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 types of tumors can’t be removed by surgery. Your doctor will
talk with you about your options.
Types of surgery for oral cancer
The type of surgery you have depends on your health and the stage of the cancer. The
surgeon may remove part or all of the affected area of the oral cavity. Your doctor
will explain in detail what your surgery options are. You may have one or more of
these types of surgery:
Primary tumor resection. The surgeon removes the tissue in your mouth that has 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.
Partial mandible resection. If the cancer is in your jawbone (mandible), your surgeon
may remove part of the bone. The jawbone may be rebuilt with bone from another part
of your body, bone from a donor, or by inserting a metal plate.
Maxillectomy. If the cancer is in the bone in your mouth that holds your upper teeth
(maxilla), your surgeon may 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 refit it after
Mohs micrographic surgery. If the cancer is in your lip, your surgeon might use the
Mohs method to remove the cancer. The goal is to help preserve the appearance and
function of your lip. The surgeon shaves off 1 layer of skin at a time. Each layer
is examined under the microscope right away to look for cancer cells. When no more
cancer cells are seen, then no more layers of skin are removed.
Removal of the tongue. A full or partial removal of the tongue (glossectomy) may be
needed for cancer of the tongue.
Neck dissection. This surgery can be done if the cancer has spread to lymph nodes
in your neck. Your surgeon removes 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 have this surgery if the cancer or surgery makes breathing difficult. The
surgeon makes a hole in 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 temporary, used only until the swelling goes down. Or
it may be permanent.
Gastrostomy tube placement. This is a feeding tube that a surgeon places in your stomach
if the cancer or its treatment makes it hard for you to eat. Your surgeon may place
the tube through your nose. Or he or she may place it through your belly (abdominal)
wall directly into your stomach. This tube may be temporary or permanent.
Before your surgery
You’ll meet with your surgeon beforehand to talk about the procedure. The surgeon
will find out if you are taking any medicines and will go over your health history.
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. You can ask any questions and address
any concerns you may have.
Questions 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 to your satisfaction, you will sign a consent form that says that
the doctor can perform the surgery.
On the day of surgery, you’ll get anesthesia so that you fall asleep and don’t feel
pain. An anesthesiologist or a nurse anesthetist will give you the anesthesia. Before
surgery, you’ll meet the anesthesiologist and can ask questions about the anesthesia
and how it will affect you.
Many of the surgeries for oral cancer may affect how you look or make it difficult
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 within several days after surgery for oral cancer. It will most
likely take you a few weeks to feel better. Once you've left the hospital, you'll
probably still need some special care as you recover from surgery. 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 days after surgery, you are likely 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 healing.
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 area.
Bleeding. Some people have bleeding or oozing from the cut (incision).
Constipation. You may have constipation from using opioid pain killers, from not moving
much, or from not eating much. Talk with your doctor or nurse about getting more fiber
in your diet.
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.
You may have trouble eating. A nurse or therapist will help you learn how to swallow
so you can eat after surgery.
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.
He or she will also show you and your caregivers how to care for the tracheostomy.
If you have a gastrostomy tube, a nurse or therapist will show you and your caregivers
how to use the tube. You may have the gastrostomy tube for a while, until you can
swallow well enough to eat again. If your treatment prevents you from swallowing well
again, you may always use a gastrostomy tube to feed yourself.
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 surgery, you may have either radiation or radiation and chemotherapy. This is
to 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
A new cough
Swelling, pain, or redness in your legs
Trouble eating or drinking
Talk with your healthcare providers about what signs to look for and when to call
them. Make sure you know what number to call with questions or problems.