Before any surgical treatment a pre-operative assessment takes place. The pre-operative assessment provides the opportunity for the surgeon, anaesthetist and patient to discuss the operation. The surgeon will explain the procedure, ask questions about the patient’s health, medical history, and home circumstances. This is to check for any medical problems that might need to be treated before surgery, or to identify any special care needs during or after the surgery.
The pre-operative assessment will cover how to prepare for surgery:
- When to stop eating and drinking before surgery
- Whether medications need to be paused before going into hospital
- What to bring into hospital on the day of surgery
- Length of stay
- At the pre-operative assessment, a consent form agreeing to the surgery is signed.
On the day of surgery
The admission letter from the hospital will provide information about the date and time of the operation, arrival time, the ward or department to present to, the hospital or ward contact number, and the name of the consultant.
On arrival for surgery an identity bracelet is provided. Staff will ask the same questions - this is routine and ensures that the correct information is checked and available at each stage of treatment. It is recommended that before having any surgery, a patient washes to minimise the risk of infection.
The surgical treatment offered will depend on where the cancer is within the head and neck. A combination of surgical and non-surgical (radiotherapy, chemotherapy, immunotherapy) may be offered. The consultant will advise a patient on the choices available.
Surgery is one of the main treatments for cancers of the head and neck. The type of surgery depends on the size and position of the cancer, and whether it has spread. The aim, of surgery is to remove the cancer completely. The surgeon will do everything possible to minimise the changes that surgery may cause to speech, swallowing, breathing, or facial appearance.
Before an operation, a surgeon will discuss the surgery with the patient so they can explain what is being removed and advise of any side effects in the short and long term.
If there is a small cancer in the mouth, it may be possible to do surgery through the open mouth. This is called transoral surgery. Transoral surgery does not leave any scars on the neck or face unless there is a need for a neck dissection.
Sometimes the surgeon removes the cancer using a laser (a high-power beam of light). The light may be attached to a microscope, so the surgeon can see the tissue in detail when they are operating. This is called transoral laser surgery and might be used for smaller cancers on the lip, mouth and throat.
Sometimes the surgeon might use robotic instruments to perform the surgery. This is called transoral robotic surgery (TORS). It may be used to treat smaller cancers on the tonsils, tongue base or throat.
The surgeon may use an endoscope to remove small tumours in the nose or sinuses through the mouth or nose. An endoscope is a thin, flexible tube with a light and a camera at the end. This type of surgery does not leave any scars on the face or neck.
This means the surgeon removes the tumour by making a cut (incision) or an opening in the skin to do the operation. A scar will be visible afterwards although this usually fades over time. Open surgery tends to be used when:
- the cancer is bigger
- the cancer is at the back of the mouth or in the throat.
If the cancer is in or near the voice box (larynx), the surgeon may need to remove some or all of the voice box. This is known as partial or total laryngectomy. The surgery will affect speech.
A neck dissection is an operation that is done to remove lymph nodes in the neck. This is usually done alongside the main operation to remove a head and neck cancer.
Treatment of cancer in the throat
If cancer is found in the throat (oropharynx) it is known as oropharyngeal squamous cell carcinoma and there are different treatment options available.
Flap surgery involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessels that keep it alive. It is used in head and neck cancer to reconstruction the areas from which cancer cells have been removed. It is complex reconstruction and a technique called free flap is used. This is where a piece of skin, and the blood vessels supplying it, are entirely disconnected from the original blood supply and then reconnected at a new site.
- Medial Sural Perforator Free Flap is also known as an “MSAP flap”. Skin is removed from the back of the lower leg and then moved to fill a ‘hole’ which has been left from having a cancer removed. It is therefore one of the ways we replace tissue in the head and neck area that has been removed.
- Scapula Free Flap Surgery is one way of filling a bony ‘hole’ in either the upper or lower jaw. It is one of the common ways of replacing bone that has been removed or damaged. It uses bone from your shoulder.
- Fibula Free Flap Surgery is one way of reconstructing bone defects in either the upper or lower jaw when a cancer has been removed using the fibula bone.
- Anterolateral Thigh Free Flap Surgery is also known as an “ALT flap”. Skin is removed from the front of the thigh and then moved to fill the ‘hole’ that has been left when a cancer has been removed. It is one of the ways of replacing such tissue in the head and neck area.
- Radial Forearm Free Flap is one way of filling a defect in the mouth which is left when a cancer has been removed. Your surgeon will take a piece of tissue including skin, fascia (fatty tissue) and blood vessels from the inside surface of your forearm near the wrist.
- Pectoralis Major Pedicled Flap The pectoralis major, also referred to as a ‘Pec Major’, is a thick, fan-shaped muscle, situated at the upper front of the chest wall. It makes up the bulk of the chest muscles in males and lies under the breast in females. A pectoralis major pedicled flap maintains its own blood supply and is one of the most common ways of reconstructing a defect when a cancer has been removed.