbness, difficulty swallowing or a neck swelling.
A timely examination does not mean that cancer is suspected in every case. It helps identify the cause and ensures that any suspicious area receives further testing without unnecessary delay.
Who May Be at Higher Risk of Oral Cancer?
The risk is higher among:
- People who use tobacco: Smoking cigarettes or bidis and using smokeless tobacco increase oral cancer risk. This includes products commonly used in India, such as gutka, khaini, zarda and paan containing tobacco. Smokeless tobacco is an established cause of oral cancer.
- People who chew betel quid or areca nut: Betel quid, with or without added tobacco, increases oral cancer risk. Areca nut itself is linked to an increased risk of oral cancer, even when it is used without tobacco.
- People who consume alcohol heavily: Regular heavy alcohol use increases the risk of cancers of the oral cavity.
- People who use both tobacco and alcohol: The combination raises oral cancer risk more than either exposure alone.
- People with a previous head and neck cancer: A personal history of head and neck cancer is associated with a higher risk of developing another cancer in this region.
- People with long-term sun exposure: This is particularly relevant to cancers that develop on the lip.
Having one or more of these risk factors does not mean that someone will definitely develop oral cancer. The disease may also occur in people without an obvious risk factor. Reducing tobacco and alcohol exposure remains one of the most important ways to lower the risk of oral and other head and neck cancers.
Oral Cancer Screening and Early Detection
Oral cancer often begins with a visible or noticeable change inside the mouth. This makes a careful oral examination useful for identifying suspicious areas that may require further investigation, particularly in people with a history of tobacco, areca nut or heavy alcohol use.
What Does Oral Cancer Screening Involve?
During an oral examination, the doctor or dentist checks the lips, tongue, gums, inner cheeks, floor and roof of the mouth for ulcers, red or white patches, lumps, thickened areas or other unusual changes. The neck may also be examined for enlarged lymph nodes.
There is no single blood test or laboratory test used to screen for oral cancer. If the examination finds a suspicious area, further evaluation and a biopsy may be required to confirm whether cancer is present.
Routine oral cancer screening has not been shown to reduce deaths in the general population. Still, people with significant risk factors or persistent changes inside the mouth should not wait for symptoms to worsen before seeking an oral examination.
How is Oral Cancer Diagnosed at RGCIRC?
Finding a suspicious ulcer, patch or lump does not automatically mean cancer. The next step is a detailed evaluation to understand what the change is and whether further testing is required. At RGCIRC, diagnosis begins with examining the affected area and is confirmed through a biopsy when cancer is suspected.
Clinical Examination of the Mouth and Neck
The doctor examines the lips, tongue, gums, inner cheeks, floor and roof of the mouth for an abnormal ulcer, growth, patch or thickening. The jaw, tongue movement and neck are also assessed, and the doctor feels for enlarged lymph nodes or other swellings.
Biopsy to Confirm Oral Cancer
A biopsy is the definitive test for confirming oral cancer. A small sample of tissue is taken from the suspicious area and examined by a pathologist under a microscope. The findings confirm whether cancer cells are present and help identify the type of cancer.
If a suspicious lymph node is present in the neck, the doctor may recommend additional sampling to determine whether cancer has reached the lymph nodes.
Imaging Tests
Once cancer is confirmed or strongly suspected, imaging helps doctors understand its extent and plan treatment. Depending on the clinical situation, RGCIRC may use:
- CT scan to assess the tumour and nearby structures
- MRI for detailed evaluation of soft tissues and local spread
- PET-CT in selected patients to assess lymph-node involvement or disease elsewhere in the body
RGCIRC reviews CT, MRI and PET-CT findings along with biopsy results when planning oral cancer surgery and treatment.
Can a Blood Test Detect Oral Cancer?
No blood test alone confirms oral cancer. Blood tests may provide information about general health and organ function before treatment, but diagnosis depends on examination and tissue biopsy. NCI also identifies biopsy as a key test for diagnosing lip and oral cavity cancer.
Once the diagnosis and imaging findings are available, doctors determine the stage of the cancer and use this information to plan treatment.
