Oral Cancer Surgery

Cancer of the oral cavity (mouth) and oropharynx (back of the throat) is mainly treated through surgery. There are different types of surgeries for oral cancer/tumour. The choice of surgery (operation) depends upon the location and extent of the tumour. The surgeon may remove a part or all of the affected area of the oral cavity. The primary surgery could be followed by reconstructive surgery, i.e., surgery done to restore the appearance (how you look after the removal of tumour) and function of the area affected by the cancer or its treatment.

Oral cancer can affect one or more regions of the oral cavity, i.e., the lips, tongue, gums, cheeks, roof of the mouth (palate), or floor of mouth. As it spreads, it can involve the upper jaw bone (maxilla) or lower jaw bone (mandible), lymph nodes in the neck or other parts in the body. Mostly, oral cancers are squamous cell carcinomas (cancer of the inner lining of the mouth).

The doctor may recommend this surgery is you have the following symptoms of oral cancer:

• An ulcer or a sore, thick patch or lump in the mouth, lips, or throat
• A red or white patch in the mouth
• Difficulty in chewing or swallowing Read more: Difficulty swallowing causes
• A sensation of something stuck in the throat
• Swelling in jaws
• Numbness in the mouth or on the tongue
• Difficulty in moving the jaw and tongue
• Pain in the ear with no loss of hearing
• Difficulty in speech
• Lump or mass in neck or a bleeding sore in the mouth
• Weight loss
• Bad odour from the mouth

You may be considered at high risk for oral if you:

• Consume alcohol or tobacco
• Have been infected with human papillomavirus [HPV]
• Have a weakened immune system Read more: How to increase immunity
• Have a family history or past history of any type of cancer
• Have chronic rubbing on the inside of the mouth from rough teeth or ill-fitting dentures
• Have poor oral and dental hygiene

Oral cancer surgery is usually recommended when the tumour is small and has not spread. However, a larger area may need to be operated on if the cancer has spread to nearby lymph nodes or other tissues and radiation therapy and chemotherapy may also be needed.

There are no contraindications for oral cancer surgery, but old age and the presence of an underlying heart disease or lung condition increases the risk of complications and death. It also affects the individual’s ability to tolerate extensive surgery and may lead to an adverse outcome.

People who are not ready to stop alcohol or tobacco consumption cannot benefit from the surgery as it can cause complications and recurrence of the cancer. So an individual’s compliance plays a vital role in the success of this surgery. Read more: Effect of smoking on oral health 

Oral cancer surgeries offer the possibility of a great outcome especially if the tumour has not yet spread to other parts of the body.

A thorough physical examination of the oral cavity, teeth and neck for lymph node involvement is essential to support the diagnosis. A small part of the lump/mass is removed for histopathology (microscopic) examination to help confirm the diagnosis and determine the type of treatment. A CT scan is recommended to know the extent of cancer and the involvement of the jaw bone or lymph nodes. In some cases, an MRI or PET scan will also be done.

Once a diagnosis is reached and surgery is scheduled, the following will need to be done:

• Ask your surgeon any questions you have before the surgery.
• Inform your doctor if you are taking any medications or have any pre-existing medical conditions so that they can make sure these do not affect the surgery.
• Before the surgery, teeth with caries (cavities), gum problems, etc., may need to be cleaned or extracted to avoid complications after the surgery.

Your doctor will ask you to sign a consent form, allowing him to perform the surgery.

Psychological counselling that enables the individual to realise the extensiveness of this surgery is one of the most essential aspects in preparing an individual for oral cancer surgery and the care to be taken after surgery

After admission to the hospital, you will be given general anaesthesia (so that you fall asleep during the procedure) under the guidance of an anaesthetist. Before the surgery begins, the anaesthetist will explain how anaesthesia will affect you.

During the surgery, the entire tumour and some margin of healthy tissue will be cut out (resected) to make sure that no cancerous cells are left behind. Depending on the location and the size of the tumour, the following methods will be used to remove it.

