Surgical Procedures: Surgery and Staging for Oropharyngeal Cancer

When there are cancer cells in the oropharynx, it is called oropharyngeal cancer. Your oropharynx is made up of:

• The back part of your tongue.
• Your soft palate (back part of the roof of the mouth).
• The side and back walls of your throat.
• Your tonsils.

The job of the oropharynx is to safely move air from your nose and mouth to your larynx and move food from your mouth to your esophagus.

What is staging and how is it done?

Staging is a way to find out 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 oropharyngeal cancer, these tests may be:

Physical Exam: This is an exam to look at your body and to talk about your health history. A mirror may be put into your mouth and down your throat to look for changes in your oropharynx.

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

• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).

Procedures: These may include:

• Endoscopy: An endoscope, or lighted tube, is put down your throat. The surgeon will look for any changes. Often, it is used to take out tissue and/or lymph nodes for biopsy.
• Laryngoscopy: A thin, lighted camera or mirror is used to look at your larynx (voice box).
• 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 behaves. A doctor called a pathologist looks at the sample in a laboratory.
• Oral brush biopsy: A biopsy that uses a small brush to remove cells to be looked at by a pathologist.

If you are diagnosed with cancer, your provider may test you for Human Papillomavirus (HPV). HPV is a virus that can cause oropharyngeal cancer.

Oropharyngeal cancer can spread to other parts of your body through the tissue, lymph, and blood systems. When the cancer spreads, it is called metastatic cancer. The stages of oropharyngeal cancer range from stage 0 through stage IV (4).

Surgical Procedures Used for the Treatment of Oropharyngeal Cancer

Surgery is often used to treat oropharyngeal cancer. The procedure used depends on many factors, like the size and location of the cancer. Your surgeon will talk to you about your specific procedure.

Surgical procedures used to treat oropharyngeal cancers include:

• Tumor resection: Removal of the whole tumor and part of the normal-looking tissue that was around the tumor.
• Neck Dissection: Neck tissue and lymph nodes are removed.
• Glossectomy: Removal of part or all of your tongue.
• Mandibulectomy: Removal of part or all of your jaw bone.
• Maxillectomy: Removal of part or all of your hard palate (roof of the mouth). An implant will fill the area that was removed.
• Laryngectomy: Full or partial removal of your larynx (voice box).
• Plastic Surgery: Implants, skin grafting, or other procedures may be done to repair parts of your oral cavity, improve function, and improve your physical appearance.
• Tracheostomy: An opening is made in your neck that is used for breathing. It may be temporary or permanent.
• Gastrostomy tube (G-tube): A tube placed into the stomach that is used for nutrition.

Some patients may be able to have a less invasive type of surgery called trans-oral robotic surgery (TORS). TORS can be used to lessen side effects. You and your surgeon will talk about your specific surgery and if TORS is an option for you.

What are the risks of surgery for oropharyngeal 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, to not remember it, and to help with pain. Reactions can include wheezing, rash, swelling, and low blood pressure.)
• Blood clots.
• Infection.
• Issues with skin healing.
• Trouble eating and speaking.
• Changes in how you look.

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

What is recovery like?

The recovery and hospital stay after surgery to treat oropharyngeal cancer will depend on the surgery you have had. You may need a tracheostomy to help you breathe.

You will be told how to care for your surgical incisions, tracheostomy (if you have one), and G-tube (if you have one). You will be given other discharge instructions before leaving the hospital. If you need rehabilitation, including physical and occupational therapy and speech and swallowing support, your healthcare provider will talk to you about that.

Your medical team will tell you the medications you will be taking, like those for pain, blood clot, infection, and constipation prevention and/or other conditions. They will also talk to you about nutrition and tell you if you need to limit certain activities.

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 directed 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.