Oral Cancer: Surgery
Surgery is a common treatment for oral cancer. It’s done to remove as much of the
cancer as possible. You have to be healthy enough to have surgery for it to be a good
option for you. Some oral cancers can’t be removed with surgery. It depends on where
the tumor is, how big it is, and if it has spread beyond where it first started. Sometime
reconstructive surgery is needed too. This is done to repair the damage caused by
taking out the tumor. It can help restore the way your body works and looks. Your
doctor will talk with you about your options.
Types of surgery for oral cancer
The type of surgery you have depends on your overall health and the stage of the cancer
(how big it is and if and where it has spread). The surgeon may remove part or all
of the tumor and a rim of healthy tissue around it. Your doctor will explain in detail
what your surgery options are.
You may have 1 or more of these types of surgery:
Primary tumor resection. The surgeon removes the tissue in your mouth that contains the cancer, along with
a little of the normal tissue around the tumor. If a large amount of tissue is removed,
reconstruction may be used to rebuild the area. Doctors do this by taking normal tissue
from another part of your body. Skin, muscle, and even bone can be used.
Mandible resection. If the cancer is in your jawbone (mandible), the surgeon may remove part or all of
the bone (called mandibulectomy). The jawbone may be rebuilt with bone from another
part of your body, bone from a donor, or by putting in a metal plate.
Maxillectomy. If the cancer is in the bone in the front part of the roof of your mouth that holds
your upper teeth (maxilla), your surgeon may need to remove part of the bone. You
may be fitted with a prosthesis. This is a special device that fits into the roof
of your mouth to cover the hole from surgery. You may get the prosthesis before surgery.
A specialist will then refit it after surgery.
Mohs micrographic surgery. If the cancer is in your lip, the Mohs method might be used to remove the cancer.
The goal is to help preserve the way your lip works and looks. The surgeon shaves
off 1 thin layer of skin at a time. Each layer is examined right away to check for
cancer cells. When no more cancer cells are seen, the surgery stops and no more layers
of skin are removed.
Removal of the tongue. A full or partial removal of the tongue (called glossectomy) may be needed for cancer
of the tongue.
Neck dissection. This surgery might be needed if the cancer has spread to lymph nodes in your neck.
The surgeon takes out the lymph nodes in the neck and some of the nearby tissue. This
is done at the same time surgery is done to remove the tumor.
Tracheostomy. You may need this surgery if the cancer or surgery makes it hard to breathe. The
surgeon makes a hole in the front of your neck, into your windpipe (trachea). The
hole is held open with a small tube called a tracheostomy (trach) tube. You then breathe
through this tube. A tracheostomy may be short-term, used only until the swelling
goes down. Or it may be permanent, so you have it for the rest of your life.
Feeding tube placement. A gastrostomy tube (g-tube or PEG tube) is a feeding tube that the surgeon puts in
your stomach if the cancer or treatment makes it hard for you to eat. It goes in through
the skin over your stomach. Another option is putting the tube into your nose, down
your swallowing tube (esophagus), and into your stomach. This is called a nasogastric
feeding tube or NG tube. Liquid nutrition is then put right into your stomach through
the feeding tube. An NG tube is short-term. A PEG or g-tube may be short-term or permanent.
Before your surgery
You’ll meet with your surgeon beforehand to talk about the details of your surgery.
The surgeon will ask if you are taking any medicines and will go over your health
history. Be sure to tell then about all prescription and over-the-counter medicines
you take. Also tell them about vitamins, supplements, and herbs you use, as well as
marijuana and any illegal drugs you take. This is done to make sure your surgery will
not be affected by any medicines you’re taking or any other health problems you have.
This is the time to ask any questions and address any concerns you may have.
Some questions you might want to ask your surgeon include:
What are the risks of having this surgery?
How do I get a second opinion?
Are there other ways to treat the cancer?
How often do you perform this surgery?
What will be done during the surgery?
What are the possible side effects of the surgery?
Will the surgery change the way I look?
Will the surgery change how I eat, breathe, or talk?
Will I need more surgeries to be able to swallow or speak?
