After your operation for mouth cancer

How you feel and what to expect after your operation will depend on the type of operation you had. Waking up after an operation can feel quite strange. You may feel a bit confused or disorientated. This is very normal. But knowing what to expect can help. If you've had a big operation, you may wake up in intensive care or a high dependency recovery unit. These are places where you can have one to one nursing care. Your surgeon and anaesthetist can also keep a close eye on your progress. As soon as your doctors are sure you are recovering well, you will go back to the ward.

When you first wake up, you will have a little clip on your finger called a pulse oximeter. The clip connects to a machine that measures your pulse and blood oxygen levels. You may also have an oxygen mask on for a while. Your nurse will measure your blood pressure often during the first few hours after you come round from the anaesthetic.

When you wake up, you may have several different tubes in place. This can be a bit frightening. It helps if you know what they are all for. You may have

• Drips (intravenous infusions)
• A breathing tube in your neck
• A fine tube into your stomach for drainage and for liquid foods
• One or more wound drains coming out of your neck or near your wound
• A tube into your bladder (catheter) so that your urine can be collected and measured

Drips

You may have a drip attached to a small tube (a cannula) going into a vein in your hand or arm. Or you may have a central line going into a main vein in your neck or chest. The drip gives you fluids until you are eating and drinking again, and blood if you need it. You may have a couple of electronic pumps attached to your drips. These give you a constant, measured dose of painkillers or other drugs or fluids through the drip.

A breathing tube in your neck

Surgery for some types of mouth and oropharyngeal cancer means that you will wake up with a breathing tube in a hole in your neck. This hole is called a stoma or tracheostomy. The tracheostomy is usually temporary. You will breathe through this tube until it is removed after 3 or 4 days. The hole (stoma) then closes up on its own. But a few patients may need a permanent tracheostomy. There is information about life with a breathing stoma in the living with mouth and oropharyngeal cancer section.

Tube into your stomach

The fine tube is to drain your stomach and stop you feeling sick. Later it may be used as a feeding tube. The tube may go up your nose and down your throat into your stomach. Or if you have a breathing stoma, it may go into the stoma, through a small hole at the back of your windpipe and into your oesophagus (food pipe). The tube helps keep open the small hole for a speaking valve, if you need to have one fitted later.

Wound drains

The wound drains come out of your wound. They stop blood and fluid collecting around the site of the operation. This helps your wound to heal and to stop infection. The drains connect to suction bottles, which helps to gently draw out the fluid. When the fluid stops coming out, your nurse will take the drains out. It usually takes a few days for the wound to stop draining.

Tube into your bladder

You will have a tube going into your bladder to collect urine. Your nurse will measure the amount of urine you produce. This helps to make sure you are not dehydrated or that you don't have too much fluid in your body.

If you have had surgery to your voice box, mouth, jaw, tongue or throat you will have problems talking to the doctors and nurses. This can be very frustrating and may make you feel as if you have no control over things. Staff will be very aware of this and will visit you often to see if you need anything. You will have a call bell close by, so that you can call for help whenever you need it. Your nurse will also give you a pen and paper for you to write down anything you want to say.

You will almost certainly have some discomfort for the first week or so. But it is possible to control your pain, and there are many different painkilling drugs you can have. So it is very important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.

Many hospitals now use electric pumps, called PCA pumps (patient controlled analgesia), to give painkillers after surgery. These attach to your drip. You have a hand control with a button to press to give yourself extra painkillers as you need them. Do use it whenever you need to. You can’t overdose because the machine is set to prevent that. But do tell your nurse if you need to press the button very often. You may need a higher dose of the painkiller in the pump.

There is a section about pain control in the section on coping physically with cancer.

This may seem impossible at first. Moving about helps you to get better, but you will need to start very gradually. Your physiotherapist will visit you every day after your operation to help you with your breathing and leg exercises. Your nurses will encourage you to get out of bed and sit in a chair one or two days after your surgery. They will help you with all the drips and drains. Over the next couple of days your nurse will take out most of the drips, drains and tubes. Then, it will be much easier to get around.

Some surgeons cover wounds with a dressing after surgery. Others just spray them with a protective clear spray so that they can see them clearly. If you have a dressing, your doctor will leave it on for a couple of days before removing it.

