Before your operation for mouth and oropharyngeal cancer

Before surgery, you have tests to check your fitness and you meet members of your treatment team. You usually go into hospital on the morning of your operation.

The length of your hospital stay depends on what operation you have.

Pre assessment

Your pre assessment appointment prepares you for your operation. This usually happens in the 2 weeks before your surgery.

At your appointment, the pre assessment team may:

ask you questions about your health and any medicines you are taking
tell you when to stop eating and drinking before your operation
tell you if you need to stop taking any medicines before the operation
check your weight, blood pressure, pulse and temperature
ask what help and support you have at home

The pre assessment team will tell you how to prepare for your operation. What you need to do depends on what operation you are having.

They may also give you a leaflet about breathing and leg exercises to do after your operation. This is to help prevent chest infections and blood clots.

It helps to write down any questions you have and take them with you. The more you know about what is going to happen, the less frightening it will seem. You can ask more questions when you go into hospital so don’t worry if you forget to ask some.

Preparing you for recovery

The pre assessment team might tell you about the Enhanced Recovery After Surgery (ERAS) Programme. This is used in some hospitals and is for people having a big operation. It helps you recover quicker. It starts before you have your operation and continues for a short time after you have gone home.

For example, they might give you carbohydrate drinks to have before your operation. How many drinks you have depends on what brand of drink the hospital uses. And when you have them depends on what time of day your operation is.

After your operation your nurses will encourage you to do breathing exercises. They will help you with getting out of bed and walking as soon as you can. And start you eating and drinking as soon as possible. This depends on the type of operation you’ve had. But your doctor will tell you when you are ready to do this.

Prehabilitation

Some people might also be asked to take part in prehabilitation (prehab). Prehabilitation means getting ready for cancer treatment in whatever time you have before it starts. It is a programme of support and advice that some NHS hospitals are using. It covers three particular parts of your health:

what you're eating and your weight
physical activity or exercise
mental wellbeing

You may also get advice about pre radiotherapy swallowing, exercises, how to stop smoking or alcohol support services. Not all hospitals have a prehabilitation programme. Sometimes the exercise programme is run at local leisure centres. You will be told where you need to go.

Who you might meet before your operation

Surgeon

A member of the surgical team will tell you about:

the operation you are going to have
the benefits of having surgery
the possible risks
what to expect afterwards

Anaesthetist

The anaesthetist gives you the anaesthetic and they look after you during the operation. The anaesthetic is the medicine that keeps you asleep during your operation. They make sure you’re fit enough for the surgery.

Clinical nurse specialist

Your specialist nurse is usually there to support you throughout your treatment. They can check what help and support you have, to see what you will need when you go home.

Physiotherapist

The physiotherapist assesses how well you can move around. They let the doctors know if there is anything that could affect your recovery.

The physiotherapist also teaches you leg and breathing exercises to do after your operation to help with recovery. Learning how to do the exercises beforehand makes it easier afterwards.

Dietitian

The dietitian gives you help and advice about managing your diet. They:

help you get as well as possible before your operation
explain how the surgery affects your diet
give useful tips on how to increase your nutrients and calories

They might give you nutritional supplement drinks to have before surgery.

Some people need a feeding tube in their stomach or small bowel. This makes sure you get the nutrition you need before your surgery.

Speech and language therapist

Sometimes, having surgery to the mouth and oropharynx can cause problems with speech and swallowing. Your speech and language therapist plays an important role during your treatment. They will:

assess your speech and swallowing
advise you on the likely impact of treatment on your speech and swallowing
offer help with difficulties you might have

Tests to check you are fit for surgery

You have tests before your operation to check:

your fitness for an anaesthetic, if you need one
that you’ll make a good recovery from surgery

You might have some or all of the following tests:

blood tests to check your general health and how well your kidneys are working
a swab test to rule out some infections
an ECG to check that your heart is healthy
breathing tests (called lung function tests)
an echocardiogram
a chest x-ray to check that your lungs are healthy
a cardio pulmonary exercise test (which checks your heart and lung function when you're resting and exercising)

Removing teeth and putting in dental implants

An oral surgeon may need to remove some or all of your teeth before surgery. They will talk this through with you before your operation and answer your questions you may have.

They will let you know about any restorative implant surgery might have and when you will have it.

Learning breathing and leg exercises

Breathing exercises help to stop you from getting a chest infection after surgery. If you smoke, it helps if you can stop at least a few weeks before your operation.

Leg exercises help to stop blood clots forming in your legs. You might also have medicines to stop the blood from clotting. You have them as small injections under the skin.

You start the injections after your operation. You might also wear compression stockings and pumps on your calves or feet to help the circulation.

Your nurse and physiotherapist will get you up out of bed quite quickly after your surgery. This is to help prevent chest infections and blood clots forming.

This 3-minute video shows you how to do the breathing and leg exercises.

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Transcript

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Breathing and circulation exercises after surgery

These exercises help prevent you developing a chest infection or blood clots in your legs after surgery. These problems are more likely when you are not moving around as you would normally.

You can do these breathing exercises while sitting up in a chair or in a bed or whilst lying down.

Relax your shoulders and upper chest.

Take a slow, deep, comfortable breath in and hold for a couple of seconds, then slowly breathe out.

Repeat this 3 times.

You can start these breathing exercises as soon as you come round from your anaesthetic.

You should try to do them every hour when awake until you are fully mobile.

If you need to cough, support your wound with your arms, a pillow or a rolled up towel.

If you are struggling to clear any phlegm, try a huff. This is where you breathe out in a short, sharp manner as if you were trying to steam up a mirror.

You should move about as soon as possible after your operation. But while you are not as mobile, try to keep your legs moving to encourage better circulation.

You can do these exercises in a bed or in a chair.

One foot at a time point your toes away from you then pull your toes towards your chin.

Try to do 10 of these on both feet at least 2-3 times an hour.

The next exercise is circling your ankles. One at time circle your ankles, clockwise and then anticlockwise. Repeat this 10 times with each ankle 2-3 times an hour.

Going into hospital

You usually go into hospital on the day of your operation.

What to take with you

Take in:

nightgowns or pyjamas
underwear
dressing gown
slippers
contact lenses, solution, glasses and a case
wash bag with soap, a flannel or sponge, toothbrush and toothpaste etc
sanitary wear or tampons
towel
small amount of money
medicines you normally take
magazines, books, playing cards
headphones and music to listen to
a tablet or smartphone for web browsing, entertainment and phone calls
chargers for electronic devices
a copy of your last clinic letter (if you have one)

Family and friends

Before you go into hospital, it might be worth checking:

whether the ward is allowing visitors
if they have set visiting times
the best number for friends and family to phone, to find out how you are

The letter you receive before your operation may contain this information. But if not, you can phone the ward or hospital reception to find out.

You can use your mobile phone in hospital. But there may be some time before and after your operation when you won’t have your mobile nearby. And you may not feel like talking.

Before you go into hospital

It’s worth sorting out a few things before you go into hospital. These might include:

taking time off work
care for children or other loved ones
care for your pets
care for your house
cancelling your milk or newspapers

Smoking

Smoking is a main risk factor for mouth and oropharyngeal cancer. And continuing smoking increases your risk of the cancer coming back. Smoking can also slow down wound healing and make complications more likely after surgery.

Your doctor will encourage you to stop smoking before the surgery. But it can be difficult if you have smoked for a long time.