Surgical Procedures: Surgery and Staging for Lip and Oral Cancer

When there are cancer cells in the lips, it is called lip cancer. When there are cancer cells inside the mouth, it is called oral cancer.

The inside of the mouth (oral cavity) is made up of many parts, including the:

• Tongue.
• Gums (gingiva).
• Lining of the inside of the cheeks (buccal mucosa).
• Area under the tongue (floor of the mouth).
• Roof of the mouth (hard palate).
• Area behind the wisdom teeth (retromolar trigone).

What is staging and how is it done?

Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For lip and oral cancers, these tests may be:

Physical Exam: This is a general exam to look at your body and to talk about your health history. An oral cavity exam may be done by a provider or dentist.

Imaging: Radiology tests can look inside your body to look at the cancer and determine if it has spread. These tests can be:

• Chest X-Ray.
• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).
• Bone scan.
• Barium swallow.

Procedures: These may be:

• Endoscopy: An endoscope, or lighted tube, is put into the oral cavity, and the surgeon will look for any changes. Often, this is needed to take tissue and/or lymph nodes for biopsy.
• Biopsy: A biopsy takes cells from the cancer, or a piece of the cancer, to see what type of cancer it is and how it acts. A doctor called a pathologist looks at the sample under a microscope.
• Exfoliative cytology: Cells from the lips or oral cavity are taken with a cotton swab, brush, or wooden stick and sent to the lab to look for cancer cells.

Oral and lip cancer spreads to other parts of the body through the tissue, lymph, and blood systems. When cancer spreads, it is called metastatic cancer. Lip and oral cancer are described as stages 0 (carcinoma in situ) to stage 4.

Surgical Procedures Used for Oral Cancer

Surgery is often used to treat lip and oral cancers. The surgery you have depends on many factors, like where the cancer is and how big it is. Your care team will talk to you about the procedure you will have.

Surgical procedures used to treat lip and oral cancer are:

• Wide Local Excision: The cancer and part of the healthy nearby tissue are removed. Some bone may also need to be removed.
• Tumor Resection: The entire tumor and some of the healthy tissue around it is removed.
• Mohs Micrographic Surgery: Used to treat some lip cancers. The cancer is removed in very thin layers. The surgeon checks for clean margins (edges of the sample that do not have cancer cells in them) during the procedure.
• Neck Dissection: Neck tissue and lymph nodes are removed.
• Glossectomy: Part or all of the tongue is removed.
• Mandibulectomy: Part or all of the jaw bone is removed.
• Maxillectomy: Part or all of the hard palate is removed. An implant will fill the area removed.
• Plastic Surgery: Dental implants, skin grafting, or other procedures may be done to fix parts of the oral cavity, to improve function of the mouth, and to improve your physical appearance.

Note: A tracheostomy and feeding tube may be needed depending on the surgery you have.

What are the risks of surgery to treat lip and oral cancer?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia: Anesthesia is the medication you are given to help you sleep through the surgery, not remember it, and to manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure.
• Bleeding.
• Blood clots.
• Infection.
• Pneumonia (infection in the lungs).
• Problems with the wound healing.
• Trouble eating/swallowing/speaking.
• Changes in or loss of speech/swallowing (common with glossectomy).
• Change in body image.

Before surgery, your surgeon will talk to you about any other risks based on your health and the surgery you are having.

What is recovery like?

Recovery from surgery to treat lip and oral cancer depends on the procedure you had. You may have to stay in the hospital. You may have a tracheostomy and/or feeding tube.

You will be told how to care for your surgical incisions (cuts) and will be given any other instructions before leaving the hospital. Instructions will include details about if you need to change your diet, feeding tube care, tracheostomy care, as well as the need for rehabilitative and/or speech therapy.

Your medical team will talk with you about the medications you will be taking, like those for pain, blood clot, infection, and constipation prevention, and/or other conditions.

Your provider will talk to you about activity restrictions and nutritional needs you may have, based on the surgery you had.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as you are told to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.