• A tumour in the front of the mouth can be removed through the mouth. If the tumour has spread into the oropharynx (the part of the throat just behind the mouth, the incision will be made in the neck or the jawbone to reach the tumour.
• In case of cancer of the floor of mouth/lower jaw bone – The surgeon may need to remove a part of your jaw bone. The jaw bone may be rebuilt later with bone from another part of your body or a donor. A metal plate may also be inserted.
• In case of cancer of the roof of the mouth/upper jaw bone – The surgeon may remove a part of the bone and the individual may be fitted with facial as well as dental prosthesis (a special device that fits into the roof of the oral cavity to cover the hole from surgery).
• In case of cancer of lips – It is vital to preserve the appearance and function of the lips. So the doctor will remove one layer of skin at a time, until no more cancerous cells are seen. All the layers are examined under a microscope right away to look for cancerous cells.
• In case of cancer of tongue – A full or partial removal of the tongue may be needed.
• If the muscles that are required to swallow are removed in cases of cancer of the tongue or oropharynx, food may enter the windpipe and, subsequently, the lungs, and lead to pneumonia. To prevent this from happening, the voice box (larynx) is also removed during surgery (laryngectomy). In this case, a hole in the front of the neck is made, which is joined to the windpipe for breathing and coughing. This procedure is called a tracheostomy. Individuals who have had their voice box removed will have to learn other ways to communicate.
• Lymph nodes – If lymph nodes in the neck are affected by the cancer, they will be removed as well, thus rendering the individual free of any cancerous cells.

If the individual experiences difficulty in breathing, a tracheostomy may need to be done. This can be a temporary or permanent procedure depending on the individual 's condition.

If cancer is in the advanced stage, a larger portion of the mouth may need to be removed, making it difficult for the individual to eat. In such cases, a tube is passed into the stomach through the nose or directly through the belly (abdominal wall - gastrostomy) to provide nutrition.

If a larger area of tissue is removed, it may affect how you look or make it difficult for you to use the mouth, hence rebuilding of this area is essential. Reconstructive surgery is done by taking healthy tissue from another part of body, skin, muscle or bone.

The time taken for surgery is variable depending upon the extent of cancer.

Additional supportive radiation or chemotherapy is done to restrict the spread of cancer (metastasis) or if there is confirmed metastasis, depending on stage of oral cancer. You may require a hospital stay for a few days depending on what part and how much of the oral cavity is removed.

• If there is a gastrostomy tube, then a therapist will show you and your family how to feed through the tube.
• A physical therapist will help you learn exercises so that you can breathe easily and guide you or your family on caring for the tracheostomy tube.
• A nutritionist will give you guidance regarding consumption of liquid food supplements to avoid dryness of the mouth and eating enough proteins or calories to maintain your weight and meet nutrient requirements.
• After the surgery, you may have trouble eating. A nurse will teach you how to swallow food so that you can eat.
• Limit the amount of alcohol (one drink/day for women or two drink/day for men) and avoid smoking as it can increase the risk of the cancer returning. Read more: What does moderate drinking mean
• Joining a cancer support group may help in relieving the stress of the illness, as sharing with others who have had similar experiences can help people to not feel alone.
• You may be scheduled to see a respiratory therapist, physiotherapist, speech therapist, dietician, or dentist according to your needs after the surgery.
• You will be asked to be physically active and maintain a healthy weight.

Following the above steps can lower the risk of some cancers. After completing the treatment, you should visit the doctor regularly to check for recurrence of cancer.

When to see the doctor?

Call the healthcare provider if you develop any of the following problems after surgery:

• Bleeding
• Swelling, redness, or leaking of fluid from the incision
• A new cough
• Fever
• Chills
• Trouble breathing, drinking, or eating

Some possible complications of this surgery include:

• Oozing or bleeding from the cut
• Signs of local infection or mucositis at the site of operation
• Dryness of mouth or difficulty in swallowing due to radiation therapy
• Disfigurement of the head, face or neck
• Metastasis (spread) of the cancer
• Altered taste
• Vascular or nerve damage during surgery, affecting speech and other functions
• Nutritional deficiency due to hampered eating and swallowing after surgery
• Dental problems - caries or gum problems
• Spasm of the muscles in the neck and jaw
• Increased risk of cancers of the lung, oesophagus, larynx, stomach, liver, colon, rectum and cervix

Your doctor may tell you when to come for a follow-up for wound check or removal of stitches, if required. Some tests may be ordered to check for signs of recurring or spreading of cancer.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.