Your wound drains will stay in until they stop draining fluid. This is usually about 3 to 7 days after the operation. Your nurses will change the bottles attached to them as needed. Your stitches or clips will need to stay in for up to 10 days. You will probably have them taken out before you go home. If your wound is not completely healed but you feel well otherwise, your doctor may let you go home with your stitches still in. You can go back to the hospital to have them taken out. Or a district nurse will visit you at home and take them out there.

Your nurses and doctors will regularly check on your wound site. They want to make sure the area is getting a good supply of blood to bring oxygen and nutrients to the healing tissues.

Having surgery to your face or neck can change the way you look. This can be quite difficult to cope with. There is information about coping with changes in your appearance in the living with mouth and oropharyngeal cancer section.

Whether or not you can eat and drink after your operation depends on the operation you’ve had. Any surgery to your mouth usually means that you can't eat or drink anything for a few days. This lets the area heal and helps to prevent infection. You will have fluids through your drip, and you can wet your mouth with ice or small sips of water.

When you were in the operating theatre, your surgeon may have put a soft plastic tube into your nose and down into your stomach. This is a nasogastric tube. If you have had major surgery you may not be able to eat or drink for some time after your surgery. If this is the case you will have liquid food put down this tube the day after your operation to keep you nourished. The hospital dietician will visit you regularly over the next week. The dietician decides when to increase the amount of feed you are having through your nasogastric tube. They will build it up slowly until you are having the same number of calories as you would have in your normal diet.

Once your wound has healed you can gradually increase the amount you can drink. Soon you will be able to eat a light, soft diet. This usually means starting with things like soup and jelly. As you are able to eat more, you can cut down your liquid tube feeds. Your dietician will monitor this. Once you are eating a normal diet, your nasogastric tube can come out. The nurses and dietician will continue to check your progress and answer your questions.

Once you have fully recovered from your operation, you can usually eat and drink whatever you normally have. But if you have lost a lot of weight you will need to build yourself up again with some high calorie liquid supplements.

There is detailed information about coping with eating and drinking after mouth and oropharyngeal cancer in the living with mouth and oropharyngeal cancer section.

Some types of mouth and oropharyngeal surgery affect your sense of smell. For example, you won't be able to smell anything if you have had a laryngectomy as part of treatment for a large tumour of the tongue or oropharynx. Air won't naturally pass through your nose when you breathe in. You can learn to draw air through your nose, but it takes a bit of practice. Your speech therapist can teach you to do it.

There is more about changes to your sense of smell in the living with mouth and oropharyngeal cancer section.

After a few days you will be up and about more. Gradually you will start to feel better. Soon you will be able to eat. At first you will find it easier to have lots of very small meals rather than 3 large meals a day. The hospital dietician will give you help and advice with managing your diet. They can get high calorie liquid supplements for you to have at home. These drinks have all the vitamins, protein and carbohydrate that you need for a balanced diet.

If you are trying to put weight on, you can sip the supplements through the day as well as eating meals. You can also get powdered protein or carbohydrate supplements to sprinkle on foods and drinks. Your dietician can help you plan a suitable diet and advise on supplements. There are also some tips for adding hidden calories to your diet in the managing diet problems section.

Your nurses and the hospital physiotherapist will teach you how to care for your tracheostomy stoma if you have one. You may also need to work closely with a speech therapist if your surgery has affected your speech.

Mouth and oropharyngeal cancer surgery may change the way you look. How you look is an important part of how you feel about yourself (your self esteem). Before your operation your surgeons and specialist head and neck nurse will talk over all the possible changes to your appearance with you. 

It can be very hard to accept sudden changes in your looks. It is common for people who have had surgery to their neck or face to find it very difficult to look in the mirror for a while. You may feel very angry, confused and upset for some time after the surgery. There is a detailed section on how to cope with changes in your appearance in the living with mouth and oropharyngeal cancer section.

Recovering from major surgery can take several months. So you will need a lot of support from your doctors and nurses, family and friends.  You can read more about this in the living with cancer of the mouth and oropharynx section.

If you would like to talk to someone outside your own friends and family, look at our page about mouth and oropharyngeal cancer organisations. You can also find out about counselling organisations in our counselling section.