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 surgery.

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 the surgery.)