Surgery is the first and main treatment for most oral cavity cancers, including cancer of the tongue. Radiation usually comes later, after the operation, if the pathology report points to a higher risk, and it takes the lead only when surgery isn’t an option. Speech and swallowing are affected because the tongue is central to both. How much changes depends on how much of it is removed, which part, and whether it’s rebuilt.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist at MACS Clinic, Bangalore, talks patients through what to expect after a glossectomy. “The first question I get before tongue surgery is almost always the same: will I be able to talk and eat afterwards? With a small tumour, usually yes, with only a mild and brief change. If a bigger part has to go, the road is longer and rehab matters a lot. We plan the surgery and the recovery together.

That depends on the tumour: how big it is, how deep, and where it sits. The surgeon takes the cancer plus a small rim of healthy tissue around it, and tries not to take more than that.

Partial glossectomy: Most people with a small tumour on the side of the tongue need only this. A piece comes out and the rest of the tongue stays. Some of these small tumours can be reached through the mouth with robotic help, and our page on trans oral robotic surgery covers where that’s used.

Hemiglossectomy: Half the tongue. This is for larger or deeper tumours.

Total glossectomy: The whole tongue, or nearly all of it. Rare, and kept for advanced cancers.

The neck: Tongue cancer often spreads to the lymph nodes in the neck, so the surgeon usually clears those during the same operation.

Rebuilding: If a big part is taken, skin and tissue from the forearm or thigh can be used to build the tongue back up.

Almost every sound you make involves the tongue. So yes, speech changes. How much is the real question.

Small removals: Many people notice very little. Some are a bit slurred for a short while, and then it settles.

Bigger removals: Clarity can drop. Sounds like t, d, l and s need the tip of the tongue to touch the roof of the mouth, so those suffer first.

Straight after surgery: Swelling makes everyone sound muffled for the first few days. It passes.

A rebuilt tongue: The tissue used to rebuild it gives the tongue enough bulk to reach the palate, and that helps with clearer sounds.

Speech therapy: This starts early. Exercises, practice, patience. Over weeks and months most people get clearer, even if it doesn’t sound exactly as it once did. Speech is a large part of head and neck cancer care, and our page on head and neck cancer treatment covers that.

Yes, you can. Sometimes the original cancer returns after treatment, which is called a recurrence. Other times a completely separate cancer shows up later in life, known as a second primary cancer. They start differently and they’re treated differently, so the first job is figuring out which one you’re dealing with.

Prof. Dr. Sandeep Nayak, Surgical Oncologist at MACS Clinic, Bangalore, explains how this is worked out. “Nobody finishes treatment and stops thinking about it. Every new ache, every scan, there’s a quiet question: is it back? Mostly the answer is no. When there is something, our first job isn’t to treat it. It’s to find out what it is, the old cancer or a new one, because the plan is different for each.” To discuss follow-up or treatment options, you can contact the clinic at +91 9482202240.

Picture someone treated for colon cancer five years ago who now has a spot on the liver. Is it the colon cancer that travelled, or something new? That’s exactly what these two terms help answer.

A recurrence means the original cancer has come back. It could be in the same place, in nearby lymph nodes, or far away in the liver or lungs. Distance doesn’t change what it is: colon cancer in the liver is still colon cancer, not liver cancer.

A second primary is a brand-new cancer that starts from different cells. It can appear in another organ or even in the same one.

The distinction matters because a recurrence is handled as the original disease, while a second primary is a fresh diagnosis judged on its own. Timing differs too. Recurrences mostly appear in the first few years, but a second primary can turn up at any point, even decades later. Our case study section includes a patient who dealt with two primary cancers.

Surgery removes what can be seen. It can’t remove what’s too small to see.

A few cells can be left behind, too tiny for any scan to detect, and they may slowly grow back. Bigger, deeper and faster-growing tumours return more often, and so do those that had already reached the lymph nodes by the time of surgery.

Timing is fairly predictable. In a combined analysis of colorectal cancer trials, recurrences levelled off at around three years, although some cancers return much later. In cancers of the colon, ovary and appendix, the lining of the abdomen is one place they can come back, and HIPEC is among the options there.

It all starts with working out which one it is.

Usually a biopsy, compared against the report on the original tumour, settles it. Scans such as CT, MRI or PET-CT show where the growth sits and how far it has gone, and in some cancers a blood marker like CEA (in colorectal cancer) adds another clue. A growth in the same spot a few years on points toward recurrence. A different organ many years later points toward a new primary.