Understanding Oral Cancer Stages and Treatment Planning
Once oral cancer is confirmed, doctors determine how far the disease has grown or spread. This process is called staging. Oral cancer usually follows the TNM system, which considers the size and depth of the primary tumour, lymph-node involvement and whether the cancer has spread to another part of the body.
Oral Cancer Stages
In simple terms:
- Stage I and II: The cancer is usually smaller and has not spread to nearby lymph nodes.
- Stage III: The tumour may be larger, deeper or may have spread to a nearby lymph node.
- Stage IV: The cancer may involve nearby structures such as the jaw, multiple or larger lymph nodes, or may have spread to distant organs.
For oral cavity cancer, doctors also consider depth of invasion, which means how deeply the tumour has grown into the tissues. This is different from simply measuring how wide or thick the tumour appears and is an important part of staging.
How is the Best Treatment for Oral Cancer Decided?
Stage is important, but it does not decide treatment on its own. The multidisciplinary team also looks at:
- The exact part of the mouth involved
- Tumour size and depth of invasion
- Whether neck lymph nodes are affected
- Whether the jaw or nearby tissues are involved
- Biopsy and pathology findings
- Overall health and fitness for treatment
- The likely effect of treatment on speech, chewing and swallowing
- Whether reconstructive surgery may be required
Early-stage cancers may require more limited treatment, while cancers involving the tongue, jaw or lymph nodes may need more extensive surgery, reconstruction or additional treatment. RGCIRC follows this site- and stage-specific approach when planning oral cancer surgery and further care.
The aim is to control the cancer effectively while preserving or restoring oral function wherever medically possible.
Oral Cancer Treatment Options at RGCIRC
The treatment plan for oral cancer depends on where the tumour is located, how deeply it has grown, whether lymph nodes are involved and the patient’s overall health. For many oral cavity cancers, surgery forms an important part of treatment. Radiation therapy, chemotherapy and other systemic treatments may be added according to the stage and findings after surgery.
At RGCIRC, treatment is planned through a dedicated Head & Neck Oncology programme, with surgical, medical and radiation oncologists working alongside pathologists, radiologists and reconstructive specialists.
Surgery for Oral Cancer
The aim of oral cancer surgery is to remove the tumour completely while preserving speech, chewing, swallowing and facial structure as far as medically possible. The extent of surgery depends on the part of the mouth involved and how far the cancer has grown.
Procedures available at RGCIRC include:
- Wide local excision: The tumour is removed along with a margin of surrounding healthy tissue. This approach is often used for smaller, localised cancers.
- Partial or total glossectomy: When cancer involves the tongue, the surgeon may remove part of the tongue or, for more extensive disease, a larger portion. Reconstruction may form part of the same procedure to support speech and swallowing.
- Mandibulectomy: Part of the lower jaw may require removal if cancer has reached the mandible.
- Maxillectomy: Part of the upper jaw or hard palate may be removed when the tumour involves these structures.
- Neck dissection: Selected lymph nodes in the neck may be removed when there is known or suspected lymph-node involvement. In some situations, doctors may also recommend neck treatment because oral cancer sometimes spreads microscopically before enlarged nodes become obvious on scans.
The surgical plan is tailored to the tumour rather than following one standard operation for every patient.
Checking Surgical Margins During Surgery
Removing the complete tumour with an adequate margin of healthy tissue is an important goal of oral cancer surgery. RGCIRC uses frozen-section analysis during selected procedures to check the edges, or margins, of the removed tissue while the patient is still in the operating theatre.
A pathologist rapidly examines samples from the margins. If cancer cells are found at an edge, the surgeon may remove additional tissue during the same operation. This helps the team assess whether adequate clearance has been achieved before completing the procedure.
Reconstructive Surgery After Oral Cancer Removal
Removing a tumour from the tongue, cheek, palate or jaw may leave a defect that affects appearance as well as speech, chewing or swallowing. In these situations, reconstructive surgery becomes part of the treatment plan rather than a separate cosmetic procedure.
RGCIRC offers microvascular free-flap reconstruction, in which tissue from another part of the body is transferred to reconstruct the affected area and its blood vessels are connected under a microscope. Tissue may come from areas such as the forearm or thigh, depending on the type of defect.
