Head and neck cancer surgery

Overview

Head and neck cancers are a broad category of malignant tumors that can develop in or around the throat, mouth, nose, and sinuses. The phrase "head and neck tumor" refers to a category of tumors that develop mostly from the surface layers of the upper aerodigestive tracts (UADT).

The upper aerodigestive tract is made up of the mouth, larynx, pharynx, and nasopharynx. Squamous cell carcinomas account for about 90% of all head and neck malignancies because to the involvement of UADT mucus linings. Squamous cell carcinoma is a kind of malignant squamous epithelial tumor that has substantial differentiation and a proclivity for primitive and extensive lymph node metastases.

Many head and neck cancers are curable, especially if detected earlier. Although the major objective of treatment is to eradicate the cancer, it is equally critical to preserve the function of adjacent nerves, organs, and tissues. Doctors examine how treatment may influence a person's quality of life, such as how a person feels, looks, talks, eats, and breathes, while planning treatment.

During surgery, the objective is to remove the malignant tumor as well as some surrounding good tissue. Laser technology, excision (this is a procedure to remove the malignant tumor and some surrounding healthy tissue known as a margin), lymph node dissection or neck dissection, and reconstructive (plastic) surgery are all options for head and neck cancer surgery.

What are Tumors of the Head & neck?

Head and neck cancers are tumors that start in the squamous cells that line the mucosal surfaces of the head and neck (for example, those inside the mouth, throat, and voice box). Squamous cell carcinomas of the head and neck are the name given to these tumors. Head and neck cancers can also start in the salivary glands, sinuses, or muscles or nerves in the head and neck, although they are considerably less prevalent than squamous cell carcinomas.

Cancers of the head and neck can form in the:

Oral cavity: It consists of the lips, the front two-thirds of the tongue, the gums, the lining of the cheeks and lips, the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and a tiny patch of gum behind the wisdom teeth.

Throat (pharynx): The pharynx is a 5-inch-long hollow tube that starts beneath the nose and goes to the esophagus. It is divided into three sections: the nasopharynx (the upper portion of the pharynx, behind the nose); the oropharynx (the middle part of the pharynx, comprising the soft palate [the back of the mouth], the base of the tongue, and the tonsils); and the hypopharynx (the bottom part of the pharynx) (the lower part of the pharynx).

The voice box (larynx): It is a small tunnel created by cartilage in the neck right below the pharynx. The vocal cords are housed in the voice box. It also features a little piece of tissue called the epiglottis that moves to cover the voice box and keep food from entering the airways.

The paranasal sinuses and nasal cavity: They are tiny hollow areas in the bones of the skull that surround the nose. The nasal cavity is a hollow region within the nose.

Salivary glands: The primary salivary glands are located on the mouth's floor and near the jawbone. Saliva is produced by the salivary glands. Minor salivary glands are found throughout the mouth and throat mucous membranes.

How Common are Head & Neck Cancers?

Head and neck cancers account for about 4% of all malignancies diagnosed in the United States.

These malignancies are more than twice as frequent in males as in women. Head and neck cancers are also diagnosed more frequently in adults over the age of 50 than in younger people.

More than 68,000 men and women in the United States are expected to be diagnosed with head and neck cancer by 2021, according to researchers. The majority will be diagnosed with cancer of the mouth, throat, or voice box. Cancer of the paranasal sinuses and nasal cavity, as well as cancer of the salivary glands, are far less prevalent.

What Causes Cancers of the Head & Neck?

Alcohol and tobacco use: The two most prominent risk factors for head and neck cancers, particularly malignancies of the oral cavity, hypopharynx, and voice box, are secondhand smoking and smokeless tobacco, sometimes known as "chewing tobacco" or "snuff." Persons who use both cigarettes and alcohol are more likely to acquire these malignancies than people who just use nicotine or alcohol. Tobacco and alcohol use are the leading causes of head and neck squamous cell carcinomas of the mouth and voice box.

Human papillomavirus (HPV): HPV type 16, in particular, is a risk factor for oropharyngeal malignancies involving the tonsils or the base of the tongue. The incidence of oropharyngeal cancers caused by HPV infection is growing in the United States, whereas the incidence of oropharyngeal cancers due by other causes is decreasing. Chronic HPV infection causes almost three-quarters of all oropharyngeal malignancies. Although HPV has been found in other types of head and neck cancer, it appears to be the only driver of cancer formation in the oropharynx. The causes behind this remain unknown.

