What Happens During Surgery for Oral Cancer

Surgery

Most tumors in the oral cavity can be removed with surgery.

When you need treatment before surgery

If you have a large tumor in your mouth, you may have another treatment before surgery. That treatment may be chemotherapy alone, chemotherapy in addition to radiation therapy, or a combination. The goal of these other treatments is to help shrink the tumor and make it easier to remove. The presurgery treatments will happen a few months before surgery. Receiving another type of treatment before surgery is called neoadjuvant therapy.

Types of surgery

The type of surgery you have depends on your health condition and stage of the tumor. The doctor may remove part or all of the affected area of the oral cavity.

Regardless of the type, 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 administer the anesthesia. Before surgery, you’ll meet the anesthesiologist and can ask questions about the anesthesia and how it will affect you.

Your doctor will explain in detail what your surgical options are. The list below will give you a general idea of the types of surgery you might hear about. You may have one or more of these types of surgery:

  • Primary tumor resection. You may have this surgery when the tumor is small and the doctor can easily feel the tumor move. The surgeon removes the tissue in your mouth that contains the cancer, along with a little of the normal tissue surrounding the tumor. If your surgical team has to remove a large amount of tissue, they may use reconstruction techniques to rebuild the area. Doctors do this by taking normal tissue from another part of your body.

  • Partial mandible resection. If the cancer involves your jawbone (also called the mandible), your surgeon may remove part of the bone. Sometimes the jawbone is rebuilt with bone from another part of your body, or by inserting a metal plate.

  • Maxillectomy. If the cancer involves the bone in your mouth that holds your upper teeth (called the maxilla), your surgeon may remove part of the bone. You may receive a prosthesis, which is a special device that fits into the roof of your mouth. You will get you a prosthesis before surgery and a specialist will refit the device after surgery.

  • Mohs micrographic surgery. If the cancer is in your lip, your surgeon might use this special technique to remove the cancer. Its goal is to help preserve your lip’s appearance and function. The surgeon shaves off layers of skin 1 at a time. Each layer is examined under the microscope to identify any cancerous cells. When your surgeon finds no more cancerous cells, then no more layers of skin are removed.

  • Removal of the tongue. Full or partial glossectomy (removal of the tongue) may be necessary 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 surrounding 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 trachea, and holds it 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. This is a feeding tube that a surgeon places in your stomach if the cancer or its treatment makes it difficult for you to eat. Your surgeon may place the tube through your nose or through your abdominal wall directly into your stomach. This tube may be temporary or permanent.

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.