Oral Cancer Surgery

Introduction

Surgery for oral cancer is a definitive and potentially curative treatment for patients with mouth and surrounding cancers. Tumor removal by surgery can greatly enhance survival, particularly when done early. With improving reconstructive procedures and minimally invasive techniques, oral cancer surgery is becoming more accurate, less disfiguring, and effective. This blog discusses everything regarding oral cancer surgery, from procedures and recovery to global treatment costs and current clinical trials in China.

About the Disease

Oral cancer occurs in many areas of the mouth, such as the tongue, gums, cheeks, lips, palate, and floor of the mouth. The majority of oral cancers are squamous cell carcinomas, which are highly aggressive and have high rates of recurrence. The condition is prevalent among users of tobacco and alcohol and also has been associated with HPV infection.

Symptoms can range from a recurring sore, chewing or swallowing difficulties, loose teeth, or spontaneous mouth bleeding. Early diagnosis enhances the success of surgery and treatment outcomes.

Indications for Surgery in Oral Cancer

Surgery is the preferred option in most cases of oral cancer, especially when the tumor is:

• Localized and resectable

• Causing functional or aesthetic concerns

• Not responsive to chemoradiation

• Recurrent after primary treatment

• Associated with lymph node involvement (requiring neck dissection)

In many cases, surgery is followed by radiation or chemoradiation depending on pathology reports.

Treatment Details

Oral cancer surgery involves the removal of the primary tumor with a safe margin of normal tissue. The extent of surgery depends on the tumor size, location, and stage.

Common Surgical Procedures:

• Wide Local Excision: Removal of the tumor with a clear margin

• Partial or Total Glossectomy: Removal of part or whole of the tongue

• Mandibulectomy: Partial or complete removal of the lower jaw (if involved)

• Maxillectomy: Removal of part of the upper jaw

• Neck Dissection: Removal of lymph nodes in the neck to prevent cancer spread

Reconstructive Surgery:

Post-tumor removal, reconstructive techniques such as flap surgeries (e.g., radial forearm flap, fibula flap) or skin grafting are used to restore function and appearance.

Medicines Used in Surgery

While surgery is a mechanical procedure, various medications support the process:

Preoperative:

• Antibiotics (to prevent infections)

• Antiseptic mouth rinses

• Pain control medications

Intraoperative:

• General anesthesia

• Local anesthetics for nerve blocks

Postoperative:

• Painkillers (NSAIDs or opioids)

• Antibiotics

• Anti-inflammatory drugs

• Nutritional supplements (if feeding through tube is required)

In advanced cases, surgery is often followed by chemotherapy or radiotherapy based on histopathology findings.

Effectiveness of Surgery

Surgery is often the most effective treatment for oral cancer in early and moderately advanced stages:

• Early-stage tumors (Stage I/II): Cure rates as high as 80–90%

• Stage III and IV: Surgery combined with adjuvant therapy significantly improves survival

• Recurrent cases: Surgery can offer symptom relief and life extension

The ability to remove the entire tumor with negative margins is the strongest predictor of long-term survival.

Risks and Side Effects

Despite being life-saving, oral cancer surgery may lead to complications depending on the extent and location of the procedure.

Immediate Surgical Risks:

• Bleeding

• Infection

• Blood clots

• Reactions to anesthesia

Long-term Side Effects:

• Speech and swallowing difficulties

• Loss of taste or sensation

• Facial disfigurement or asymmetry

• Jaw stiffness

• Emotional distress

Rehabilitation and reconstructive surgery can significantly improve quality of life after surgery.

Recovery and Aftercare

Recovery from oral cancer surgery varies from a few weeks to several months, depending on the procedure and complications.

Key Components of Aftercare:

• Pain management

• Nutritional support (liquid or tube feeding)

• Oral hygiene to prevent infections

• Physiotherapy (jaw and facial exercises)

• Speech therapy

• Psychological counseling

Regular follow-ups with imaging and endoscopic evaluations are crucial to monitor for recurrence.

Cost and Availability

The cost of oral cancer surgery varies significantly depending on the type of procedure, hospital setting, surgeon expertise, and the need for reconstruction.

In India:

• Minor oral surgeries: ₹40,000 – ₹75,000 (USD 500 – 900)

• Major procedures with neck dissection: ₹1,00,000 – ₹2,50,000 (USD 1,200 – 3,000)

• Reconstructive surgery (flap/graft): ₹1,50,000 – ₹4,00,000 (USD 1,800 – 5,000)

• Available at Tata Memorial, AIIMS, CMC Vellore, and major private hospitals

In China:

• Public hospitals (basic surgery): ¥12,000 – ¥30,000 (USD 1,800 – 4,500)

• Advanced procedures with reconstruction: ¥50,000 – ¥100,000 (USD 7,000 – 14,000)

• Leading centers: Peking University Hospital, Fudan Cancer Hospital, Sun Yat-Sen Cancer Center

Insurance and government schemes in both countries can reduce the out-of-pocket burden.

Patient Experiences

Patients report a mix of emotions before and after surgery. Many initially fear disfigurement and speech loss, but report gratitude for survival and relief after successful outcomes.

Common observations include:

• Initial pain and discomfort lasting 1–2 weeks

• Gradual improvement in eating and speaking

• Emotional adaptation to physical changes

• Importance of family and peer support in recovery

Patients who undergo timely surgery often return to work and social life within 3–6 months.

Cost in Countries (in USD)

List of Ongoing Clinical Trials in China

China is a leading hub for surgical innovation in head and neck cancers. Some ongoing trials include:

• Minimally invasive robotic surgery vs traditional open surgery for oral tumors

• Comparison of flap types in reconstructive surgery

• Clinical evaluation of AI-assisted surgical planning tools

• Real-time fluorescence-guided resection to improve margin clearance

• Neoadjuvant immunotherapy followed by surgery in resectable oral cancer

These trials aim to improve precision, cosmetic outcomes, and long-term survival.

FAQ

Is surgery the best treatment for oral cancer?

Yes, especially in early-stage or resectable tumors. It offers the highest chance of complete cure.

How long is the hospital stay after oral cancer surgery?

Typically 5 to 10 days, depending on the complexity of the surgery.

Will I be able to talk and eat normally after surgery?

Most patients regain speech and eating function with time and therapy, especially if reconstruction is done well.

Is oral cancer surgery painful?

Pain is controlled with medications. Discomfort is common but temporary.

Is facial disfigurement permanent?

Reconstructive surgery significantly minimizes visible deformities. Cosmetic outcomes have improved greatly.

When can I return to work after surgery?

Depending on recovery and therapy, most patients return to work within 1–3 months.

Can cancer return after surgery?

Yes, which is why regular follow-ups and additional therapy may be needed.

Is surgery available under government schemes in India and China?

Yes, public hospitals and insurance schemes cover surgical treatment for oral cancer in both countries.