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.
Enhanced Recovery After Surgery (ERAS) Programme
The pre assessment team might tell you about the Enhanced Recovery After Surgery (ERAS) Programme. This is for people having a big operation and is to help 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
Not all hospitals have a prehabilitation programme. Sometimes the 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 help you with your speech and any swallowing 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.
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.
