Lip cancer: the decisions you may face
4 treatment settings, 3 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Early disease
Wedge or V excision with local flap reconstruction, or radiotherapy (external beam or brachytherapy) for commissure tumours or unfit patients.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
- Conformal dose, fewer side effects
- Hypofractionation saves visits
Brachytherapy places a radioactive source directly inside or next to the tumour.
- Highest conformality
- Short treatment
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Low-dose bath to normal tissue
- Motion management
- Invasive
- Declining expertise in some regions
- Between IMRT / IGRT (modern external beam) and Brachytherapy, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (early disease), which of the standard options do you recommend and why?Why: Guideline options include: Wedge or V excision with local flap reconstruction, or radiotherapy (external beam or brachytherapy) for commissure tumours or unfit patients.
Add these to your appointment list, or take the full question set for this cancer.
Large, thick or node-positive disease
Resection with flap reconstruction, sentinel node biopsy or neck dissection, and postoperative radiotherapy; cisplatin for extranodal extension or positive margins.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
- Conformal dose, fewer side effects
- Hypofractionation saves visits
Removing just the first lymph node a tumour drains to, instead of all of them, to check for spread.
- Avoids lymphoedema from full dissection
Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Low-dose bath to normal tissue
- Motion management
- False negatives in ~5-10%
- Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
- Between IMRT / IGRT (modern external beam), Sentinel lymph node biopsy and Cisplatin, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (large, thick or node-positive disease), which of the standard options do you recommend and why?Why: Guideline options include: Resection with flap reconstruction, sentinel node biopsy or neck dissection, and postoperative radiotherapy; cisplatin for extranodal extension or positive margins.
- Am I a candidate for Cisplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Add these to your appointment list, or take the full question set for this cancer.
Unresectable or metastatic
Cemiplimab as for cutaneous squamous cell carcinoma, or pembrolizumab-based treatment as for head and neck squamous cell carcinoma.
A PD-1 blocker that is the standard for advanced skin squamous cell carcinoma, and in 2025 became the first adjuvant immunotherapy for it.
Pembrolizumab is a PD-1 blocking antibody approved in more than 40 settings, from melanoma and lung cancer to the first tumour-agnostic approval for mismatch-repair-deficient tumours in 2017, and before and after surgery in triple-negative breast cancer. A subcutaneous form arrived in 2025, and it is the backbone partner for ADCs and personalised neoantigen vaccines.
- Tests PembrolizumabUntreated recurrent or metastatic HNSCC: pembrolizumab alone, pembrolizumab + platinum/5-FU, or cetuximab + platinum/5-FU (EXTREME)
OS 14.9 vs 10.7 months (CPS ≥20, monotherapy); 13.0 vs 10.7 (all, with chemotherapy).
Overall survival, CPS ≥20, pembrolizumab monotherapy (months): Pembrolizumab 14.9 vs Cetuximab + chemotherapy 10.7 · HR 0.61 · source
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Hypothyroidism (immune-mediated) · Pooled monotherapy data, >2,800 patients | 8% | - |
| Pneumonitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 3.4% | - |
| Colitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 1.7% | - |
| Hepatitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 0.7% | - |
- No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Between Cemiplimab and Pembrolizumab, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in KEYNOTE-048, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Pembrolizumab are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (unresectable or metastatic), which of the standard options do you recommend and why?Why: Guideline options include: Cemiplimab as for cutaneous squamous cell carcinoma, or pembrolizumab-based treatment as for head and neck squamous cell carcinoma.
- Am I a candidate for Cemiplimab, Pembrolizumab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-048 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Prevention
Sun protection of the lips, smoking cessation, and treatment of actinic cheilitis.
Stopping smoking after a cancer diagnosis improves survival, reduces treatment complications and second cancers, and is the single most effective supportive intervention that oncology services still routinely fail to deliver.
- Large survival effect in lung and head and neck cancer
- Cheap, effective drugs available
- Opt-out models are proven to raise uptake
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Under-delivered: most patients never offered treatment
- Stigma and fatalism among patients and clinicians
- Reimbursement gaps for cessation pharmacotherapy
- Is Smoking cessation in cancer patients the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?Why: A single standard does not mean a single choice; timing and trials are decisions too.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (prevention), which of the standard options do you recommend and why?Why: Guideline options include: Sun protection of the lips, smoking cessation, and treatment of actinic cheilitis.
Add these to your appointment list, or take the full question set for this cancer.