Occupational exposure: Wood dust exposure at work is a risk factor for nasopharyngeal cancer. Certain occupational exposures, such as asbestos and synthetic fibers, have been linked to voice box cancer, although the increased risk remains debatable. People who work in the construction, metal, textile, ceramic, logging, and food sectors may be at a higher risk of developing voice box cancer. Exposure to wood dust, nickel dust, or formaldehyde in the workplace is a risk factor for paranasal sinus and nasal cavity cancer.

Radiation exposure: Radiation to the head and neck, for noncancerous conditions or cancer, is a risk factor for cancer of the salivary glands.

Epstein-Barr virus infection: Infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of the salivary glands.

Ancestry: Asian ancestry, particularly Chinese ancestry, is a risk factor for nasopharyngeal cancer.

Head & Neck Cancer Symptoms

A lump in the neck or a sore in the mouth or throat that does not heal and may be uncomfortable, a sore throat that does not go away, trouble swallowing, and a change or hoarseness in the voice are all indications of head and neck cancer. Other, less dangerous illnesses may also cause same symptoms. It is critical to consult a doctor or dentist if you have any of these symptoms.

Symptoms of cancers in specific areas of the head and neck include:

Oral cavity: A white or red patch on the gums, tongue, or mouth lining; a growth or swelling of the jaw that causes dentures to fit poorly or become unpleasant; and unusual bleeding or discomfort in the mouth.
The Throat (pharynx): Pain when swallowing; persistent pain in the neck or throat; pain or ringing in the ears; or hearing loss.
The voice box (larynx): Breathing or speech difficulties, swallowing pain, or ear ache
Paranasal sinuses and nasal cavity: Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.
Salivary glands: Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away.

Surgical Options for Neck & Head Cancer

Your doctor may recommend a specific surgical treatment depending on the type and stage of your head and neck cancer. Options may include:

Flexible robotic surgery:

Flexible robotic surgery is a minimally invasive therapy option for some head and neck cancer patients that allows surgeons to use a flexible scope to access difficult-to-reach parts of the mouth and throat.

Voice cord stripping:

A lengthy surgical instrument is used to remove the outer layers of tissue on the vocal cords with this method. This method might be utilized to get a biopsy sample or to treat certain stage 0 malignancies of the vocal cords. Speech is seldom affected by vocal cord stripping.

Laser surgery:

It involves inserting an endoscope with a high-intensity laser on the tip down the throat. The tumor can then be destroyed or surgically removed using a laser.

Cordectomy:

In a cordectomy, part or all of the vocal cords are removed. This approach may be used to treat glottic cancer that is very small or located only on the surface tissues. Patients who receive a cordectomy may experience changes in speech. Removing part of a vocal cord may lead to a hoarse voice. If both vocal cords are removed, speech is no longer possible.

Laryngectomy: This operation removes part or all of the larynx:

Partial laryngectomy: For minor laryngeal tumors, it may be feasible to remove only the cancerous area of the voice box, leaving the remainder of the larynx intact. A partial laryngectomy can be used to remove the region of the larynx above the vocal cords (supraglottic laryngectomy) or simply one of the two vocal cords (partial laryngectomy) (hemilaryngectomy).

Total laryngectomy: A complete laryngectomy may be recommended for more advanced laryngeal malignancies. The complete vocal box is removed during this treatment. The windpipe is then surgically shifted toward a hole in the neck for breathing, a procedure known as a tracheostomy. Normal speech is no longer viable for people who choose this treatment option, although alternative types of communication can be learnt. Foods and beverages can be consumed regularly, as they were prior to the operation.

Myocutaneous flaps: Muscle and skin from a surrounding location are turned toward the throat to rebuild the throat.

Pharyngectomy: This procedure involves the removal of part or all of the throat.

Free flaps: It may be feasible to reconstruct the neck using tissues from other parts of the body, such as the intestines or arm muscle, utilizing "microvascular surgery," in which minuscule blood arteries are sewed together under a microscope.

Lymph node removal: Pharyngeal cancer can spread to the lymph nodes in the neck. If such spread is likely, removal of the lymph nodes may be advised. This procedure is known as a neck dissection, and it is frequently performed in conjunction with surgery to remove an existing tumor. The precise amount of tissue that must be removed is determined on the stage of the malignancy. Some nerves and muscles that regulate neck and shoulder mobility may be removed along with lymph nodes in the most intrusive operation. However, surgery of this type often does not require as much of the good tissue to be removed, allowing the shoulders and neck to function normally.