What can I do to make it easier to return to my normal activities after surgery?
After you have discussed all the details with your surgeon, and all your questions
have been addressed, you'll sign a consent form that says that the doctor can do the
Before surgery, you’ll also meet the anesthesiologist and can ask questions about
the anesthesia and how it will affect you. (Anesthesia is the medicine used during
On the day of surgery, you’ll get anesthesia so that you go into a deep sleep and
don’t feel pain. An anesthesiologist or a nurse anesthetist will give it to you.
Oral cancer surgery can be very complex and might take a long time. Many of the surgeries
for oral cancer may affect how you look or make it hard to use your mouth. You may
need more surgery to rebuild your mouth. This is called reconstructive surgery. Your
surgeon may do this right after the tumor is removed. Or it may be done later, as
a separate surgery.
What to expect after surgery
After surgery, you may have to stay in the hospital for a few days. How long you stay
in the hospital depends on how much and what part of your oral cavity was removed. Most
people can go home a few days after surgery for oral cancer. If needed, you'll be
taught how to take care of any dressings, tubes, or drains before you go home.
It will most likely take you several weeks to feel better. Once you've left the hospital,
you'll likely still need some special care as you recover. Here are some of the things
you can expect during your recovery.
Common side effects after surgery for oral cancer include:
Pain. For the first few weeks after surgery, you are likely going to have pain. Your pain
can be controlled with medicine. Talk with your doctor or nurse about your pain relief
options. Some people are hesitant to take pain medicine. But doing so can actually
help your recovery.
Tiredness. You may feel tired or weak for a while. The amount of time it takes to recover from
surgery is different for each person.
Symptoms from lymph node removal. If lymph nodes were removed from your neck, you may notice shoulder weakness, ear
numbness, or weakness in your lower lip. You also may notice some swelling in that
Bleeding. Some people have bleeding or oozing from the cut (incision).
Constipation. You may have constipation from using pain medicine, from not moving much, or from
not eating much. Talk with your doctor or nurse about what you can do to help prevent
Diarrhea. You may have diarrhea from tube feedings, stress, or an infection. Talk with a dietitian
about what you can eat to reduce the chances of getting diarrhea.
Bloated face. You may have facial swelling or bloating. This will go away over time. Talk with your
doctor about what you can do to manage it.
Eating problems. You may have trouble eating and drinking. A nurse or therapist will help you learn
how to swallow so you can eat after surgery. If needed, a feeding tube can be put
it to help you get the nutrients you need.
In some cases, you may need extra care after surgery.
If you have a tracheostomy, a physical or respiratory therapist can teach you exercises
to make breathing easier. You and your caregivers will also be shown how to care for
If you have a feeding tube, a nurse or therapist will show you and/or your caregivers
how to use it. You may have the gastrostomy tube for a while, until you can swallow
well enough to eat again. If your treatment keeps you from swallowing well again,
you may always need the tube.
You may have had to have teeth removed as part of your surgery. Many people have dental
problems addressed by their dentist or oral surgeon after they have healed from their
cancer treatment. There are many options for restoring teeth after surgery.
Your doctor will tell you when to return to check the wound and, if needed, to remove
stitches. You may also be scheduled to see a physical therapist, respiratory therapist,
dietitian, speech pathologist, or a dental specialist, depending on your needs after
After you heal from surgery, you may need more treatment. This could be either radiation
or radiation and chemotherapy. This is to help reduce the chance that the cancer will
come back. Having another type of treatment after surgery is called adjuvant therapy.
When to call your healthcare provider
Let your healthcare provider know right away if you have any of these problems after
Redness, swelling, or fluid leaking from the incision
Pain that's getting worse or not getting better with pain medicine
Trouble breathing or shortness of breath
A new cough
Swelling, warmth, pain, or redness in one arm or leg
Trouble eating or drinking
Trouble passing urine, pain with urination, or changes in how your urine looks or
Talk with your healthcare providers about what changes you should watch for and when
to call them. Make sure you know what number to call with questions or problems. Is
there a different number for evenings and weekends?