Surgery is an important treatment for most head and neck cancers of all stages. At Seattle Cancer Care Alliance (SCCA), we use the latest techniques to remove tumors and reconstruct tissue to restore function and appearance.
As an SCCA patient, you’ll have access to national leaders in surgical treatment of head and neck cancers. UW Medicine surgeons at University of Washington Medical Center (UWMC) Otolaryngology–Head and Neck Surgery Center treat SCCA patients. Our surgeons perform a high volume of complex surgical procedures every year. Their extensive experience makes them the region’s experts.
Three types of surgical procedures are used for head and neck cancers:
- Minimally invasive procedures
- Traditional open procedures
- Reconstructive procedures
Depending on the location, grade, and stage of your cancer, you may be treated with one or more of these. Small tumors may require only outpatient surgery, while larger tumors or cancer that has spread may require an overnight hospital stay. Your team will discuss and determine with you the best option for your cancer.
Minimally Invasive Procedures
Minimally invasive procedures are usually used for upper-airway tumors. These procedures are done through the mouth (transorally) or the nose so no incisions have to be made on the neck or face. Whenever possible, UW Medicine surgeons opt for this method in order to remove the cancer while preserving a patient’s function and appearance.
The surgeon may use a variety of tools and technologies to assist with surgery. For example, the surgeon may use an endoscope (a thin tube with a light and a lens) to access and remove a tumor with a laser (transoral laser microsurgery). An endoscope can also be used to transmit images to a video display during surgery (as in transoral video-assisted surgery).
The newest technique for removing head and neck tumors is transoral robot-assisted surgery (TORS), also called transoral robotic surgery. It is used for tumors of the back of the tongue and upper throat (aerodigestive tract). Removal of these tumors used to require a large incision in the neck and lower jaw, which meant many patients had trouble swallowing or speaking afterward. Now using the da Vinci Surgical System, or da Vinci robot, UW Medicine surgeons can remove tumors in this area through the mouth. UWMC brought robot-assisted surgery using the da Vinci robot to our region, and it continues to be a leading center for robot-assisted surgery where other surgeons come to train.
Patients whose tumors can be removed with a minimally invasive approach can expect to return home in only a day or two.
Traditional Open Procedures
When a minimally invasive approach cannot be used because of a tumor’s location or size, the surgeon will use a traditional open approach. Open surgery requires an incision in the face or neck. It may be more involved and take longer than minimally invasive surgery. Recovery may take longer as well because of the incision size. With new open techniques, surgeons strive not only to remove the cancer (and lymph nodes, if needed) but also to avoid disturbing important nerves, muscles, and blood vessels in the neck and shoulder region.
Not everyone who has surgery to remove head or neck cancer needs reconstructive surgery. But for those who do, UW Medicine reconstructive surgeons are experts in their field. Great advances have been made in anaplastology, the branch of medicine that uses prosthetics to restore missing or malformed parts of the body. It is considered an art form as much as a surgical specialty. If structures in your head or neck are affected by treatment, they can be reconstructed to minimize any change in your appearance.
Using a team approach, your oncology surgeon and a reconstructive surgeon will work together during one operation to both remove the cancer and complete any reconstruction you need. The combined operation means you’ll be under anesthesia and in surgery for significantly less time that you would be for two separate operations. After surgery, a team of nurses, speech pathologists, and social workers will help you recover and rehabilitate.
For patients who’ve had their larynx removed (laryngectomy), doctors can now restore vocal ability using a quick procedure to implant a tracheoesophageal puncture prosthesis (TEP) in a small hole made between the windpipe (trachea) and esophagus. A TEP restores the patient’s ability to deliver air from the lungs into the throat to produce speech. Another option for restoring vocal ability is an electrolarynx—a device that the speaker places against his or her neck to help produce sound that comes out through the mouth.
Free Flap Surgery
Another reconstructive technique is free flap surgery, in which surgeons remove skin, tissue, or bone from one part of the body to reconstruct another part. For example, if a patient needs part of their lower or upper jaw removed, UW Medicine surgeons can refashion a jawbone using bone from the patient’s leg, hip, or shoulder blade. Even the tongue can be reconstructed with appropriate soft tissue from another part of the body.
After free flap surgery for head or neck cancer, patients aren’t able to eat by mouth right away, so while the patient is still anesthetized the surgeon inserts a feeding tube endoscopically into the patient’s stomach. This way nutrition in the form of special formulas can be delivered directly to stomach while the patient heals. Patients report that feeding tubes are a huge comfort while they recover from surgery, allowing them time to gradually return to normal eating.
For patients whose structures cannot be saved or restored, we have several new ways of improving speech, swallowing, and other functions. Your SCCA team will talk with you in detail about your options.
What to Expect If You Need Surgery
At your first visit, you will meet your surgeon and a nurse practitioner to go over your medical history, have a physical exam, and talk about your surgical plan. You may be asked to have a few tests, like blood work, an electrocardiogram (EKG), or a chest X-ray, to further define your state of health before beginning any treatment for your cancer.
Next, you’ll have an appointment at the Pre-Anesthesia Clinic. Be sure to bring a list of all your medications, including dosages and schedules. You may need to stop taking some medicines for a day or more before your surgery. This is a good time to ask any remaining questions about what will happen on the day of your surgery. You may want to read about how to prepare for surgery on the UWMC website.
Follow-Up After Surgery
You will return to UWMC one week after you are discharged from surgery to follow up with your surgeon. Your pathology report, which provides details about the tissue that was removed, will be available, and your doctor or nurse practitioner will review it with you. Decisions about any further treatment will be based on the findings in this report.
The pathology report will include information on what kind of tumor you had, how large it was, and whether all of the cancer was removed in the surgery. It will also answer whether the tumor spread to lymph nodes in your neck. The report will allow your doctors to determine the extent (stage) of your cancer and help guide decisions about further treatment, which may include radiation therapy, chemotherapy, or both. Your nurse practitioner will continue to follow up with you on your post-surgical care.
We will do everything we can to prevent or minimize side effects and will provide care to help you deal with any side effects that do occur. Side effects of head and neck cancer surgery often include short-term swelling that may change the way you look but will subside after a few weeks.
Some swelling may result from lymph collecting in your tissues because the cancer or surgery disrupted the vessels that normally drain this fluid. Generally, this type of swelling, called lymphedema, is chronic and is treated with specialized massage and with compression. You may need care from a lymphedema specialist, who can teach you how to manage lymphedema.
If you have had surgery to your throat, jaw, or larynx, you may find it difficult to swallow, chew, or talk. We have specialists to help you manage these potential side effects. For example, an SCCA nutritionist may be able to help if you are having trouble eating.
If you had your larynx removed, you may experience numbness in your neck or stiffness and pain in your shoulder or neck. Depending on the nerves and muscles affected by the cancer or surgery, these side effects may be temporary or permanent. Physical therapists and occupational therapists at SCCA and UWMC will work with you to recover as well as possible.
If scar tissue (fibrosis) forms in your neck and causes pain or restricts your range of motion, physical and occupational therapists can help with this as well. Our Patient Guide provides general information about coping with side effects of cancer and treatment.