From there, the plan depends on the type of cancer, where it is and how far it has spread. What’s already been given matters too. Radiation usually can’t be repeated at full dose in the same area, so earlier treatment narrows the choices. Where surgery is the right call, a minimally invasive route may still be possible, as our page on robotic cancer surgery explains. Overall fitness for an operation counts as well, and if the pattern suggests an inherited condition, genetic counselling can help the whole family.

Once treatment is done, follow-up means regular visits, scans and blood tests on a schedule that suits the cancer. Report anything new quickly. Staying tobacco-free, keeping alcohol low, staying active and keeping up with screening all help.

Ask a newly diagnosed patient what is troubling them and one question comes up early: oncology vs surgery, which one do I need? It is a fair question, but it is not a contest. Oncology is the whole subject of cancer care. Surgery is one of the things it uses. What separates them is reach: drugs go round in the blood and find cancer cells wherever they are hiding, while surgery works on one spot, the solid tumour and a little healthy tissue around it. The surgical oncologist sits where the two meet, and that is why oncology and surgical oncology get talked about together.

According to Dr. Sandeep Nayak, a surgical oncologist in Bangalore, nobody is really asked to pick between the two. Many solid tumours need both at some point. What changes from case to case is the sequence, and the cancer type, the stage and the patient’s fitness for surgery decide it.

Oncology is the field. Surgery is one tool inside it. At a cancer centre they sit side by side in one team of oncologists.

• Oncology: All of cancer care, from the first scan to the last follow-up visit. It has three main arms: medical, radiation and surgical.
• Medical oncology: The drug arm. Chemotherapy, targeted tablets, immunotherapy and hormone treatment go round in the blood, so they reach the main tumour, the lymph nodes and any organ it may have spread to, in one go.
• Surgery: The operating arm. The surgeon takes the tumour out from where it started, with a rim of normal tissue and the lymph nodes next to it.
• Radiation oncology: Beams of radiation aimed at one area. Local, like surgery, but with no incision.
• Why both exist: A drug can reach cells that scans can’t see, but it can’t take out a solid lump. Surgery gets the lump out, but a cell that has already moved on is beyond its reach.

A surgical oncologist is a surgeon who looks at cancer cases day in and day out. The job is bigger than the operation, and surgical oncology takes in the steps before and after it too.

• Biopsy: First, a piece of the tumour has to be taken out and looked at under a microscope. Quite often the surgeon does this, with a needle, an endoscope or a small cut.
• Staging: Once the scans and biopsy are in, the cancer gets a stage. The TNM system looks at three things: how big the tumour is, whether the nodes are involved, and whether it has spread. Every later decision leans on this.
• The operation: The surgeon wants a clear margin, which means healthy tissue all round the tumour, and the nearby lymph nodes out as well. Leaving cancer behind weakens the benefit of everything that follows.
• Function: Where it can be done, speech, swallowing and bowel or bladder function are kept safe, and what had to be removed is rebuilt.
• Relief of symptoms: Sometimes the cancer can’t be removed fully. An operation can still open a blocked bowel or stop a bleed, and the patient feels better for it.

Rectal cancer surgery can be done robotically, laparoscopically or through an open incision, and the right choice turns on where the tumour sits, how narrow the pelvis is and what kind of recovery the patient is aiming for. All three can cure the cancer in experienced hands, which is why the decision is about what fits the individual patient and not about which technology is newest.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist at  Clinic, Bangalore, explains how the three approaches are weighed in rectal cancer surgery. “Patients often come asking which of the three is best. The rectum is hard to reach, down in a narrow pelvis, so how we operate matters a little more here than in other cancers. Whatever the route, the plan is the same: take the whole tumour out, save the nerves and the sphincter if the cancer allows it, and get the patient back on their feet. If one route does that better for you, that’s the one we use.”

The aim is the same in all three. What changes is how the surgeon gets down to a tumour sitting low in the pelvis.

Open surgery: One longer cut in the abdomen. The surgeon can put their hands in and see the area directly.

Laparoscopic surgery: Several short cuts take its place. A camera and thin instruments go through them, and the surgeon works by hand while watching a monitor.

Robotic surgery: The cuts are small here too. The surgeon sits at a console a few feet from the patient, the screen is magnified and in 3D, and the instrument tips can turn in ways a straight laparoscopic instrument can’t. The robot decides nothing. Every movement is the surgeon’s own.

