The type of surgery you have depends on the size and location of your cancer.
Surgery to remove the cancer
Your surgeon removes the cancer and a border (margin) of normal tissue around it. This checks there are no cancer cells left behind. The operation is called a primary tumour resection.
A sample of tissue from around the cancer (margin) is sent to the laboratory. A specialist (pathologist) looks at the cells under a microscope to check for cancer cells. If there are no cancer cells, it is called a clear margin.
You can have different types of primary tumour resection. It depends on the location of your cancer.
When the cancer is small and easy to reach, you have the surgery through your mouth. This is called transoral surgery. Your surgeon might use different types of transoral surgery. These include:
- transoral laser microsurgery (TLM)
- transoral robotic surgery (TORS)
Sometimes your surgeon may need to make a cut in your neck or jawbone (mandible) to reach the tumour.
Surgery on the jawbone
Mouth and oropharyngeal cancer can sometimes spread to your jawbone. Your surgeon might need to remove some or all the tissue and bone in your jaw. This is called a mandibular resection.
There are 2 types of mandibular resection:
- partial thickness
- full thickness
Partial thickness resection
You have the thin layer of bone removed. This layer contains the teeth. You might have this if your doctor thinks the cancer has spread to your jawbone, even though there is no sign of this on an x-ray.
Full thickness resection
You have all the bone in your jaw removed. You may have this if an x-ray shows that your cancer has spread to your jawbone.
Surgery on the bones in the roof of the mouth (hard palate)
The bones in the roof of the mouth are called the hard palate. Cancer affecting the hard palate might be removed with surgery. The operation is called a maxillectomy. You might have surgery to remove:
- all of the bones in the roof of your mouth (total maxillectomy)
- some of the bones in the roof of your mouth (partial maxillectomy)
Both types of surgery leave a space in the roof of your mouth into the nose above. Your surgeon may be able to rebuild this area (reconstruction). Or a restorative consultant can make a false part (a prosthesis) to fill the space and make a seal between the nose and the mouth.
Surgery on the lips
If the cancer is in your lip, micrographic surgery (also called Mohs' surgery) can work well. This type of surgery involves taking away the cancer in thin slices.
Your doctor looks at each slice under a microscope before taking another slice. They stop when they find a slice free of cancer.
Examining every slice means the doctor can remove the minimum possible amount of tissue.
Surgery on the tongue
Surgery to remove the tongue is called a glossectomy. There are 2 types of glossectomy:
- partial glossectomy
- total glossectomy
The surgeon removes less than half of your tongue. You may have changes to your speech after this operation. Your surgeon will explain the possible effects of a partial glossectomy.
This means removing more than half or all of your tongue. Your surgeon will rebuild (reconstruct) your tongue. But your speech and swallowing will change after the surgery. You will have a lot of support to help you cope afterwards.
Surgery on the voice box (larynx)
This type of surgery is rare for mouth and oropharyngeal cancer.
Sometimes large tumours of the tongue or oropharynx mean that your surgeon needs to remove tissue that helps you swallow. A possible complication is food going into your windpipe (trachea) and lungs. This can cause choking and chest infections.
To lower the risk of choking or infection, your surgeon might remove all or part of your voice box (larynx) as well as the cancer. This is called a laryngectomy.
The larynx connects the mouth and lungs. It allows you to breathe. If the surgeon removes your larynx, they attach the end of your windpipe to a hole made in your neck. You then breathe through the hole. This hole or opening in your neck is called a stoma (or tracheostomy).
Surgery to your lymph nodes
Sometimes cancers of the mouth and oropharynx can spread to the lymph nodes in the neck. If this happens, the surgeon also removes some or all of the lymph nodes in your neck. This is called a neck dissection.