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 methods may be used to rebuild the area. Doctors do this by taking normal tissue from another part of your body.
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 receive 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 surgery.
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 there is a chance 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.
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 hold is held open with a small tube called a tracheostomy (trach) tube. You then breathe through this tube. A tracheostomy may be temporary or 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 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 medical records. 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 go about getting a second opinion?
Are there other ways to treat the cancer?
How often do you perform this surgery?
What are the possible side effects of the surgery?
Will the surgery change my appearance?
Will the surgery change how I use my mouth to 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 your appearance 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 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 options for pain relief. 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.
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.
Bloating of the face. You may have facial swelling or bloating. This will go away over time.
You may have trouble eating because your ability to swallow is limited. 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 surgery.
After surgery, you may have either radiation or radiation and chemotherapy. This is to reduce the chance that any cancer cells that remain will spread. 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 surgery:
Redness, swelling, or fluid leaking from the incision
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.
March 21, 2017
Gersten, Todd, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS