Surgery for head and neck cancer

You will see different people from your head and neck team to help you prepare for cancer treatment. They will give you advice on getting ready for surgery. It is important to follow this advice.

You usually have an appointment at a pre-operative assessment clinic. Tests to check your general health may include:

• blood and urine tests
• chest x-rays
• a recording of your heart (ECG).

You go into hospital on the day of your operation or the day before. The nurses give you elastic stockings (TED stockings) to wear during and after surgery, to help prevent blood clots.

Surgery to remove the lymph nodes in one or both sides of the neck is called a neck dissection. This surgery:

• tells your doctor more about the stage of the cancer
• removes any lymph nodes that contain cancer cells
• reduces the risk of the cancer coming back (if the lymph nodes contained cancer cells).

You have tests first to see if there are signs of cancer in the lymph nodes. If the cancer is large, your doctor may advise neck dissection surgery even if your test results are negative. With bigger cancers, there may be small amounts of cancer in the lymph nodes. This may not show up on scans or in other tests.

You may have a neck dissection:

• at the same time as surgery to remove the primary cancer
• before or after chemoradiation or radiotherapy, if there are still cancer cells in the lymph nodes
• if the cancer is still present or comes back in the nodes after treatment.

After a neck dissection

After a neck dissection, possible side effects may include:

Rarely, other nerves connected to the tongue and voice box can also be affected. Sometimes there may be a change in the shape of your neck.

Your surgeon and nurse will explain more about the possible side effects of a neck dissection. We have more information about neck and shoulder problems after treatment.

Although some people have surgery as a day patient, head and neck surgery often involves a stay in hospital. This may be for several days or up to a few weeks. This depends on the type of operation you have and whether you need reconstructive surgery.

After your operation, you will be encouraged to start moving around as soon as possible. This is an important part of your recovery. If you have to stay in bed, it is important to do regular leg movements and deep-breathing exercises. These help to reduce your risk of getting a blood clot or a chest infection. A physiotherapist will show you how to do these.

If you had a bigger operation, you may spend some time in intensive care or a high-dependency unit after the operation. You have one-to-one nursing care for as long as necessary to help you recover.

After surgery you may wake up with a number of drips, drains and tubes attached to you. These are gradually removed as you recover.

Operations to the mouth and throat area usually cause swelling. This can make eating and drinking difficult and uncomfortable for a time. You will usually have a tube going into a vein in your arm or neck (an intravenous drip). The nurses give you fluids through this tube for a few days. It is removed when you can drink fluids again.

Depending on the surgery, you may have 1 or 2 thin plastic drainage tubes coming from the operation area. The tubes have bottles attached to collect fluid from the wound. If you had reconstructive surgery, you may have a drain in the area where the tissue was taken from. Drains usually stay in place for 2 to 7 days. If you go home with a drain, the district nurse can check it. You usually come back to hospital to have it removed.

The type of wound you have depends on the surgery. The nurses will check it regularly and change the dressings when needed. If you do not have dissolvable stitches, you usually have your stitches or staples removed about 7 days after surgery. The nurses will give you advice on what to do when you go home and how to recognise any signs of infection. District nurses can visit you at home and check your wound.

A feeding tube can be used if you are not able to eat or drink in the usual way. If you are likely to need this, your team will discuss it with you. The tube may be put in before or during your operation.

You may have a thin tube passed through the nose and into the stomach. This is called a nasogastric tube. It can usually be removed when you are able to swallow.

Having a feeding tube into your stomach means you get the nutrition you need while your tissue heals. Your dietitian prescribes high-protein, high-calorie, liquid food, to give through the tube.

Once your mouth and throat have healed, your speech and language therapist (SLT) may do a swallowing assessment. When you can eat and swallow safely, they remove the feeding tube. If you are having chemoradiation or radiotherapy after surgery, you may need to keep the tube in until all your treatment is finished.

If you need to go home with a feeding tube, your head and neck team will teach you and your family or friends how to look after it. You can also have daily home visits from community nutritional care nurses. They can help with feeding tube care and setting up the feeds.

The swelling from your operation usually goes down after about 5 to 7 days and you can then breathe easily. When this happens, the tracheostomy tube is taken out. The opening is left to heal over naturally. You usually cannot speak with the tube in place. Your nurse or SLT will have talked to you about how best to communicate with others. This could be using writing materials, picture boards, a mobile phone, laptop or tablet.

How long you are in hospital for will depend on the type of surgery you had and your recovery. It may be 2 to 4 weeks if you had reconstructive surgery.

You will have an appointment to come back to the outpatient clinic a few weeks later to see your surgeon. You will also be given appointments if you need to see any other members of the team, such as your speech and language therapist (SLT), specialist nurse or dietitian.

At the outpatient appointment with your surgeon, they will check that your wound is healing and you are recovering well. They will talk to you about the results of your operation and any more treatment you might need.

You can also ask any questions you have.