Surgery for head and neck cancer

Your surgeon aims to remove the cancer and reduce any effects on your speech and swallowing. They will explain the operation to you and tell you if your appearance, speech, swallowing or eating may be affected. You may see a speech therapist and a dietitian.

Small cancers in the mouth may be removed through your mouth. The surgeon will need to make a cut in your skin to remove larger cancers at the back of the mouth or in your throat. If a cancer is in the hypopharynx, the surgeon may need to remove some or all of the voicebox (larynx).

If cancer is in the lymph nodes in the neck, a neck dissection may be carried out to remove some or all of the lymph nodes.

If some bone, such as the cheekbone or palate is removed, you may be given an artificial part (prosthesis). Some people have reconstructive surgery using tissue or bone from another part of the body.

Surgery

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. But your surgeon will also do everything possible to minimise the changes that surgery may cause to your speech and swallowing.

The type of surgery you have depends on the size and position of the cancer, and whether it has spread (staging).

Before your operation, your surgeon will discuss the type of 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 there is a risk your speech, swallowing or eating could be affected for a time after surgery, you may also meet a speech and language therapist or dietitian before the operation.


Types of surgery

Most surgery for head and neck cancer involves 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. In that case there is no need to stay in hospital overnight.

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 are having a neck dissection.

If the cancer is larger, or at the back of your mouth or in your throat, the surgeon will usually need to make a cut (incision) in your skin to reach it. This means that you’ll have a visible scar afterwards. This often fades over time.

If the cancer is in the hypopharynx, the surgeon may need to remove some or all of your voicebox (larynx). This is known as a partial or complete laryngectomy. The surgery will affect your speech. The surgeon will discuss the operation with you beforehand.

There is more information about having a laryngectomy in our section on cancer of the voicebox (larynx).


Neck dissection

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 is 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 specialists will assess the risk of cancer having spread to lymph nodes in your neck. This will 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 are having lymph nodes removed from your neck, you will often have this done at the same time as the operation to remove the cancer. You may also have a neck dissection before you have radiotherapy or chemoradiation as your main treatment.

A neck dissection may sometimes be done if the cancer has come back (recurred) in the nodes after initial treatment.

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.


Reconstructive surgery

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.

This is when the surgeon takes tissue from another part of the body, such as the forearm, thigh or chest, and uses it to replace tissue taken from the head and neck. This is known as a flap.

If the cancer is in your jawbone, the surgeon will need to remove the affected bone 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.

Before you have 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.  We have more information about coping with changes to how you look.

The doctors were extremely kind, frank and helpful. My best option was to have surgery to remove the tumour and reconstruct my mouth with muscle, fat and skin from my belly.

Christine


Prosthetics

Sometimes, the surgeon may need to remove bones from your 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. This is a denture with an extension that’s used to cover any gaps in the roof of the mouth.

If you are 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

Mohs surgery

Small cancers on the lip are sometimes treated with a type of surgery called micrographic surgery or Mohs surgery.

The surgeon removes the cancer in thin layers. The tissue that has been removed is looked at 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.

PDT is sometimes used to treat very small, early cancers. It may also be used to shrink an advanced cancer, when the aim is to relieve symptoms rather than cure the cancer. This is called palliative treatment.

You may be offered PDT as part of a clinical research trial.

Your doctor can tell you whether PDT may be an appropriate treatment in your situation. This treatment isn’t available in all hospitals so you may have to travel to have it.

Back to Surgery explained

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.

Recovery after surgery

As you recover, you may be coping with some effects of surgery. You surgeon will explain how these can be managed.