Surgery for oral cancer
Oral cancer that is detected at an early stage, before the cancer cells have spread to other areas of the body, is treated with surgery. We also perform oral cancer surgery for patients with advanced-stage and recurrent cancers, often in combination with radiation therapy, chemotherapy or targeted therapy.
Numerous surgical techniques are available to remove a tumor and restore the appearance and function of any tissues affected by either the cancer or the treatment.
Many oral cancer surgery patients are often concerned about disfigurement; but recent advances in reconstructive surgery mean that appearances can be restored, sometimes with little or no sign of change. Your doctor will work closely with you to ensure that your treatment is appropriate for your health and well-being.
Surgical Oncology Procedures
Depending on the stage of oral cancer, your doctor may recommend one or more of the following procedures.
- Tumor resection: An operation to remove the entire tumor. Some normal tissue surrounding the tumor is also removed to ensure that no cancer cells remain in the body. A small tumor that is easily reached can often be removed through the mouth. For tumors that are larger or harder to reach, an incision may be made in the neck or jawbone.
- Mohs micrographic surgery: This surgical oncology procedure, also known as micrographic surgery, may be recommended for some cancers of the lip. With this approach, a tumor is removed in very thin slices, with each slice examined under the microscope for the presence of cancer cells. The process continues until no cancer cells are seen. This gradual approach helps prevent the removal of normal tissue as well as changes in appearance.
- Full or partial mandible (jawbone) resection: When a tumor has grown into the jawbone, a mandibular resection, or mandibulectomy, may be needed. In this procedure, all or part of the jawbone is removed. If the jawbone appears normal in an X-ray and there is no other evidence of cancer cells in the area, then just a small piece of the bone may be removed. However, if the X-ray shows cancer in the jawbone, then the entire bone may need to be removed.
- Glossectomy: This type of cancer surgery, which involves removal of the tongue, is used to treat cancers of the tongue. When a tumor is very small, only partial removal may be necessary. Larger tumors may require removal of the entire tongue.
- Maxillectomy: This operation removes all or part (partial maxillectomy) of the hard palate, the front of the roof of the mouth. A special denture can be created to fill the hole created by this surgery. Your doctor will likely refer you to a prosthodontist, a specialized dentist, who can make a prosthetic tailored to your exact mouth shape.
- Laryngectomy: This surgical oncology procedure involves removing the voice box along with the primary tumor. When a large tumor has grown on the tongue or in the oropharynx, it may be necessary to remove some tissue that is involved in swallowing to ensure that all the cancer cells are removed. As a result of this process, food may enter the windpipe (trachea) and then the lungs, which may cause pneumonia. When the risk of pneumonia is high, a laryngectomy may be recommended. With this process, the windpipe is attached to a hole in the skin of the neck for breathing. A laryngectomy does not always mean losing the ability to talk. In fact, there are several techniques available to restore vocal capabilities afterwards.
- Neck dissection: This type of oral cancer surgery is used to remove lymph nodes in the neck if cancer has spread to this area. Depending on the size and extent of cancer in the lymph nodes, different procedures are recommended:
- Partial or selective neck dissection: to remove only a few lymph nodes
- Modified radical neck dissection: to remove most lymph nodes on one side of the neck between the jawbone and collarbone, along with some muscle and nerve tissue
- Radical neck dissection: to remove almost all lymph nodes on one side, with more extensive removal of muscle, nerves, and veins
Other Surgical Oncology Procedures for Oral Cancer:
- Pedicle or free flap reconstruction: When a large tumor is removed, the mouth, throat, or neck may require repair of some kind. Sometimes, a skin graft may be done. Here, a thin slice of skin is taken from the thigh and reattached in the oral cavity area in need of repair. When the defect is larger, a piece of muscle, with or without skin, can be shifted from a nearby area, such as the chest or upper part of the back.
Advances in microvascular surgery, which involves attaching blood vessels under a microscope, have led to dramatic improvements in reconstructing the oral cavity and oropharynx. These techniques mean that tissue from distant parts of the body, such as the intestine, arm muscle, abdominal muscle, or even lower leg bone can be used to replace parts of the mouth, throat, or jawbone. If you are a candidate for extensive surgery to treat oral cancer, your doctor can talk with you about the latest reconstructive surgery options before your treatment begins.
- Tracheostomy: If a tumor in the oropharynx is too large to remove completely, a hole can be opened in the windpipe and front of the neck to allow comfortable breathing. Sometimes, removing a tumor may lead extensive swelling in the neck afterwards. In this case, your surgical oncology team can perform a temporary tracheostomy, in which an incision is made in the trachea, can ease breathing until the swelling goes down.
- Gastrostomy tube: A gastrostomy tube is a feeding tube that can be inserted directly into the stomach. This approach may be recommended if a cancer in the oral cavity or oropharynx is preventing swallowing. A gastrostomy tube can ensure that an individual is getting adequate nutrition. A feeding tube can also be placed in the stomach through the mouth. With this process, known as a percutaneous endoscopic gastrostomy, or PEG, a camera is attached to the end of a long, thin tube, allowing your doctor to see directly into the stomach. Special liquid nutrients can be provided through the tube. These tubes may be inserted on a short-term or long-term basis. They can help keep you healthy and fed during treatment, and can be left in after treatment if necessary. The tube can be easily removed as soon as normal eating is possible.
- Dental extraction and implants: When radiation is used to treat oral cancer, it may be necessary to remove teeth, because exposure of unhealthy teeth to radiation may lead to serious problems. A complete dental evaluation is always done for patients receiving radiation therapy for oral cancer. If your surgical oncology team removes your jawbone and reconstructs it using bone from another part of the body, dental implants might be placed in the new bone. These implants are hardware that prosthetic teeth can attach to, either during reconstructive surgery or later.