What stays constant: In all three, the central step is total mesorectal excision, where the rectum comes out together with the fat and lymph nodes around it as a single package. How cleanly that is done matters more than which instrument did it. Our page on robotic cancer surgery explains how the system works.

For laparoscopic surgery, the evidence is reasonably firm.

The COLOR II trial: Roughly a thousand patients were randomly placed into laparoscopic or open surgery groups. Three years later the cancer had returned in the pelvis in 5% of each group, and survival was close.

Recovery: People who had keyhole surgery tended to bleed less, have less pain and go home sooner.

A caution: Rectal surgery by keyhole is demanding, and the trial results came from surgeons who did it regularly.

For a wider look across other cancers, see our blog on whether minimally invasive cancer surgery gives the same cure rate as open surgery.

Compared with open esophagectomy, the minimally invasive route puts the body through less surgical trauma. Blood loss is lower and lung complications are fewer, especially in the weeks right after the operation. Long-term cancer outcomes in the trials so far are comparable, so the decision comes down to the tumour, the patient’s overall health and how experienced the surgeon is with the technique.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist at MACS Clinic, Bangalore, explains how the two approaches compare for cancers of the food pipe. “It’s a big operation however you do it. What the keyhole route changes is the chest wall, which isn’t cut open, and you see that in the first few weeks, with fewer chest infections and an easier recovery. None of that counts if the cancer isn’t cleared as well, so that’s the first thing we make sure of.”

Both operations do the same job. The diseased part of the food pipe comes out, and what’s left gets joined to the stomach. How the surgeon reaches it is what differs.

Open: Big cuts, one in the chest and one in the abdomen. The surgeon works through them by hand.

Keyhole: A few small cuts instead. A camera and long, thin instruments go in through openings in the chest and belly.

Hybrid: Part keyhole, part open. Some surgeons do the abdomen by keyhole and the chest the open way.

Robotic: The same small cuts, with a robot holding the instruments and giving the surgeon a magnified 3D view.

What doesn’t change: The tumour and the nearby lymph nodes come out whichever route is used. The stomach is shaped into a tube and lifted up to take the place of the food pipe. If you’re curious how keyhole operations work in general, our page on laparoscopic cancer surgery explains it.

Keyhole isn’t for everyone.

Large or invasive tumours: A tumour pressing on nearby structures can call for the room and control that open surgery gives.

Earlier surgery: Scarring from a previous chest or abdominal operation can make keyhole surgery harder to do safely.

Changing course: Sometimes the surgeon starts with keyhole and moves to open because carrying on isn’t safe. That’s judgement, not a failed operation.

Experience: It’s a demanding operation to do by keyhole, and results are best where the team does it regularly. You can read about the surgeon’s background on our expertise page.

It’s decided case by case. A few things steer it.

Stage and site: Where in the food pipe the cancer sits, how deep it goes, and whether the lymph nodes are involved. Esophageal cancer is one of the upper GI cancers, and the stage shapes the whole plan.

Before surgery: Many patients have chemotherapy or chemoradiation first, and how the tumour responds affects the planning.

General health: Heart, lungs and nutrition all count. A lot of people have lost weight because swallowing has been difficult.

Team review: Surgical, medical and radiation oncologists usually go through the case together.

Your priorities: Recovery time, scars, getting back to normal life. Robotic-assisted surgery is one of the keyhole options, and our page on robotic cancer surgery covers it.

Key Takeaways

• Minimally invasive esophagectomy may reduce blood loss, lung complications, and hospital stay compared with open surgery.

• Long-term survival outcomes appear similar between the two approaches in available clinical trials.

• Open surgery may be more suitable for certain tumours, depending on their location and extent.

• The choice of surgical approach depends on the patient’s condition, tumour characteristics, and the surgeon’s experience.

• Discuss the benefits and risks of each option with your specialist. To learn more, book an appointment or call +91 9482202240.

References

National Cancer Institute (NCI) – Esophageal Cancer Treatment (PDQ®) Explains treatment options for esophageal cancer, including surgery, and discusses factors that influence treatment decisions. Link: https://www.cancer.gov/types/esophageal/hp/esophageal-treatment-pdq

American Cancer Society – Surgery for Esophageal Cancer Describes esophagectomy, including minimally invasive and open surgical approaches, and outlines potential risks and recovery considerations. Link: https://www.cancer.org/cancer/types/esophagus-cancer/treating/surgery.html

Disclaimer: This blog is for informational and educational purposes only and is not a substitute for professional medical advice or diagnosis.