Many cancers located in the head and neck region can be cured, especially when discovered early. While elimination of the disease is the primary goal of treatment, preservation of nerve, organ, and tissue function in the region is also very important.
When planning treatment, the doctor evaluates the location of the tumor and how the chosen approach might affect the patients’ quality of life, in aspects such as the way they speak (their voice), eat, breathe, and even the aesthetic outcome.
Surgery is one of the main treatment options for head and neck cancer. It can be done alone or associated with radiotherapy, chemotherapy, and targeted therapies. Before deciding to undergo it, the doctor evaluates factors such as the type and stage of the tumor, possible adverse effects, and the patient’s general state of health.
Types of surgery for head and neck cancer
There are several types of surgery for the treatment of head and neck cancer. Understand the main ones and for which cases they are indicated:
- Laser surgery: can be used to treat a tumor at an early stage, especially if it is located in the larynx;
- Excision: technique that removes the tumor and part of the healthy tissue around it (the safety margin);
- Lymph node dissection or neck dissection: if it is suspected that the cancer has spread, the doctor can remove the lymph nodes (lymph nodes) present in the neck. This procedure can be done in conjunction with excision;
- Video-assisted surgery: a minimally invasive procedure using a video system and thin, delicate forceps;
- Flexible robotic surgery: minimally invasive treatment adopted in selected cases, in which the surgeon needs to access regions of the mouth and throat that are difficult to reach. It is done with the help of a flexible scope (a very thin tube);
- Partial laryngectomy: used in the treatment of small larynx tumors, in which only the portion affected by the cancer is removed, leaving the rest of the larynx intact;
- Total laryngectomy: adopted in more extensive laryngeal cancers, in which the total removal of the vocal box is required. Then a tracheostomy is performed, a process in which the trachea is surgically removed through an incision made in the neck to facilitate breathing. Patients undergoing this procedure have their speech impaired, but on the plus side, liquids and solid food can continue to be ingested normally;
- Myocutaneous flaps: the throat is reconstructed using muscle and skin flaps located in a nearby area; and
- Reconstructive plastic surgery: if the surgery to remove the tumor requires the removal of a large part of the tissue, such as in the jaw, pharynx, or tongue, the doctor may include plastic surgery in the treatment. Besides reconstructing the affected area, this type of surgery works on the aesthetic issue, making the appearance as natural as possible.
Other professionals can act in the surgeries for head and neck cancer. This is the case of the prosthodontist (a dentist specialized in dental prostheses, to develop a prosthesis that helps the patient swallow food and speak) and the speech therapist (a specialist who can use techniques and equipment to help the patient rehabilitate speech and the ability to eat).
Possible adverse effects from the surgery
The possible adverse effects of the surgery depend on the technique adopted and the location where it was performed. The main ones are
- Temporary or permanent loss of voice;
- Vocal cord lesions, which impair the way the person speaks;
- Hearing loss;
- Difficulty chewing and/or swallowing food;
- Lymphedema (the accumulation of lymphatic fluid in fat tissue);
- Decreased thyroid gland function (can occur after total laryngectomy, and is corrected with the use of thyroid hormone); and
- Swelling of the mouth and throat (making breathing difficult; if this occurs, a temporary tracheostomy may be performed).