Oral Cancer Surgery
Listed below is the step by step procedure of oral cancer surgery:
- What is Oral Cancer Surgery?
- Why is Oral Cancer Surgery Required?
- Pre-operative Preparations
- Day Before Surgery
- Procedure Day
- Methods/Techniques of Oral Cancer Surgery
- Post Procedure
- Risks and Complications
What is Oral Cancer Surgery?
Oral Cancer surgery is performed to eradicate cancer by surgically removing the cancerous cells or tumors present within your oral cavity. Surgery is mainly conducted so that cancer does not spread to other parts of your body. Hence, the aim of performing surgery is to remove any affected cancerous tissues subject to causing minimum damage to the mouth. Surgery includes removing cancerous lymph nodes too. In addition to this, other marginal lymph nodes can also be removed.
Why is Oral Cancer Surgery Required?
Oral cancer can be treated using various methods and techniques. Surgery is one of the methods used to treat cancer. If oral cancer is detected in its early stage, it can be surgically removed well before it grows and spreads to other body parts. Hence, if cancer is detected earlier, it can be life saving. Also, at such times, it becomes easy for the doctors to treat such conditions.
Surgery can also be used when other treatment measures fall short or do not show any necessary improvements.
The pre-operative preparations involve various steps that patients need to follow. Doctors may require pictures of various sections of your mouth to diagnose, examine and learn about your cancer state. Based on your test reports, your surgeon will decide which type and technique of surgery is beneficial for the patient.
Certain imaging tests and blood tests can be required to learn about your cancer condition before the surgery. This gives us details about the following:
- Size of tumor
- Type of tumor
- Stage of cancer
- Extent to which cancer has spread
- Location of cancer/tumor
- Affected lymph nodes
X-rays are used to check the presence of cancer cells to the neighboring region of the affected area, as cancer can spread to the jaws, chest or lungs.
- CT scan
To locate tumors inside your mouth or other parts of the body.
- PET scan
PET Scan is used to detect whether cancer has spread to lymph nodes or other body parts.
- MRI scan
MRI scan is used to provide an accurate image of the head and neck, and also to determine the extent to which cancer has developed.
Endoscopy is used to examine windpipe, nasal passages, sinuses, inner throat, pharynx, larynx, tonsils and nearby regions.
Blood tests can be conducted to learn about the blood count. Most cancer patients experience a change in their blood cell count, and proteins. Also, kidney function tests and liver function tests are conducted to check if the patient's body is ready for surgery or not.
Day Before Surgery
Before you undergo surgery, there are certain points that your must discuss with your doctor and plan. For example, your doctor will learn about your health status and cancer state, and plan a specific date to conduct your oral cancer surgery accordingly. There are various precautions that patients must follow that are necessary for the surgery. Such precautionary measures are as follows:
- Patients should stop consuming some medicines, before and on the surgery day
- Blood thinning medicines must also be avoided for some days
- Avoid smoking or consuming any forms of tobacco
- Avoid consuming alcohol
- Avoid certain food items that can hamper your cancer conditions
Doctor will discuss with patients and their family regarding some measures they must follow on the day of surgery. One of these measures includes fasting. Sometimes, doctor can ask the patients to fast for some hours before the surgery begins. This includes avoiding consumption of food as well as water intake. Surgeon may also provide patients with certain medications that are required to consume before surgery begins.
Your team of doctors will first conduct your routine check up to examine your vitals. If your vitals are normal, you are eligible for the surgery or else your doctor may reschedule your surgery.
Patient's body is subjected to general anesthesia, before starting with the surgery process, so that they remain unconscious while the surgery is being performed. During the surgery, the doctor keeps track of the patient's blood pressure. A normal blood pressure (BP) is required for the surgery to run smoothly. If there is any rise or drop in the BP level, patient might require immediate medical care to normalize it. On a similar note, patient's sugar levels are also measured substantially.
Surgery begins by making incisions around your mouth or throat depending upon the location of oral cancer. Cancer cells and tumors are cut off along with the marginal areas. This removal of margin ensures that all the cancer cells are eradicated. For advanced stages of cancer, neighboring lymph nodes can also be removed.
