• Inside of cheek: Radical surgery alone, radiotherapy alone or both in sequence. Clinical trials involve adding chemotherapy . • Floor of mouth: Extensive surgery or radiotherapy (may include implant). • Lower gums: Combined radiotherapy and radical surgery. • Behind wisdom teeth: Surgery followed by radiotherapy. Clinical trials involve adding chemotherapy. • Upper gums: Superficial lesions are treated with radiotherapy alone. Deep lesions also require surgery. • Hard palate: Same as upper gums. Five-Year Survival 50 percent (lip and inside of cheek), 50 to 60 percent (tongue), 70 percent (floor of mouth), 90 percent (lower gums), 80 percent (hard palate and upper gums) Stage IV Standard Treatment Surgery and/or radiotherapy, depending on the location of the tumor . Neoadjuvant chemotherapy has been used to shrink tumors and improve the possibility of successful treatment with surgery or radiation. Patients with advanced lesions should have radiotherapy to lymph nodes or surgery to remove them. Clinical trials involving adjuvant chemotherapy are in progress and are appropriate for all sites. • Lip: Combined surgery and radiotherapy. Both sides of the neck have to be treated.