The aim of surgery for head and neck cancer is to remove cancerous tissue and preserve the functions of the head and neck, such as breathing, swallowing and talking, as much as possible.
If surgery is minor, recovery is usually fast and there are often few long-term side effects. For more advanced cancer, surgery will be more extensive, lasting 12 hours or more, and often cause longer-lasting or permanent side effects. Visit Managing side effects for more on this.
To learn more about surgery, call Cancer Council 13 11 20, download a booklet from this page, or see Surgery.
Learn more about:
- Removing lymph nodes
- How the surgery is done
- Surgery for oral cancer
- Surgery for pharyngeal cancer
- Surgery for laryngeal cancer
- Surgery for salivary gland cancer
- Surgery for nasal and paranasal sinus cancer
- What to expect after surgery
- After surgery: Long-term side effects
- Video: What is surgery?
Removing lymph nodes
If a head and neck cancer has spread to the lymph nodes in your neck, or if there is a chance the cancer will spread, your surgeon will probably remove some lymph nodes. This operation is called a neck dissection or lymphadenectomy.
Most often lymph nodes are removed from one side of the neck, but sometimes they need to be removed from both sides.
A neck dissection may be the only surgery needed when the primary cancer will be treated with radiation therapy, or a neck dissection may be part of a longer head and neck operation.
Removing the lymph nodes may affect the movement and appearance of your neck or shoulder (see Lymphoedema).
How the surgery is done
If you have surgery for a head and neck cancer, different surgical methods may be used to remove the cancer. Each method has advantages in particular situations – your doctor will advise which method is most suitable for you.
The options may include:
- endoscopic surgery – uses telescopes and microscopes through the nose and mouth to remove cancers
- trans-oral robotic surgery (TORS) – uses robotic arms to access areas through the mouth using standard surgical tools, or specialised tools incorporating laser or robotic technology
- open surgery – involves making cuts in the neck or the lines of the face to access and remove cancers. Used for larger cancers and those in difficult positions. Bones of the upper and lower jaw or skull may need to be partially removed.
Endoscopic and trans-oral robotic surgery usually mean less scarring, a shorter hospital stay and faster recovery. However, open surgery may be a better option in many situations.
After open surgery, reconstructive surgery may be needed to restore functions such as eating, talking and breathing, and improve cosmetic appearance. Some people have reconstructive surgery at the same time as the surgery, others at a later date.
Reconstructive surgery may involve using skin, bone or tissue from another part of the body to rebuild the area. This is called a free flap. Occasionally synthetic materials such as silicone and titanium are used to re-create bony or structural areas. This is called a prosthetic reconstruction.
Surgery for oral cancer
The type of surgery will depend on the size of the cancer and where it is.
Localised cancers can be treated by removing part of the tongue or mouth. There are often few side effects. If the cancer is larger, surgery may be more extensive and require reconstructive surgery to help you chew, swallow or speak.
Different types of oral surgery include:
- glossectomy – removes part or all of the tongue
- mandibulectomy – removes part or all of the lower jaw
- maxillectomy – removes part or all of the upper jaw (maxilla)
- mandibulotomy – cuts through the lower jaw to access a cancer in the throat or back of the tongue
- trans-oral primary tumour resection – removes the tumour through the mouth.
I had surgery to remove the tumour, the affected jaw bone and lymph nodes. Later my jaw was reconstructed with bone from my leg. I also had radiation therapy to my lower jaw and neck for six weeks. I recovered well. My only ongoing side effect is a dry mouth.
Surgery for pharyngeal cancer
Early pharyngeal cancers may be treated with either surgery or radiation therapy.
If you have surgery, the surgeon will cut out the tumour and a margin of healthy tissue, which is checked by a pathologist to make sure all the cancer cells have been removed.
If the cancer is large or advanced, the surgery is often followed with radiation therapy and possibly chemotherapy. The surgery is more likely to be extensive and may require reconstruction.
Different types of pharyngeal surgery include:
- pharyngectomy – removes part or all of the pharynx
- mandibulotomy – cuts through the lower jaw
- mandibulectomy – removes part or all of the lower jaw
- maxillectomy – removes part or all of the upper jaw
- laryngopharyngectomy – removes part or all of the larynx and pharynx.
Surgery for laryngeal cancer
If the cancer is at an early stage, it may be removed through the mouth using trans-oral surgery with standard surgical equipment or laser or robotic surgery. It may take up to six months for your voice to recover. In some cases, there may be long-term or permanent changes to the pitch, loudness or quality of your voice – see Changes to Speech for more on this.
If the cancer has advanced, you may need open laryngeal surgery. This will involve removing all of the larynx (total laryngectomy) or part of the larynx (partial laryngectomy).
Total laryngectomy – This operation removes the whole larynx and separates the windpipe (trachea) from the oesophagus. Without your vocal cords, you won’t be able to speak naturally, but you will work with a speech pathologist to learn new ways to communicate.
If you have a total laryngectomy, your thyroid gland may be removed during surgery (thyroidectomy). Once the thyroid is removed, you will no longer produce thyroxine (T4), the hormone that maintains your metabolism, energy levels and weight. You will be prescribed an oral hormone tablet, which you will need to take daily for the rest of your life. Ask your doctor for more details.
Partial laryngectomy – This type of operation is used for small laryngeal cancers. A cut is made on your neck and the part of the larynx with the cancer is removed. This surgery is now rare as surgery through the mouth (endoscopic surgery) has become more common for small cancers.
