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.
- Removing lymph nodes
- How the surgery is done
- Reconstructive surgery
- Surgery for oral cancer
- Surgery for pharyngeal cancer
- Surgery for laryngeal cancer
- Surgery for nasal and paranasal sinus cancer
- Surgery for salivary gland cancer
- Key questions
- What to expect after 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 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).
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.
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.
The type of surgery depends on the cancer’s size and location. Localised cancers can be treated by removing part of the tongue, mouth or lip. For larger cancers, the surgery will affect a bigger area and you may need reconstructive surgery so you can continue to chew, swallow or speak.
Some tumours can be removed through the mouth, but you may need 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 (mandible)
- maxillectomy – removes part or all of the upper jaw (maxilla).
Podcast: Making Treatment Decisions
A/Prof Richard Gallagher, Head and Neck Surgeon, Director of Cancer Services and Head and Neck Cancer Services, St Vincent’s Health Network, NSW; Dr Sophie Beaumont, Head of Dental Oncology, Dental Practitioner, Peter MacCallum Cancer Centre, VIC; Dr Bena Brown, Speech Pathologist, Princess Alexandra Hospital, and Senior Research Fellow, Menzies School of Health Research, QLD; Dr Teresa Brown, Assistant Director, Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, QLD; Lisa Castle-Burns, Head and Neck Cancer Specialist Nurse, Canberra Region Cancer Centre, The Canberra Hospital, ACT; A/Prof Ben Chua, Radiation Oncologist, Royal Brisbane and Women’s Hospital, GenesisCare Rockhampton and Brisbane, QLD; Elaine Cook, 13 11 20 Consultant, Cancer Council Victoria; Dr Andrew Foreman, Specialist Ear, Nose and Throat Surgeon, Royal Adelaide Hospital, SA; Tony Houey, Consumer; Dr Annette Lim, Medical Oncologist and Clinician Researcher – Head and Neck and Non-melanoma Skin Cancer, Peter MacCallum Cancer Centre and The University of Melbourne, VIC; Paula Macleod, Head, Neck and Thyroid Cancer Nurse Coordinator, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Dr Aoife McGarvey, Physiotherapist and Accredited Lymphoedema Practitioner, Physio Living, Newcastle, NSW; Rick Pointon, Consumer; Teresa Simpson Senior Clinician, Psycho-Oncology Social Work Service, Cancer Therapy Centre, Liverpool Hospital, NSW.
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