Surgery for head and neck cancers
The aim of surgery is to remove cancerous tissue and, as much as possible, 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 tumour and a margin of healthy tissue, which is checked by a pathologist to make sure all the cancer cells have been removed.
It can be frightening to think about having surgery to your head and neck. Talking to your treatment team can help you understand your situation or see our information about what to expect before, during and after surgery.
- Removing lymph nodes
- How the surgery is done
- Reconstructive surgery
- Surgery for oral cancer
- Surgery for nasal and paranasal sinus cancer
- Surgery for salivary gland cancer
- Surgery for pharyngeal cancer
- Surgery for laryngeal cancer
- What to expect after surgery
- Long-term side effects of treatment
- Video: What is surgery?
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.
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 neck or shoulder moves and looks. A physiotherapist can help improve movement and function (see also Lymphoedema).
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 a long thin flexible tube with a light and camera that is inserted through the nose or mouth so the surgeon can see and remove the cancer; often used for cancers in the nasal cavity, pharyngeal cancers and laryngeal cancers
- trans-oral robotic surgery (TORS) – uses robotic arms to reach cancerous areas through the mouth using standard surgical tools, or specialised tools with laser or robotic technology; often used for oropharyngeal cancers
- open surgery – involves making cuts in the neck or the lines of the face to reach 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, these types of surgery are not possible in all cases, and open surgery is often the best option in many situations.
After open surgery, reconstructive surgery may be needed to restore functions such as eating, talking and breathing, and to improve how the area looks. 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 recreate bony areas or other structures in the head and neck, such as the palate. This is called a prosthetic reconstruction.
The type of surgery will depend on the size and location of the cancer. Localised cancers can be treated by removing part of the tongue, mouth or lip. If the cancer is larger, surgery may be more extensive and you may need reconstructive surgery to help you chew, swallow or speak.
Some tumours can be removed through the mouth, but you may require open surgery for larger tumours. 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).
Video: What is surgery?
A/Prof David Wiesenfeld, Oral and Maxillofacial Surgeon, Director, Head and Neck Tumour Stream, The Victorian Comprehensive Cancer Centre at Melbourne Health, VIC; Alan Bradbury, Consumer; Dr Ben Britton, Senior Clinical and Health Psychologist, John Hunter Hospital, NSW; Dr Madhavi Chilkuri, Radiation Oncologist, Townsville Cancer Centre, The Townsville Hospital, QLD; Jedda Clune, Senior Dietitian (Head and Neck Cancer), Sir Charles Gairdner Hospital, WA; Dr Fiona Day, Staff Specialist, Medical Oncology, Calvary Mater Newcastle, and Conjoint Senior Lecturer, The University of Newcastle, NSW; Dr Ben Dixon, ENT, Head and Neck Surgeon, Peter MacCallum Cancer Centre and St Vincent’s Hospital Melbourne, VIC; Emma Hair, Senior Social Worker, St George Hospital, NSW; Rosemerry Hodgkin, 13 11 20 Consultant, Cancer Council WA; Kara Hutchinson, Head and Neck Cancer Nurse Coordinator, St Vincent’s Hospital Melbourne, VIC; A/Prof Julia Maclean, Speech Pathologist, St George Hospital, NSW; Prof Jane Ussher, Chair, Women’s Health Psychology, Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, NSW; Andrea Wong, Physiotherapist, St Vincent’s Hospital Melbourne, VIC. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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