Surgery for head and neck cancer
Surgery is one of the main treatments for cancers of the head and neck. The main aim of surgery is to remove the cancer completely.
Your surgeon will also do everything possible to minimise the changes that surgery may cause to functions such as speech and swallowing.
The type of surgery you have depends on the size and position of the cancer, and whether it has spread.
Before your operation, your surgeon will discuss the surgery with you. It’s important that you understand what’s going to be removed and how this will affect you after the operation, both in the short- and long-term.
If your speech, swallowing or eating could be affected for a time after surgery, you may also meet other members of the team before your operation, such as a speech and language therapist or dietitian.
Most operations for head and neck cancer involve a hospital stay and an operation under general anaesthetic. But, in some situations if you have a very small cancer, it may be treated with a simple operation or laser surgery with no need to stay in hospital overnight.
The extent of surgery depends on the size of the cancer and where it is.
If you have a small cancer in your mouth, the surgeon may operate through your open mouth. This means you won’t have any external scars, unless you’re having a neck dissection (see below).
If the cancer is larger, at the back of your mouth or in your throat, the surgeon will usually need to make a cut (incision) so they can reach it. This means that you’ll have a scar afterwards.
If cancer cells spread from the head or neck, the first place they are likely to go to is the lymph nodes in the neck.
A neck dissection is an operation to remove some or all of the lymph nodes in one or both sides of the neck. It’s done if tests show cancer has spread to the lymph nodes. It’s also done if the cancer has reached a certain size, even if there are no signs of cancer in the neck. This is because very small amounts of cancer in the lymph nodes don’t show up on scans or in other tests.
Your cancer specialist will assess the risk of cancer having spread to lymph nodes in your neck to help them decide whether a neck dissection is appropriate for you. Your risk will depend on factors such as the type of head and neck cancer you have, the size of the tumour and where it is.
If you’re having lymph nodes removed from your neck, it will usually be done at the same time as the operation to remove the cancer.
After a neck dissection, the nerve that helps move the lower lip can sometimes be affected. This can cause weakness on one side of your mouth. It may mean your smile is a bit crooked (asymmetrical) for a while, but this will usually return to normal after a few months. The nerve that helps with shoulder movement may also be affected. This can cause shoulder stiffness. A physiotherapist can give you exercises to help with this.
If your operation involves removing tissue that is important for your speech, swallowing or appearance, you may have reconstructive surgery as part of the operation.
Tissue can be taken from another part of the body, such as the forearm, thigh or chest, and used to replace tissue taken from the head and neck. This is known as a flap.
If the cancer is in your jawbone, the affected bone will need to be removed with the tumour. Bone taken from another part of your body (usually the lower leg) may be used to replace the missing jawbone. This is known as a bone flap. Your doctor and specialist nurse will be able to give you specific information about this type of operation. You will usually be able to move your jaw again as soon as the operation is over.
If you’re having surgery that is likely to change your appearance, it may help to talk to someone who has had a similar operation. Your surgeon or specialist nurse may be able to put you in touch with other people who can talk to you about how the surgery has affected them, and how they coped with the changes.
Occasionally, the surgeon may need to remove bones from the face, such as the cheekbone or palate, in order to remove all of the cancer. Depending on the extent of the operation, you may be offered an artificial replacement called a prosthesis (false part). This is a specially designed, soft, plastic replacement for the part of your face that has been removed. The most common prosthesis is an obturator, which is a denture with an extension that’s used to cover any gaps in the roof of the mouth.
If you’re likely to need a prosthesis, your doctor and specialist nurse will discuss this with you before your operation. You will also talk to a prosthetics technician, who will be involved in designing and making your prosthesis.
It’s important to discuss your operation fully with your surgical team so that you know what to expect and how it will affect you.
Less common types of surgery
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Sometimes small cancers on the lip are treated with a type of surgery called micrographic surgery or Mohs surgery.
The surgeon removes the cancer in thin layers, and the tissue that has been removed is examined under a microscope during the surgery. The surgeon continues to remove more layers until no cancer cells are seen in the tissue. This technique makes sure that all the cancer cells are removed and only a very small amount of healthy tissue is removed.
Transoral laser surgery
This type of surgery is sometimes used to treat smaller cancers on the lip, mouth or throat. Laser surgery is a way of removing a tumour using a high-power beam of light.
The light is attached to a microscope so that the surgeon can see the tissue in detail when they are operating.
Transoral means the surgeon operates through the open mouth so this surgery doesn’t cause any external cuts or scars.
Photodynamic therapy (PDT)
Photodynamic therapy uses a combination of laser light and a light-sensitive drug to destroy cancer cells.
It’s sometimes used to treat very small, early cancers and is most likely to be given as part of a clinical research trial.
PDT may also be used to shrink an advanced cancer. The aim is to relieve symptoms rather than cure the cancer. This is called palliative treatment.
Your doctor can advise whether PDT may be an appropriate treatment in your situation.
Some people have surgery as a day patient, but surgery often involves a stay in hospital. This may be for several days or for up to a few weeks. Your length of stay will depend on the extent of the surgery and whether or not you’ve had reconstructive surgery.
After your operation, you’ll be encouraged to start moving around as soon as possible. This is an essential part of your recovery. If you have to stay in bed, it’s important to do regular leg movements and deep breathing exercises. A physiotherapist will explain these to you.
If you’ve had a bigger operation, you may spend some time in intensive care immediately after the operation. This is a ward where you will be closely checked and given intensive nursing care for as long as necessary to help you recover.
After the operation, it’s likely that you will wake up with a number of drips, drains and tubes attached to you. These will gradually be removed as you recover.
