10. Surgical management of oral cancer

Surgery was the original treatment developed for oral cancer. It is still widely carried out, in order to achieve more than one of the following goals.

The excision of a tumour confined to one area. Surgery may then be used along with radiotherapy (RT) and/or chemotherapy (CTX), given before, during or after surgery. Transoral laser microsurgery is an innovation for complete resection of tumours with preservation of function (organ preservation).

Neck dissection to clear the neck of lymph nodes containing cancer is often also needed in addition to the excision of the primary tumour. Surgery of the neck is, however, evolving to more selective treatments. Initially radical and leading to complications such as pain and damage to the spinal accessory nerve, currently it is function-preserving, resulting in less frequent and less severe neck and shoulder pain, less depression and with less pain and better QoL. The concept of sentinel lymph node biopsy (see below) has gradually been established in the management of early oral cancer to establish whether neck dissection is required.