Surgery is an important part of the treatment of head and neck cancers and aims to remove them completely. The part of your mouth or throat that the doctor may remove depends on where the tumour is. Very small cancers can often be treated with a simple surgical operation under local or general anaesthetic, or with laser surgery, with no need to stay in hospital overnight.

If the cancer is larger, surgery will often involve a hospital stay and an operation under general anaesthetic. Sometimes the amount of surgery may involve more than one part of your head and neck, and may cause scarring on your face or neck. Some people may also need to have reconstructive surgery to the face.

Laser surgery may sometimes be used to remove small tumours in the mouth and the pharynx. This may be combined with a light-sensitive drug (sometimes called a photosensitising agent) in treatment known as photodynamic therapy (PDT).

A type of surgery called micrographic surgery or Mohs’ surgery is sometimes used for cancers of the lip. The surgeon removes the cancer in thin layers, and the tissue that has been removed is examined under a microscope during the surgery. The surgeon will continue to remove more layers until no cancer cells are seen in the tissue. This technique makes sure that all the cancer cells are removed, but that only the minimum of healthy tissue is removed.

If you need to have surgery, your doctor will discuss the best type of operation for you, depending on the size and position of your cancer, and whether it has spread. It is important to make sure that you have discussed your operation fully with your surgical team. This will help you to understand exactly what is going to be removed and how this will affect you after the operation – in both the short and the long term.

It is likely that during the operation the surgeon will also remove some of the lymph glands on one or both sides of the neck, even if they are not swollen. This is called a neck dissection. Sometimes this is done because the glands may contain a small number of cancer cells that did not show up in the earlier scans.

The surgeon may need to remove part of the mouth or throat lining and occasionally some facial skin. This can be replaced using a thick piece of skin taken from another part of the body – usually the forearm or chest. This is known as a skin flap.

If the cancer is affecting part of your jawbone, the affected bone may be removed with the tumour. In this case, you may need to have part of a bone taken from elsewhere in your body to replace the missing jawbone. Usually the bone is taken from the leg. This is known as a bone graft. Your doctor will discuss this operation with you.

Modern techniques usually enable you to move your jaw again as soon as the operation is over.

Occasionally, in order to remove the cancer, the doctor may also need to remove some of the facial bones such as the cheekbone or palate. Depending on the extent of the operation, you may be offered an artificial replacement called a prosthesis (false part). This is a specially-designed soft plastic replacement for the part of your face that has been removed. The most common prosthesis is an obturator – a denture with an extension that is used to replace the upper jaw.

Modern prostheses can be designed to suit your needs. While they can never feel like your own tissue they can look very realistic and work very well. If you are likely to need a prosthesis, your doctor will discuss this with you fully before you have the operation. You will also talk to a prosthetics technician, who will be involved in designing and making your prosthesis for you.

It is important to discuss your operation fully with your surgical team so that you know what to expect and how it will affect you.

Some people can have their surgery as a day patient, particularly when this involves just an examination under anaesthetic or a biopsy. If your surgery is more complicated, you will need to stay in hospital for several days or up to a few weeks. Your stay in hospital will depend on the extent of your surgery and whether or not you have had a skin flap or tissue graft.

After your operation you will be encouraged to start moving around as soon as possible. This is an essential part of your recovery and, even if you have to stay in bed, it is important to do regular leg movements and deep breathing exercises. A physiotherapist will explain these to you.

If you have extensive surgery, you may spend some time in intensive care immediately after the operation. This is a ward where you will be closely checked and given intensive nursing care for as long as necessary to help you recover.

After the operation, it is likely that you will wake up with a number of tubes attached to you. Whilst this can be alarming, they are necessary and temporary measures, which will be gradually removed as you recover.

Drips

Most operations to the mouth and throat area can make eating and drinking uncomfortable for a time. Because of this, you will probably wake up from the operation with an intravenous drip (a tube inserted into a vein in your arm or your neck). This will give fluids and essential nutrients directly into your bloodstream for a few days. It will be removed once you are able to eat and drink again.

If eating is likely to be difficult for longer than a few days, the surgeon will do one of two things during the operation, while you are still under the anaesthetic:

• You may have a thin tube passed through your nose and throat into your stomach. This is called a nasogastric tube (or NG tube). The nurses on the ward will put special high-protein, high-calorie liquid food down the tube at regular times. This will help you to keep your strength up and help your body to recover from the operation. The NG tube may need to stay in place for a couple of weeks, until you can eat properly again, and will be removed when you can manage to eat by yourself.

• You may have a tube that passes directly through the wall of your abdomen into your stomach, near your waist. Liquid food can be passed into the stomach directly through this. This is called percutaneous endoscopic gastrostomy (PEG). For a few people this may be permanent.

A dietitian will visit you to discuss how much food you need to keep up your strength. They will decide the exact amount and type of food you should be given to replace your normal diet. You may also want to look at the changes to eating section.

Drains

Often a small tube (catheter) is put into your bladder, and your urine is drained through this into a collecting bag. This will save you having to get up to pass urine and it is usually removed after a couple of days. You may also have a thin plastic drainage tube leading from the operation site, with a bottle attached to it to collect any fluid from the wound site. This helps the wound to heal properly.

Tracheostomy tube

Sometimes surgery to the mouth or throat can cause some swelling or bruising to the surrounding tissue, which may make it difficult for you to breathe. In this case the surgeon will create an opening into your windpipe (in the lower part of the neck) called a tracheostomy (or stoma) for you to breathe through. The tracheostomy will be held open by a small plastic tube a few centimetres long. It will be removed when the swelling from your operation goes down and the airway is clear again. This type of change is usually temporary.

If you have a tracheostomy you may not be able to talk, because air will not be able to pass through your larynx to produce your voice. Your medical team will make sure that you have some way to communicate during this time.

You may have some pain or discomfort for a few days after your operation. For example, a neck dissection can often cause shoulder stiffness. It is also possible that the surgery may affect the sensation in your mouth, face, neck or shoulders so that some areas feel numb. This can happen even with a very small operation if some of the small nerves in the area need to be cut.

There are several different types of effective painkillers. If you are unable to eat properly you may be given painkillers by injection, or a liquid can be injected through your NG or PEG tube. Once you are able to eat and drink properly again, you can be given your painkillers as tablets or a liquid that you drink. It is very important to let your doctor, or the nurses on the ward, know as soon as possible if you have any pain. If your drugs do not completely relieve your pain, the dose can be increased, or the painkillers changed.

Some operations to the mouth and throat can affect the way that you speak. Speaking is a very complicated process. The throat (pharynx), nose, mouth, tongue, teeth, lips and soft palate are all involved in producing speech. Any operation that changes one of these parts of the head and neck may affect your speech. For some people this is hardly noticeable, but for others, speech may be temporarily or permanently altered.

There are several ways to help people to speak and adapt to this situation. See the changes to speech section.

Usually, you will be encouraged to start walking around the ward with the help of the nurses as soon as possible after your operation.

Most people are ready to leave hospital within a few weeks, even after quite extensive operations.

Before you leave hospital you will be given an appointment to attend an outpatient clinic for check-ups. If you need to see any of the other members of the team, such as the speech and language therapist or the dietitian, you will also be given appointments to see them. This is a good time to discuss with your doctor any problems you may have after your operation.