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Head and neck cancer surgery: why detailed planning is crucial

25 Oct 2019

Any cancer that arises in the head and neck presents special challenges; it is quite typical for a patient to be diagnosed when their cancer is already advanced and treatment may then involve major surgery, followed by extensive reconstruction.

Types of head and neck cancer

I specialise in diagnosing and treating tumours of the mouth, face, jaws and neck including salivary gland tumours.

Salivary gland tumours can arise in any of the three larger glands on the sides of the face; the parotid gland, the submandibular gland and the sublingual gland, or any one of the hundreds of minor salivary glands that line the mouth.

Salivary gland tumours tend not to respond to radiotherapy so surgery is the principal treatment. I also treat patients with tumours of the mouth and those who develop jaw bone tumours, such as ameloblastomas.

A lady feels her lymph nodes on her neck

The importance of an initial evaluation

At least half of the patients we see for the first time have relatively advanced head and neck cancer, although it’s quite heartening that more patients are presenting earlier.

There is evidence that head and neck cancer is being diagnosed in younger patients, and in more female patients, probably because of greater awareness of the early symptoms and signs.

When I first see a patient, it is important that I evaluate them very carefully before making any treatment decisions.

This involves a full clinical examination, blood tests, taking a full medical history and record of symptoms, and extensive imaging to find out as much as possible about the tumour enabling us to provide leading edge treatment.

“At The London Clinic we have excellent facilities for CT scanning, MRI scanning and we tend to do a PET scan as well.

The CT scan and the MRI scan can provide a lot of detail about the anatomy of the tissue, but the PET scan offers functional imaging. It can show whether the tumour is very active, for instance.

If it is, this tells us that the tumour is more likely to be cancer and gives us detailed information about the margins of the cancerous tissue. This is invaluable when planning complex surgery to treat the patient effectively.

The first treatment often offers the best chance at dealing with head and neck tumours and cases can be very complex. They require a multi-disciplinary approach and we have a regular meeting in which we discuss every case, analysing all the information from clinical investigations and imaging and then we decide on the best treatment.

Supporting each patient along their journey

Any cancer diagnosis is distressing but the prospect of having major surgery on your mouth and face can be particularly alarming.

Patients are naturally devastated by the news. In the beginning they may be highly suspicious and anxious that they may have cancer and their diagnosis then marks the start of a long journey.

Each patient then goes through extensive evaluation and treatment planning and we provide as much support as possible. In fact, patients almost become a member of a family together with the team treating them.

People need a lot of emotional care to keep up their morale through months of treatment.

We then follow through with them right to the end of treatment, and for five  years or more afterwards, so it’s a highly significant process for all of us.”

Tumour removal and reconstructive surgery

Treatment for head and neck cancer needs to be highly individualised to each patient and appropriate to their particular tumour.

This usually involves surgery, which can be very radical, involving removing half of the upper or lower jaw, or large parts of the facial tissue.

These operations are life-changing and it is vital that we perform a full reconstructive procedure in the same operation.

The tumour and associated tissue are removed first, then we use microvascular free flaps and perhaps also bone from other parts of the body. The aim is to reconstruct the face and jaw using the patient’s own tissue, matching like with like, to enable the new grafts to settle in quickly so that the results are as natural and cosmetically successful as possible.

The treatment, including an operation to remove the entire tumour if possible, is planned meticulously.

Each operation has to be unique. We aim to devise a leading edge treatment to give them the best chance of cure, whether they have cancer in the mouth, face, jaws, or salivary glands.

The operation needs to remove the tumour with a good margin of healthy tissue to prevent it recurring but, at the same time, we need to minimise the fall-out in terms of deformity and loss of function.

Having surgery for head and neck cancer can impact on eating, drinking and speaking, as well as physical appearance.

Reconstructive surgery also needs very careful planning and input from other specialists at The London Clinic.

Although I sometimes do some reconstructive surgery, I concentrate more on the resection of the tumour and I tend to work in teams with another reconstructive surgeon. As a team, we plan and organise everything in detail and decide what will be the best approach to reconstruction.

We now use a sophisticated technique called 3D stereolithographic modelling. This uses CT scan data to produce a 3D model of the jaw or the part of the face in plastic, which helps us to plan exactly how we will rebuild the jaw, and where we will attach any free tissue flaps.

Any metal prostheses that are required can be made to size in advance. Even dental implants can be inserted to replace teeth removed when the tumour is resected.

Once all the planning is done, we know exactly what will happen during surgery, which reduces the time of the operation for the patient and also improves results.

After surgery and beyond

Extensive surgery requires a significant hospital stay, and patients are then followed up:

  • monthly for the first year
  • every three months in the second year
  • at decreasing intervals up to five years

At the five-year point, the patient can choose to have an annual check-up, or discharge themselves from any future appointments.

Patients usually stay in hospital for about three weeks.

Everyone who has this type of surgery goes through the same stages in the two to three weeks that they are with us. In the first week they regret having the surgery, by the second week they are beginning to realise it was a good thing, but are glad they don’t have to go through it again.

By the third week they are much more positive and optimistic but, ironically, this is when they start to complain about little things. We take that as a very positive sign, and we know they are definitely on the road to recovery!

Further information


Any views expressed in this article are those of the featured specialist(s) and should not be considered to be the views or official policy of The London Clinic.


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