Operations to the mouth and throat area usually cause quite a bit of swelling and make eating and drinking uncomfortable for a time. Because of this, you’ll probably wake up from the operation with a tube going into a vein in your arm or your neck (an intravenous drip). The nurses will give you fluids through this tube for a few days. It will be removed once you’re able to drink fluids again.
Drains and dressings
Depending on the extent of your surgery, you may have one or two thin, plastic drainage tubes coming from the operation area, with bottles attached to them to collect fluid from the wound. This helps the wound to heal. Drains usually stay in place for about 2-7 days.
If you’ve had reconstructive surgery using tissue taken from another part of your body, you may have stitches or a dressing on this area too.
When you go home, your wound and drain (if it’s still in) can be checked and dressed by a district nurse if necessary.
Or you may be asked to go back to the hospital every few days to have it checked there. If you don’t have the type of stitches that dissolve, you’ll usually have your stitches or staples removed about seven days after your operation.
You may not be able to eat for a few days while your tissue heals. This means you may have to get the nutrition you need through a feeding tube that goes into your stomach.
The surgeon may put this in during the operation.
There are two types of feeding tube:
A gastrostomy tube, which is a tube that is passed through the tummy wall (abdomen) into your stomach. This is sometimes called a PEG or RIG tube.
A nasogastric (NG) tube, which is a thin tube passed up your nose, down your throat and into your stomach.
The dietitian will talk to you about this before your operation and will be on hand to provide support afterwards. They’ll prescribe a high-protein, high-calorie, liquid food to be given through the tube.
Once the tissues in your mouth and throat have healed, your surgeon may arrange for you to have a swallowing assessment by a speech and language therapist. When you can eat and swallow safely, the feeding tube can be removed.
If you’re going to have radiotherapy after your surgery, you may need a feeding tube until all your treatment is completed. This is because radiotherapy can give you a sore mouth and throat, which can make it difficult for you to eat.
If you need to go home with a feeding tube, the nurses will be able to teach you and/or your carers how to look after it safely and will arrange community support to visit your home. A small number of people will have a gastrostomy tube for a longer period of time.
We have more information on nutritional support, which includes information on NG, PEG and RIG tubes.
You may have a small tube (catheter) to drain urine from your bladder into a collecting bag. This will save you having to get up to pass urine, and it is usually removed after a couple of days.
Sometimes surgery to the mouth or throat can cause temporary swelling. This can narrow your airway and make it difficult for you to breathe. If the type of surgery you’re having is likely to cause this problem, the surgeon will create a small opening into your windpipe, called a tracheostomy or stoma, for you to breathe through.
The opening is made in the lower part of the front of your neck. It’s held open by a small plastic tube a few centimetres long. When the swelling from your operation goes down (after about 5–7 days) and you can breathe easily, the tube is taken out. The opening will then be left to heal over naturally.
If you have a tracheostomy, usually you won’t be able to speak with the tube in place. However, you will be able to use a pen and paper to communicate with other people.
If you’re likely to have a tracheostomy for a short time after your operation, your surgeon will explain this to you in advance. You’ll also have time to ask the specialist nurse or speech and language therapist questions about it before you have your surgery.
You may have some pain or discomfort for a few days after your operation. It’s very important to let your doctor or the nurses on the ward know as soon as possible if you have any pain. If the drugs aren’t relieving your pain, the dose can be increased or the painkillers changed.
Changes in sensation (numbness)
Depending on the area of your head or neck that’s been operated on, surgery may affect the sensation in your mouth, face, neck or shoulders, and some areas may feel numb. This can happen if nerves are bruised during the operation. It may take several months for nerves to heal and for normal sensation to come back.
If you have an external scar after the operation, it’s common to have numbness in the skin around the area. It may take several months for normal sensation to return.
Occasionally, if a cancer is growing very close to a nerve, the only way to remove all of the cancer is by cutting the nerve. If this happens, the changes in sensation can be permanent.
Some operations to the mouth and throat can affect the way that you speak. The throat, nose, mouth, tongue, teeth, lips and soft palate are all involved in producing speech. Any operation that changes one of these parts of the head and neck may affect your speech.
For some people this is hardly noticeable, but for others speech may be temporarily or permanently altered. A speech and language therapist will be able to help you adapt to any changes with your speech.
When you’re ready to start taking fluids and food by mouth, you’ll see a speech and language therapist. If you’re finding chewing or swallowing difficult, they can advise you about the safest and easiest types of food to have. They will also teach you mouth and jaw exercises that will improve your swallowing.
Difficulty opening your mouth due to a stiff jaw (trismus)
Some operations to the back of the mouth and throat can lead to a stiff jaw. You will be given exercises to prevent this from becoming a permanent problem.
Changes to your appearance
Your surgeons and specialist nurse can talk over the possible changes in your appearance with you before your operation. It’s important to have a good idea of what to expect.
Operations in the mouth or throat can often cause temporary swelling. So your face may look very swollen immediately after the operation. This will gradually get better over a few months.
Whenever possible, your surgeon will plan the operation so that if you have scars they will be in less noticeable places, such as in skin creases on your face or a fold in your neck. Scars are usually red or dark to begin with but gradually fade over time.
It can take some time to adjust to changes in how you look and it’s important to know that support is available. We have more information about coping with changes in your appearance.
Preparing to go home
Before you leave hospital, you’ll be given an appointment for a check-up or to plan further treatment, such as radiotherapy. If you need to see any other members of the team, such as the speech and language therapist, specialist nurse or dietitian, you’ll also be given appointments.
If it’s needed, the ward nurses can arrange for district nurses to visit you at home and check that you’re managing with any wounds and dressings.