Surgery for head and neck cancers

The aim of surgery is to completely remove the cancer and preserve the functions of the head and neck area, such as breathing, swallowing and talking. If you have surgery, the surgeon will cut out the cancer and a margin of healthy tissue, which is checked by a pathologist to make sure all the cancer cells have been removed. Often some lymph nodes will also be removed.

The types of surgery used for the different head and neck cancers are described in this section. Thinking about having surgery to your head and neck can be frightening. Talking to your treatment team can help you understand what will happen. You can also ask to see a social worker or psychologist for emotional support before or after the surgery.

For more on this, see Surgery.

Learn more about:

• Removing lymph nodes
• How the surgery is done
• Reconstructive surgery
• How long will I stay in hospital?
• Will I have any side effects?
• Surgery for oral cancer
• Surgery for pharyngeal cancer
• Surgery for laryngeal cancer
• Surgery for nasal and paranasal sinus cancer
• Surgery for salivary gland cancer
• What to expect after surgery

Removing lymph nodes

If the cancer has spread to the lymph nodes in your neck, or it is highly likely to spread, your surgeon will probably remove some lymph nodes. This operation is called a neck dissection or lymphadenectomy. Your surgeon will let you know if this is recommended and explain how the procedure is done.

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, or it may be part of a longer head and neck operation. The surgeon will make a cut under your jaw and sometimes down the side of your neck. You will often have a small tube (drain) in your neck to remove fluids from the wound for a few days after the surgery.

A neck dissection may affect how your shoulder moves and your neck looks after surgery. A physiotherapist can help improve movement and function (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 – a rigid instrument with a light and camera is inserted through the nose or mouth so the surgeon can see and remove some cancers, particularly from the nose and sinuses
• transoral laser microsurgery (TLM) – a microscope usually with a laser attached is used through the mouth to remove cancers, particularly of the larynx and lower throat
• transoral robotic surgery (TORS) – the surgeon uses a 3D telescope and instruments attached to robotic arms to reach the cancer through the mouth; often used for oropharyngeal cancers
• open surgery – the surgeon makes cuts in the skin of the head and neck to reach and remove cancers; used for larger cancers and those in difficult positions. Part of the upper and lower jaw or skull may need to be removed and then replaced or reconstructed.

Minimally invasive surgery such as endoscopic, TLM and TORS usually means less scarring, a shorter hospital stay and faster recovery. However, these types of surgery are not possible in all cases, and open surgery is often the best option in many situations.

Reconstructive surgery

After open surgery, you may need reconstructive surgery to help with your swallowing and to improve how the area looks. It is usually part of the same operation but is sometimes done later.

Reconstructive surgery uses a combination of skin, muscle and occasionally bone to rebuild the area. This can be taken from another part of the body and is called either a free flap or a regional flap. Occasionally synthetic materials such as silicone and titanium are used to re-create bony areas or other structures in the head and neck, such as the palate. This is called a prosthetic.

How long will I stay in hospital?

How long you stay in hospital depends on the type of surgery you have, the area affected, and how well you recover. Surgery to remove some small cancers can often be done as a day procedure. Recovery is usually fast and there are often few long-term side effects.

Surgery for more advanced cancers often affects a larger area, can involve reconstructive surgery and may last all day. You may need care in the intensive care unit before being transferred to the ward, and side effects may be long term or permanent. Once you return home, you may be able to have nurses visit to provide follow-up care.

Will I have any side effects?

Most surgeries for head and neck cancer will have some short-term side effects, such as discomfort and a sore throat. Recovery after larger surgeries may be more challenging, especially at first. Learn more about what to expect in the first days after surgery.

Depending on the type of surgery you had, after a period of recovery, you may not have any ongoing issues. However, some people do need to adjust to lasting changes after head and neck surgery. Long-term side effects can include changes to energy levels, eating, speaking, breathing, appearance, sexuality, vision and hearing, as well as ongoing pain and lymphoedema (swelling caused by a build-up of lymph fluid).

Talk to your treatment team about what to expect and try to see a speech pathologist and/or dietitian before treatment starts. For more information and tips, see Managing side effects.

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