“Doctor, I understand that the cancer has to be removed. But what exactly will you do during the surgery?”
Once a patient hears the word cancer, everything that follows can become difficult to absorb.
Suddenly, the consultation is filled with unfamiliar words—margins, neck dissection, reconstruction, free flap, ICU. Families are trying to understand the disease while simultaneously worrying about what the patient will look like, whether they will be able to speak, and when they will eat again.
So before discussing the technical details, I usually explain one principle:
Good oral cancer surgery is not simply about removing a tumour. It is about removing the disease safely while planning what the patient will be left with afterwards.
As an Oral Cancer Surgeon Pune, this is how I approach treatment planning.
Let me take you through what actually happens.
The Operation Really Begins Before the Operation
Surgery does not begin with the first incision.
It begins when I examine the patient.
Where exactly is the tumour? How deep does it appear? Is the jaw involved? How close is it to important structures? Are lymph nodes suspicious? What will happen to speech and swallowing if this tissue is removed?
Clinical examination, biopsy and appropriate scans help answer these questions.
This is also when I start thinking about reconstruction.
If removing the tumour is likely to leave a significant defect, I don’t want reconstruction to become a decision made after the cancer has already been removed.
For me, reconstruction begins during cancer treatment planning.
That philosophy is particularly important when oral cancer involves the jaw, tongue, cheek or floor of the mouth.
Step 1: Removing the Cancer Safely
The first priority during surgery is cancer clearance.
Oral cancer cannot simply be “scooped out.” The tumour is removed together with an appropriate margin of surrounding tissue, depending on its location and extent.
For a small cancer, this may mean removing a relatively limited amount of tissue.
For a larger cancer, surgery may involve part of the tongue, cheek, floor of the mouth or jaw.
This is where surgical judgment becomes important.
Removing too little can compromise cancer treatment. Removing unnecessarily large amounts of normal tissue can compromise function.
The objective of a Mouth Cancer Surgeon is therefore not to perform the biggest operation possible.
It is to perform the right operation for that particular cancer.
Step 2: What Happens to the Lymph Nodes in the Neck?
Patients are sometimes surprised when I discuss surgery in the neck even though their cancer is inside the mouth.
The reason is that oral cancers can spread through lymphatic channels to lymph nodes in the neck.
Depending on the site and stage of the cancer, treatment of these lymph nodes may be recommended through a procedure called neck dissection.
This does not mean every structure in the neck is removed.
Modern neck surgery aims to treat the lymph-node regions at risk while preserving important nerves, muscles and blood vessels whenever oncologically appropriate.
A Head & Neck Cancer Surgeon Pune considers the primary tumour and the neck together while planning comprehensive cancer treatment.
Step 3: Do We Always Have to Remove Part of the Jaw?
No.
This is an important fear among patients with mouth cancer.
The jaw should not be removed merely because a tumour is close to it. The decision depends on whether the cancer has involved the bone, how extensive that involvement is, and whether the jaw can be safely preserved.
Sometimes only a portion of the thickness of the jaw needs removal.
In other situations, a segment of jaw may need to be removed to achieve adequate cancer clearance.
Before recommending this, I ask myself a fundamental question:
Does oncological safety genuinely require removal of this bone?
Preserving normal anatomy when safely possible is an important part of good cancer surgery.
Step 4: What Happens to the Defect?
This is the part of oral cancer surgery that particularly shapes my treatment philosophy.
Imagine removing a significant portion of someone’s jaw or tongue.
Removing the cancer successfully is essential—but the operation cannot conceptually end there.
Now we have another question:
How do we rebuild what has been lost?
Smaller defects may sometimes be closed using nearby tissues. Larger defects can require advanced reconstruction, including microvascular free flap surgery.
Skin, soft tissue, muscle or bone can be transferred from another part of the patient’s body depending on what needs reconstruction. Tiny blood vessels from this tissue are connected to vessels in the neck under magnification so that the transferred tissue receives its own blood supply.
As a Maxillofacial Surgeon Pune, I don’t see this simply as “closing a defect.”
The reconstruction needs to consider facial contour, tongue mobility, swallowing, speech, jaw continuity and, whenever feasible, future dental rehabilitation.
Remove the disease. Rebuild the defect. Restore the person.
That is the larger objective.
Step 5: What Happens Immediately After Surgery?
After major oral cancer surgery, patients are closely monitored during the initial postoperative period.
Depending on the complexity of surgery, this may include ICU or high-dependency monitoring.
Pain control, breathing, nutrition, wound healing and the reconstructed tissue are carefully observed.
Patients undergoing free flap reconstruction require particularly close monitoring of the flap during the early postoperative period.
Feeding may initially be supported through a tube while tissues heal. Gradually, depending on the surgery and recovery, oral intake is introduced.
Recovery happens step by step rather than overnight.
When Does Rehabilitation Begin?
In my view, rehabilitation shouldn’t begin several months later.
It begins with the original surgical plan.
If we know a patient is likely to have difficulty swallowing, speech therapy can be incorporated appropriately.
If the jaw has been reconstructed, we can think ahead about facial symmetry and chewing.
For selected patients, dental rehabilitation—including dental implants and prosthetic teeth—may eventually become possible.
This is why comprehensive oral cancer care involves much more than a successful operation.
An Oral Cancer Specialist Pune treating these patients must think beyond survival alone toward long-term function and quality of life.
Three Questions I Encourage Patients to Ask Their Surgeon
If you are preparing for oral cancer surgery, don’t hesitate to ask:
- What exactly are you planning to remove?
- How are you planning to reconstruct what is removed?
- What should I realistically expect regarding eating, speech and appearance afterwards?
A good consultation should help you understand all three.
You may not remember every medical term—and you don’t need to.
But you should understand the overall plan.
How I Think About Oral Cancer Surgery
As an Oral Cancer Surgeon Pune, I naturally want the pathology report after surgery to tell us that the cancer has been adequately removed.
But my responsibility doesn’t end with that report.
I also want to see the patient months later.
Eating with the family.
Speaking comfortably.
Returning to work.
Feeling confident enough to meet people again.
And, when possible, moving toward dental rehabilitation.
That’s why, as both a Mouth Cancer Surgeon and Maxillofacial Surgeon Pune, I think about cancer removal and reconstruction as parts of the same journey.
An experienced Head & Neck Cancer Surgeon Pune may perform an operation lasting several hours, but the consequences of those decisions stay with the patient for years.
So when I plan oral cancer surgery, I don’t think only about:
“How do I remove this cancer?”
I also think:
“What kind of life are we trying to give this patient after we remove it?”
For me, that is where truly comprehensive oral cancer surgery begins.