After a partial laryngectomy you will keep parts of your voice box and usually be able to speak and swallow afterwards. However, your voice may be hoarse after surgery and you may have a tracheostomy tube inserted for a short time after the operation – see Changes to Speech for more details. Talk to a speech pathologist about ways to improve your ability to swallow and speak after surgery.
Surgery for salivary gland cancer
Most salivary gland tumours affect the parotid gland. Surgery to remove part or all of the parotid gland is called a parotidectomy. Some people with salivary cancer will also need a neck dissection.
The facial nerve, which controls expressions of the face and movement of the eyelid and lip, runs through the parotid gland. If this nerve is damaged during surgery, you may be unable to smile, frown or close your eyes. This is known as facial palsy, and it can take months to a year for movement to improve. In some cases, it may need to be repaired using a nerve from another part of the body, often from the leg (nerve graft). If the facial nerve is removed (facial nerve sacrifice), several procedures will help improve movement and appearance of the face.
If the cancer affects the submandibular gland or the sublingual gland, the gland will be removed, along with some surrounding tissue. Nerves controlling the tongue and lower part of the face may be damaged, causing some loss of function. If the cancer is in a minor salivary gland, it may be removed with endoscopic surgery.
Some tumours found in the salivary glands are benign, but these are removed using the same surgical techniques.
– Geoff (salivary gland cancer)
Surgery for nasal and paranasal sinus cancer
Your doctor may advise you to have surgery if the tumour isn’t too close to your brain or major blood vessels. The aim of surgery is to remove all of the tumour and a small area of normal tissue to obtain clear margins.
The type of surgery depends on the location of the tumour and, if you have paranasal sinus cancer, the affected sinuses.
Different types of surgery for nasal cancer include:
- maxillectomy – removes part or all of the upper jaw (maxilla), possibly including the upper teeth, part of the eye socket and/or the nasal cavity
- craniofacial resection – removes tissue between the eyes, requiring a cut along the side of the nose
- lateral rhinotomy – requires cuts along the edge of the nose to gain access to the nasal cavity and sinuses
- orbital exenteration – removes the eye
- rhinectomy – removes part or all of the nose
- endoscopic sinus surgery – removes part of the nasal cavity or sinuses through the nostrils, using an endoscope
- midface degloving – accesses your nasal cavity or sinuses by cutting under the upper lip, which avoids scarring of the face.
The surgeons will consider how the operation will affect your appearance, and your ability to breathe, speak, chew and swallow. If your nose, or a part of it, is removed, you may get an artificial nose (prosthesis). This will be synthetic or made of tissue from other parts of your body.
What to expect after surgery
The length of your hospital stay will depend on the type of surgery you have and how well you recover. The side effects listed below are often temporary. For more information about ongoing effects, see Managing Side Effects.
Pain – At first, you will need some pain relief. You will have patient-controlled analgesia (PCA), which delivers a measured dose of pain relief when you press a button.
Drips and drains – You may have tubes at the surgery site to drain excess fluid.
Sore throat – This usually lasts for less than 24 hours, but may take longer if you were treated for pharyngeal or laryngeal cancer.
Breathing difficulties – If your mouth or tongue is swollen and breathing is difficult, the surgeon will place a breathing tube in your lower neck (tracheostomy). The tracheostomy is usually temporary. See Breathing Changes for more information.
Speech changes – Your ability to speak may be affected. Often this is temporary, but see page 59 if this side effect is ongoing.
Dietary changes – You will usually start with fluids, move on to pureed food, and then soft foods. A temporary feeding tube may be inserted through your nasal passageway for a few days or weeks. Alternatively, a gastrostomy tube, known as a PEG feeding tube, may be inserted. See Taste, smell and appetite changes for more information.
After surgery: Long-term side effects
After surgery or radiation therapy, many people have to adjust to significant changes. You may also see a speech pathologist and/or dietitian before surgery or radiation therapy to discuss these issues. Talk to your doctor about what to expect.
Long-term side effects may include:
- Breathing changes – After some types of throat surgery, the surgeon may need to help you breathe using a temporary tube in your neck. If you have a total laryngectomy, you’ll need a permanent hole (stoma).
- Taste and smell changes – If you have a craniofacial resection, you may lose your sense of smell, and your sense of taste will be affected. If you have a laryngectomy, air will no longer pass through your nose, which can affect your sense of smell.
- Swallowing difficulties – Surgery may affect your ability to swallow. A speech pathologist can suggest modifications to the texture of your food and drink to make them easier to swallow. If you are having difficulty eating or drinking, you may be given a temporary or permanent feeding tube.
- Speech changes – Changes to how clearly you speak and/or the quality of your voice depend on the surgery you had. A speech pathologist can provide strategies to help you adjust to these changes.
- Appearance changes – Many types of head and neck surgery will cause temporary or permanent changes to appearance. You may feel distressed or embarrassed about these changes. A reconstructive surgeon is often able to make physical changes (such as scars) less visible. If you have lost teeth, they may be able to be replaced/reconstructed surgically.
- Pain and physical discomfort – If you have lymph nodes removed, you may have numbness, reduced movement and/or pain in your neck or shoulder on the side of surgery. Sensation may gradually improve over 12 months and rehabilitation with a physiotherapist can help you regain movement.
- Vision changes – If the cancer is in your eye socket, the surgeon may have to remove your eye (orbital exenteration). Your changed vision should not prevent you from continuing activities such as driving or playing sport, but it may take time to get used to – and accommodate – the changes.
- Lymphoedema – If you have lymph nodes removed, you may experience persistent swelling in the soft tissue of the affected head and neck area.
– Peter (nasopharyngeal cancer)
Video: What is surgery?
Watch this short video to learn more about surgery.