When part of the lower jaw requires removal, a fibula free flap may be used in selected patients. A segment of bone from the lower leg helps reconstruct the jaw, restore facial contour and support chewing function.
For complex procedures, RGCIRC also uses a two-team surgical approach in selected cases. One team removes the tumour while another prepares the tissue required for reconstruction, allowing tumour removal and reconstruction to proceed as part of the same operative plan.
Radiation Therapy
Radiation therapy uses high-energy radiation to destroy cancer cells in a carefully planned area. Its role depends on the tumour site, stage and surgical findings.
It may be recommended:
- After surgery when there is a higher risk of the cancer returning
- Along with chemotherapy in selected high-risk or locally advanced cases
- As the main treatment in some situations where surgery is not appropriate
- To control symptoms in advanced disease
For many advanced oral cavity cancers, treatment involves surgery followed by radiation therapy when indicated. The final pathology report, including margin status and lymph-node findings, helps doctors decide whether additional treatment is required. RGCIRC similarly reviews final pathology through its multidisciplinary Head & Neck Tumour Board when planning post-operative treatment.
Chemotherapy and Chemoradiation
Chemotherapy uses medicines that travel through the bloodstream to treat cancer cells. In oral cancer, chemotherapy is not required for every patient.
It may be used together with radiation therapy in selected patients with high-risk or locally advanced disease, or as part of treatment when cancer cannot be managed adequately with surgery alone. Systemic therapy also has a role when oral cancer returns or spreads to another part of the body.
When chemotherapy and radiation are given during the same treatment period, the approach is called concurrent chemoradiation. Because combined treatment may cause more side effects, doctors assess general health, kidney function, nutrition and other medical factors before recommending it.
Targeted Therapy and Immunotherapy
For selected recurrent or metastatic oral cancers, treatment may include medicines that work differently from traditional chemotherapy.
Targeted therapy acts on particular proteins or pathways that help cancer cells grow. Its use depends on the clinical situation, previous treatment and the characteristics of the cancer.
Immunotherapy helps the immune system recognise and attack cancer cells more effectively. Medicines such as pembrolizumab or nivolumab are used in selected patients with recurrent or metastatic head and neck squamous cell carcinoma. Biomarker findings such as PD-L1 expression may help guide treatment decisions in some patients.
Treatment for Recurrent or Metastatic Oral Cancer
Oral cancer is called recurrent when it returns after treatment and metastatic when it spreads to a distant part of the body.
Treatment depends on where the cancer has returned, what treatment the patient has already received and their current health. Options may include further surgery or radiation therapy in selected cases, chemotherapy, targeted therapy, immunotherapy or a combination of systemic treatments. When cure is not possible, treatment also focuses on controlling symptoms, maintaining nutrition and supporting quality of life.
Clinical Trials at RGCIRC
RGCIRC has a dedicated Clinical Research Centre and established its Central Clinical Trial Department in 2019. Its medical, surgical, radiation and other oncology units participate in clinical research evaluating newer cancer treatments and treatment approaches.
A patient with oral cancer may be considered for a suitable clinical trial when one is available and the eligibility criteria match the diagnosis, stage, previous treatment and overall health. Participation remains voluntary, and the clinical team explains the treatment being studied, possible benefits and risks, and available standard treatment options before enrolment.
Recovery and Rehabilitation After Oral Cancer Treatment
Recovery from oral cancer treatment involves more than healing from surgery or completing radiation or chemotherapy. Depending on the area treated, patients may experience changes in speech, chewing, swallowing, mouth opening or facial movement. Rehabilitation helps restore these functions as far as possible and supports a gradual return to everyday activities.
At RGCIRC, post-treatment rehabilitation is planned according to the type and extent of treatment received, with support for speech, swallowing, nutrition and facial rehabilitation where required.
Speech, Chewing and Swallowing Rehabilitation
Surgery involving the tongue, jaw, cheek or palate may temporarily or permanently affect speech and swallowing. Radiation treatment may also cause problems such as dry mouth, soreness or difficulty swallowing.
Speech and swallowing therapy may include exercises and techniques to improve:
- Speech clarity and communication
- Tongue and jaw movement
- Chewing
- Safe and comfortable swallowing
- Mouth opening and oral function
The rehabilitation plan depends on the structures affected and how the patient is recovering.
