Surgery for head and neck cancer

Your surgeon aims to remove the cancer and limit 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 and language therapist (SLT) 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. Talking to other people who have had this surgery about how they have coped can help.

Surgery

Surgery is one of the main treatments for cancers of the head and neck. The type of surgery you have depends on the size and position of the cancer, and whether it has spread (its stage).

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, swallowing and breathing.

Before your operation, your surgeon will discuss the type of surgery with you. It is important that you understand what they are going to remove and how this will affect you after the operation, in the short and long term.

There may be a risk your speech, swallowing or eating could be affected for a time after surgery. If this is the case, you may also meet a speech and language therapist (SLT) or dietitian before the operation.


Types of surgery

You usually need to stay in hospital if you have surgery for a head and neck cancer. Most operations are done under a general anaesthetic. If you have a very small cancer, it might 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 the mouth, the surgeon may operate through the open mouth. This means you will not have any external scars, unless you are having a neck dissection.

If the cancer is bigger, or at the back of the mouth or in the throat, the surgeon usually needs to make a cut (incision) in the skin to reach it. This means you will have a scar afterwards. This usually fades over time.

If the cancer is in or near the voicebox (larynx), the surgeon may need to remove some or all of the voicebox. This is known as a partial or total laryngectomy. The surgery will affect your speech.

The surgeon will discuss the operation with you beforehand.


Neck dissection

If the cancer spreads from where it started in the head or neck, it is likely to go to the lymph nodes in the neck.

If tests show the cancer has spread to the lymph nodes, you may have an operation to remove some or all of the lymph nodes in one or both sides of the neck. This is called a neck dissection. It may also be done if the cancer is large, even if there are no signs of cancer in the lymph nodes. This is because when the cancer is large, there may be small amounts of cancer in the lymph nodes that do not show up on scans or in other tests.

Your cancer specialist assesses the risk of the cancer being in lymph nodes in the neck. This helps them decide whether you need to have a neck dissection. Your risk depends on 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 the neck, you may have this done at the same time as the operation to remove the cancer. Or you may have a neck dissection before having radiotherapy or chemoradiation as your main treatment. A neck dissection may also sometimes be done if the cancer has come back (recurred) in the nodes after 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 the mouth. It may mean your smile is a bit crooked (asymmetrical) for a while, but this usually returns 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. Other nerves may also be affected. Your surgeon can explain more about the possible effects after having a neck dissection.


Reconstructive surgery

Your operation may involve removing tissue that is used for speech or swallowing. It might also affect your appearance. If this is the case, 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. They use it to replace tissue taken from the head and neck. This is known as a flap.

If the cancer is in the jawbone, the surgeon needs to remove the affected bone, as well as the tumour. They may use bone from another part of the body (usually the lower leg) to replace the missing jawbone. This is known as a bone flap. Your doctor and specialist nurse can give you specific information about this type of operation. You can usually 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 people. They can talk to you about how the surgery has affected them, and how they have coped.

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


Prosthesis (artificial replacement)

Sometimes, the surgeon may need to remove bones from the face, such as the cheekbone or palate, to remove all of the cancer. Depending on the extent of the operation, they may offer you an artificial replacement called a prosthesis (false part). This is a specially designed, soft, plastic replacement for the part of the face that has been removed.

The most common prosthesis is an obturator. This is a denture with an extension that is 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 is important to discuss your operation in detail with your surgical team, so you know what to expect and how it will affect you.


Less common types of surgery

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 may be attached to a microscope, so the surgeon can see the tissue in detail when they are operating.

Transoral means the surgeon operates through the open mouth, so this surgery does not cause any external cuts or scars.

Transoral robotic surgery

This type of surgery may be used to treat smaller cancers on the tonsils, tongue base or throat. The surgeon controls robotic instruments to perform the surgery. The surgeon operates through the open mouth, so this surgery does not cause any external cuts or scars.

Back to Surgery for head and neck cancer

Who might I meet?

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