After successful implementation of oral cancer surgery, your doctor will suture the areas of incisions by stitching them up. Internal as well as external stitches will be done wherever a cut is made. External stitches will be bandaged and covered with cotton dressing to avoid bleeding. Sometimes doctor can also give an injection or medicine after the surgery to ease your pain temporarily. Patients will be asked to stay back and rest at the hospital after the surgery.
Methods/Techniques of Oral Cancer Surgery
There are various methods to remove oral cancer. The amount of surgery you require also depends on the stage of your cancer. For some early stage, cancer growths can be removed using a laser surgery.
Most of the operations for oral cancer are major surgeries. The amount of tissues that your surgeon removes depends on where the cancer is. For example, if you tongue gets affected with oral cancer, you can get a bigger section of your tongue removed.
Oral caner surgery includes:Primary Tumor Resection
This surgery is done for removing the tumor and surrounding tissues. The procedure includes removal of entire cancer with marginal area of tissues surrounding it. This gives a surety that cancer has been eradicated completely. The surgeon will collect the cancerous tissues and send them to a lab. In pathology lab, these tissue samples are examined. If no cancer cells are detected at the edge of the tissue, it indicates a clear margin.
If the tumor is small and reachable for the surgeon, a surgery can be performed through your mouth. In case of larger ones, surgeons can make a cut through your jaw bone or neck to get access to the tumor. This process is known as mandibulotomyMandibular Resection
If at all the cancer has affected your jaw bone, your doctor will suggest you to go for a mandibular resection. This surgery includes removing some part or all the tissues and bone in your jaw along with the tumor. Surgery can involve partial thickness resection or full thickness resection.
Partial thickness resection involves removing the thin layer of bone of the mandible (jaw bone) that contains your teeth. This is mainly done when your doctor suspects that cancer might have affected your jaw bone even if the X-ray does not show any such signs.
Full thickness resection is removing all of the jaw bone. This surgery can be suggested to patients whose X-ray reports shows signs that cancer has affected the jaw bone.Maxillectomy
If the cancerous tumor has spread on the bones in the roof of your mouth (hard palate), you require to undergo maxillectomy to remove one or more of these bones. There are two categories in this operation: partial maxillectomy and full maxillectomy.
Both of these surgeries leave one space in the hard palate into your nose above. A reconstruction surgery can be done by your surgeon in that area to fill in the space, in order to make a partition between the nose and mouth.Mohs' Surgery
Mohs' surgery is also known as micrographic surgery. It is an advanced treatment method used to treat skin cancer. If cancer has affected your lip, this surgery is very effective to deal with it. Procedure of this surgery includes removing the cancer by taking a thin layer of your lip. Every layer is examined until the surgeon finds a layer free of cancer.
This surgery is very useful as it involves taking thin layers and examining them, that indicates removal of minimum possible amount of tissues. Although, the amount of tissues removed from the lip may make a difference on your facial appearance.Glossectomy
There are two types in this; partial glassectomy and total glassectomy. Partial glossectomy is removing a part of your tongue. Total glossectomy is removing all of your tongue. These surgeries are only done if there is an urgency to remove the cancer. Patients feel it quite frightening when they are recommended a glossectomy surgery. Most cases of tongue cancer are dealt with radiotherapy or chemotherapy.
This surgery will make a lot of difference to your speech and also your eating and drinking habits. Partial glossectomy includes less than half of your tongue removed. You will have a change of speech after this surgery. In case of total glossectomy, your surgeon can reconstruct your tongue.Laryngectomy
Surgery to remove your larynx (voice box) is known as laryngectomy. Large cancerous tumors on your tongue require removal of the tissue that aids you to swallow. A possible complication would be that food could enter your trachea (windpipe), and lungs. This would lead to choking and chest infections. If it looks risky, your surgeon may remove entire or a part of your larynx along with the tumor in your tongue.
Your larynx is an organ that allows you to breathe. If this organ is removed, your surgeon will attach the end of your trachea to a hole connecting your neck. You can then breathe through the hole. This hole in your neck is called as a stoma or tracheostomy.Removing teeth and replacing it with dental implants
Some or all of your teeth can be removed before a radiotherapy. A dental implant can also be done during or after the surgery.Reconstruction Surgery
Some of the above surgeries require a reconstruction surgery. If a large section of your tissue is removed during cancer surgeries, your surgeon can reconstruct that section. They can do it by using the following methods:
- Using tissues from another part of the body
A surgery that moves tissues from one part of the body to another is known as flap repair or free flap reconstruction. For example, if your surgeon removes a lining of your mouth, tissues from your bowel or muscles from your arms, back or tummy area can be used. A micro vascular technique is used to sew tiny blood vessels under the microscope. This step is carried out by specially trained surgeons.