Nutrition During Recovery
Eating may be difficult for some time after oral cancer treatment. A dietitian helps patients maintain adequate nutrition while adapting to changes in chewing or swallowing. Depending on individual needs, this may involve softer foods, texture-modified meals, nutritional supplements or temporary feeding support.
Dental, Jaw and Facial Rehabilitation
Oral and dental care is particularly important for patients who receive radiation to the head and neck. Regular dental assessment helps manage treatment-related changes affecting the teeth, gums, mouth and jaw.
Patients who undergo reconstruction may also require rehabilitation to improve jaw movement, facial function and the ability to chew. Prosthetic or dental rehabilitation may be considered according to the structures removed and reconstructed.
Emotional and Psychological Support
Changes in eating, speaking or facial appearance may affect confidence, social interactions and emotional well-being. Psychological support and counselling help patients and families adjust to these changes as recovery progresses. RGCIRC includes psychological support alongside nutrition, speech and swallowing rehabilitation within its head and neck cancer care services.
Follow-Up After Oral Cancer Treatment
Regular follow-up remains important after treatment ends. These visits help the care team monitor recovery, look for signs of recurrence and manage any lasting effects of treatment. Follow-up may include examination of the mouth and neck, imaging when clinically indicated, dental review, nutritional assessment and continued rehabilitation support.
Patients are also encouraged to stop tobacco and areca nut use and discuss any new or persistent mouth ulcer, swelling, pain, difficulty swallowing or neck lump with their care team rather than waiting for the next scheduled appointment.
Why Choose RGCIRC for Oral Cancer Treatment in Delhi?
Oral cancer treatment often involves more than removing a tumour. The treatment plan may also need to protect or restore speech, chewing, swallowing and facial structure. RGCIRC brings these aspects together through a dedicated Head & Neck Oncology programme, where specialists plan cancer treatment and functional recovery as part of the same care pathway.
Dedicated Head & Neck Cancer Expertise
Oral cancer cases at RGCIRC are managed by specialised head and neck onco-surgeons with support from medical oncologists, radiation oncologists, pathologists, radiologists and other specialists. This site-specific approach helps the team plan treatment according to the exact tumour location, stage, lymph-node involvement and reconstructive requirements.
Multidisciplinary Tumour Board Planning
RGCIRC follows a structured Head & Neck Tumour Board approach. Before surgery, specialists review biopsy findings, imaging and clinical assessment together to decide the extent of tumour removal, management of neck lymph nodes and the need for reconstruction. The team reviews the final pathology after surgery to determine whether radiation therapy, chemotherapy or other treatment is required.
Advanced Oral Cancer Surgery and Reconstruction
For patients who require surgery, RGCIRC combines tumour removal with intraoperative margin assessment and reconstructive planning. Frozen-section analysis helps assess surgical margins during the operation, while microvascular free-flap reconstruction and fibula free-flap reconstruction support restoration of oral and jaw structures in selected patients. For complex procedures, a two-team approach allows tumour removal and preparation for reconstruction to take place simultaneously.
Integrated Rehabilitation and Support
Treatment does not end with cancer removal. RGCIRC integrates dental and maxillofacial support, speech and swallowing therapy, nutritional guidance and rehabilitation into oral cancer care. This coordinated approach supports recovery of oral function and helps patients adjust to changes following treatment.
Accreditation, Recognition and Accessible Cancer Care
RGCIRC holds NABH and NABL accreditations, along with Green OT and Nursing Excellence certifications. The Institute was recognised among Newsweek’s World’s Best Specialised Hospitals in 2024 and 2025, ranked No. 1 in North India among single-specialty hospitals in The Times of India’s 2025 critical-care hospital survey, and received the Best Oncology Hospital of the Year award at the IHW Council’s Cancer Summit Awards 2026.
Established in 1996 as a not-for-profit cancer centre, RGCIRC works to make specialist cancer care more accessible and affordable. Its Patient Welfare and Philanthropy teams help arrange financial assistance for eligible patients. Over the years, RGCIRC has touched the lives of more than 3.5 lakh patients from India, neighbouring SAARC countries and other regions.