Tracheotomy/tracheostomy: A tracheotomy is a surgical procedure that creates a hole, or stoma, in the trachea, or windpipe, to provide an additional conduit for breathing. A tracheotomy may be required in a variety of conditions. Following a complete laryngectomy, the aperture in the windpipe is linked to an orifice in the front of the neck to create a new breathing pathway. This is referred to as a tracheostomy, and the alterations it causes to the throat are permanent.

Reconstructive microsurgery: It may be an option to reconstruct areas of the head and neck affected by cancer with reconstructive microsurgery. It may be possible to reconstruct the nose, tongue or throat using tissues from other areas of the body, such as the thigh, abdomen or forearm. The lower jawbone (mandible) can be reconstructed using the smaller bone from the lower leg (fibula). For patients with facial paralysis secondary to tumor removal, transfer of a small muscle from the inner thigh can be performed to restore a smile.

Side Effects of Head & Neck Cancer Treatment

Surgery for head and neck malignancies can impair a patient's ability to chew, swallow, or speak. The patient's appearance may change following surgery, and the face and neck may be swollen. Swelling normally subsides with time. However, removing lymph nodes may cause the flow of lymph in the area where they were removed to be slower, and lymph may accumulate in the tissues (a condition known as lymphedema), producing extra swelling that may last for a long period.

Lymphedema of the head and neck can be external or internal. In most situations, if addressed quickly, it may be reversed, improved, or decreased. Patients with untreated lymphedema may be more vulnerable to consequences such as cellulitis, or tissue infection. If left untreated, cellulitis can be harmful, causing further swallowing or breathing issues.

Because nerves have been severed during a laryngectomy (surgical to remove the voice box) or other neck surgery, regions of the neck and throat may feel numb. The shoulder and neck may become weak and stiff if lymph nodes in the neck are removed.

Patients who get radiation to the head and neck may develop adverse effects such as redness, irritation, and ulcers in the mouth; a dry mouth or thicker saliva; trouble swallowing; changes in taste; or nausea during and after treatment. Radiation can also induce taste loss, which can reduce appetite and impact nutrition, as well as earaches (caused by the hardening of ear wax). Patients may also notice swelling or sagging of the skin beneath the chin, as well as changes in skin texture. Patients' jaws may feel stiff, and they may not be able to open their mouth as wide as they could before treatment.

Although many patients' adverse symptoms resolve gradually over time, others will endure long-term side effects after surgery or radiation therapy, such as trouble swallowing, speech impairment, and skin abnormalities.

Patients should notify their doctor or nurse of any adverse effects and discuss how to cope with them.

Is Follow-Up Care Necessary?

Following treatment for head and neck cancer, it is critical to have regular follow-up care to ensure that the disease has not returned and that a second primary (new) malignancy has not grown. Head and neck cancers that are not caused by HPV infection are more likely to return following therapy. Medical examinations may involve examinations of the stoma, if one has been developed, as well as the mouth, neck, and throat, depending on the kind of malignancy. Regular dental examinations may also be required.

A comprehensive physical exam, blood tests, x-rays, and computed tomography (CT), positron emission tomography (PET), or magnetic resonance imaging (MRI) scans may be performed on occasion. Thyroid and pituitary gland function may be monitored by the doctor, especially if the head or neck was treated with radiation. In addition, the doctor is likely to advise patients to quit smoking. According to research, a patient with head and neck cancer who continues to smoke may diminish the effectiveness of therapy and raise the risk of developing a secondary primary malignancy.

Head and Neck Tumor Prevention

People who are at risk for head and neck tumors, especially smokers, should talk to their doctor about quitting smoking and lowering their risk.

Avoiding oral HPV infection can help to lower the risk of HPV-related head and neck cancers. In June 2020, the Food and Drug Administration approved the HPV vaccination for the prevention of oropharyngeal and other head and neck malignancies caused by HPV strains 16, 18, and 58 in persons aged 10 to 45.

Although there is no standardized or routine screening test for head and neck malignancies, dentists can search for cancer-related signs in the oral cavity during normal checkups.

Conclusion

Malignancies of the mouth (such as the lip and tongue), the pharynx or throat, and the larynx or voice box are all examples of head and neck cancers. Early signs include a lump or nodule, numbness, swelling, hoarseness, sore throat, or trouble moving the jaw or swallowing. Smoking, heavy alcohol intake, and chewing smokeless tobacco are all risk factors.

Despite the fact that head and neck cancer is associated with pain, deformity, dysfunction, emotional anguish, and mortality, recent advances have resulted in considerable improvements in outcomes.

Treatment for head and neck cancer is determined by the kind, location, and size of your cancer. Surgery, radiation treatment, and chemotherapy are frequently used to treat head and neck malignancies. Treatments can be used in conjunction.