After a flap repair, your doctors and nurses will make sure that the flap is getting good amount of blood supply so that the oxygen and nutrients from the blood help the tissues to heal well. A tiny probe will be inserted in that area to make sure that the flap is working properly.
- Using skin grafting
A skin grafting procedure includes replacing an area of your skin with another piece of skin of your body taken from elsewhere. You surgeons may cover your free flap by using a skin graft. This is done by taking a thin sheet of skin from your inner thigh or forearm. This site is known as a donor site.
After the surgery, the donor site's skin grows quickly within a couple of weeks. Sometimes a thicker graft can be removed from the donor site. At such occasions, the donor site is repaired by stitching it back together.
After skin grafting procedure, the new skin looks different from its surrounding area. Difference of color and surface can be seen. Your appearance will also look different than before.
- Using bone from another part of the body
When the surgery requires to remove your jaw bone, it may be replaced by using bone taken from your hip, back or lower leg.
Oral cancer can spread to your lymph nodes. Some of your lymph nodes can br removed if they get affected. This process is called as a neck dissection. Neck dissection also includes removing some or all of your lymph glands and its nearby affected structures. More often, surgeons perform radiotherapy for curing the affected lymph nodes as surgical methods are found to have long term side effects.
There are many aspects that patients must follow after their cancer operation.
Recovery at Hospital
Patients are taught facial exercises if they have undergone reconstructive surgery for their tongue or jaw bones. Meditation techniques are recommended to relieve stress. Patients are advised to continue the same at home after they are discharged.
The vitals of patients are regularly monitored during their stay at hospital. Certain medications are prescribed to patients based on their health and recovery status.
Recovery at Home
Doctor will make a diet chart for cancer patients. One must follow the diet chart to stay healthy. The food you consume contains various essential nutrients that help your body recover faster. Your body is subjected to strong medications, so it should be capable to bear those heavy dosages of medicines. Therefore, nutritious diet plays a major role in helping your body cope up.
After surgery, it is very important for patient to keep at track of their health and recovery status. There are follow-up appointments with your doctor to learn about the following:
- How well the medications are working
- Side effects
- Whether any changes in treatments, therapies or medications are required
- Check your vitals
- How well your healing
Life after surgery
Oral cancer can affect your tongue, lips, teeth, throat, and many other organs within your mouth and its surroundings. Oral cancer surgeries where part or entire of your tongue, throat, etc, are removed can affect many aspects of your life. Activities like speaking, eating and breathing can become problematic after these surgeries. You may require a therapist who can help you deal with these activities. Sometimes, if the tongue is removed, doctors reconstruct them surgically; but it requires time to heal. At such times, visiting a therapist can be helpful for you.
After the oral cancer surgery, patients may also experience some changes in their external facial appearance. Sometimes it is quite depressing to see such changes. Your therapist can give your some stress management guidelines to help your recover from it.
There is always a 20% chance of cancer to return if you are previously diagnosed of cancer. Patients must always take necessary precautions that may prevent cancer from coming back.
Your doctor will enlighten you about the precautionary measures that you should follow so that your recovery process is not disturbed. Some of these precautions include:
- Avoid smoking
- Avoid consumption of alcohol
- Avoid consuming hard food unless your internal scars heal
- Change the cotton dressing from time to time
- Avoid certain food items that can disturb your healing process
- Elevate your head when you are asleep so that you do not hurt the area where you have stitches
- Do not let water affect your stitches and scars; cover those areas before you wash your face or take a bath
Risks and Complications
Risks and complications of having a surgery in your oral section influence a lot of factors related to the functioning of your mouth. Some of these include:
- Breathing issues if larynx is removed
- Eating and speaking problems, if tongue, throat, jaw or teeth is removed
- Change in the facial appearance
- Recurrence of oral cancer or any other forms of cancer