Patient education: Surgical treatment for head and neck cancer (The Basics)

What is head and neck cancer? — Head and neck cancer (or "HNC") is a group of cancers that form in the head and neck area. These cancers start in the "mucous membranes" of the head and neck. Mucous membranes are the moist tissues that line some of the spaces inside the body (figure 1). For example, HNC could form in the:

●Mouth

●Throat

●Larynx (voice box)

●Nose

●Sinuses

●Trachea (windpipe)

●Esophagus (the tube that carries food from the throat to the stomach)

HNCs can also spread to lymph nodes nearby.

Most HNCs are a type of cancer called "squamous cell carcinoma," or "SCC." Squamous cells are a type of cell found in mucous membranes.

When is surgery an option for treating HNC? — Many HNCs can be treated with surgery, radiation therapy, or chemotherapy. In some cases, you might get more than 1 treatment. For example, you might have:

●Surgery and radiation therapy

●Radiation therapy and chemotherapy

●Surgery, radiation therapy, and chemotherapy

The goal of surgery is to remove as much of the cancer as possible without having a negative effect on your quality of life.

Whether surgery is an option for you depends on:

●Whether your cancer is "early stage" or "late stage" – Cancer staging means how far your cancer has spread. Generally, early-stage cancer is easier to treat than late-stage cancer.

●Where your cancer is

●How surgery would affect your quality of life – For example, doctors try to avoid surgery if it would make it difficult for you to talk or swallow.

●Whether there are other treatments that might work

●Whether the cancer has spread to other parts of your body – This is called "metastasis."

In some cases, surgery to remove HNC changes the way a person looks or makes it difficult to eat, swallow, and talk. Sometimes, it is possible to do more surgery to fix or improve these problems. This is called "reconstruction." But it's important to know that reconstruction is not always possible. Even when reconstruction is an option, you still might look or talk differently than before your surgery, or still have some problems eating or swallowing.

When deciding whether to have surgery for HNC, talk to your doctor about all of your options. Make sure that you understand what treatments are available, and the benefits and drawbacks of each. Your doctor will help you come up with the best treatment plan for your situation.

What happens during surgery for HNC? — In general, the cancer and some of the healthy tissue around it will be removed. Some of the lymph nodes in the area might also be removed if the cancer has spread to them.

There are 2 main ways of doing the surgery:

●Open surgery – With open surgery, the surgeon makes 1 large cut to see into and work on the body.

●Minimally invasive surgery – With minimally invasive surgery, the surgeon inserts a device called a "scope" through the natural opening closest to the cancer, such as the mouth. A scope is a thin, flexible tube with a camera on the end. It lets the surgeon see inside of the body. Then, the surgeon inserts special long, thin tools to do the surgery. In some cases, the surgeon moves the tools with the help of a robot (this is called "robot-assisted" surgery).

The type of surgery you have depends on the type of cancer you have and how big it is.

If you are having reconstruction, this might be done during the same surgery or in a separate surgery.

Will I need other treatments? — In most cases, yes. Other treatments for HNC might include:

●Radiation therapy

●Chemotherapy

You might also need other treatments after having surgery to remove the cancer. These might include:

●Reconstruction or plastic surgery – Reconstruction is surgery to rebuild a body part. The goal is to improve appearance, function, or both. Plastic surgery is surgery to improve appearance. These treatments might include skin grafts or "prosthetic" parts.

●Tracheostomy – Some people with cancer in the larynx (voice box) might need a tracheostomy after surgery. A tracheostomy, or "trach," is a procedure where a doctor makes a cut in the neck to create an opening into the windpipe. Then, a tube is placed through the hole to help with breathing and speech. People who have their whole larynx removed will need a tracheostomy permanently.

●Dental treatments – These might include dental implants or other treatments.

●Rehabilitation – Rehabilitation therapy helps you adjust to any changes from your surgery. For example, if your surgery affected your throat, a rehabilitation therapist can help you learn how to swallow again. Or you might work with a "speech pathologist" to improve how well you can talk after surgery.

What are the drawbacks of surgery for HNC? — These depend on the type of surgery you have and where your cancer is. Your doctor will talk to you about all of the risks and drawbacks.

Drawbacks of surgery for HNC can include:

●Changes to appearance – Having surgery might change the way you look. For example, you might have scars. Parts of your body, such as your jaw, might need to be removed.

●Problems talking or being unable to talk

●Problems chewing, swallowing, or breathing

●Pain – Some people have pain in the area where their HNC was removed after they have surgery.

●Infection or wound healing – In rare cases, people might get an infection or heal slowly from the cuts made during surgery.

There are treatments and therapies that can help with many of these things.

What will my life be like after surgery? — Even when it works to remove cancer, surgery for HNC can have a negative effect on a person's quality of life. This is because it often affects the way a person looks, or makes it difficult to eat, swallow, or talk. Having reconstruction surgery can help with these problems.

You might also get therapy to help with things like:

●Speech

●Swallowing and eating

●Strengthening muscles

●Relearning how to do your normal daily activities

●Coping with mental health challenges

It's important to know that even if surgery is successful, you might not look the same as before. It can also be hard to have to relearn how to do things like speaking or swallowing. If you are struggling to cope, or dealing with depression or anxiety, talk to your doctor and nurse. They can help you.

What else do I need to know? — Your doctor or nurse will want to see you regularly after surgery. They will talk to you, do exams, and order imaging tests. (Imaging tests create pictures of the inside of the body.) This way, they can see how you are recovering. If your cancer comes back after surgery, they can talk to you about other treatment options.

More on this topic

Patient education: Flap surgery (The Basics)
Patient education: Throat cancer (The Basics)
Patient education: Tongue cancer (The Basics)
Patient education: Laryngeal cancer (The Basics)
Patient education: Esophageal cancer (The Basics)