If the cancer has spread to the lymph nodes in your neck, or it is highly likely to spread, your surgeon will probably remove some lymph nodes. This operation is called a neck dissection or lymphadenectomy. 

Most often lymph nodes are removed from one side of the neck, but sometimes they need to be removed from both sides. A neck dissection may be the only surgery needed, or it may be part of a longer head and neck operation.

The surgeon will make a cut under your jaw and sometimes down the side of your neck. You will often have a small tube (drain) in your neck to remove fluids from the wound for a few days after the surgery.

A neck dissection may affect how your shoulder moves and your neck looks after surgery. A physiotherapist can help improve movement and function.

Different surgical methods may be used to remove the cancer. Your doctor will advise which method is most suitable for you. The options may include:

• endoscopic surgery – a rigid instrument with a light and camera is inserted through the nose or mouth to see and remove some cancers, particularly from the nose and sinuses.
• transoral laser microsurgery (TLM) – a microscope (usually with a laser attached) is used through the mouth to remove cancers, particularly of the larynx and lower throat.
• transoral robotic surgery (TORS) – the surgeon uses a 3D telescope and instruments attached to robotic arms to reach the cancer through the mouth. It is often used for oropharyngeal cancers.
• open surgery – the surgeon makes cuts in the skin of the head and neck to remove cancers. It is used for larger cancers and those in difficult positions. Part of the upper and lower jaw or skull may need to be removed and then replaced or reconstructed.

Minimally invasive surgery such as endoscopic, TLM and TORS usually means less scarring, a shorter hospital stay and faster recovery. However, these types of surgery are not possible in all cases, and open surgery is often the best option.

After open surgery, you may need reconstructive surgery to rebuild your tongue, mouth or jaw and help with speech and swallowing, and to improve how the area looks. It is usually part of the operation to remove the cancer, but is sometimes done later.

In reconstructive surgery, a combination of skin, muscle and sometimes bone is used to rebuild the area. This can be taken from another part of the body and is called either a “free flap” or a “regional flap”.

Occasionally synthetic materials such as silicone and titanium are used to re-create bony areas or other structures in the head and neck, such as the palate. This is called a prosthetic.

The type of surgery depends on the cancer’s size and location. Localised cancers can be treated by removing part of the tongue, mouth or lip.

For larger cancers, the surgery will affect a bigger area and you may need reconstructive surgery so you can continue to chew, swallow or speak.

Some tumours can be removed through the mouth, but you may need open surgery for larger tumours. Different types of oral surgery include: 

• glossectomy – removes part or all of the tongue
• mandibulectomy – removes part or all of the lower jaw (mandible)
• maxillectomy – removes part or all of the upper jaw (maxilla). 

Pharyngeal cancers are treated differently depending on which part of the pharynx is affected.

Surgery is used for many oropharyngeal and hypopharyngeal cancers. Nasopharyngeal cancers are usually treated with chemotherapy, radiation therapy or chemoradiation, and rarely treated with surgery.

Small oropharyngeal and hypopharyngeal cancers can often be treated with minimally invasive surgery, sometimes followed by radiation therapy with or without chemotherapy.

If the cancer is large or advanced and surgery is an option, it is more likely to be open surgery through a cut in the neck.

Surgery is often followed with radiation therapy and possibly chemotherapy. If surgery is not possible due to the size or location of the tumour, radiation therapy or chemoradiation is usually given instead.

Different types of pharyngeal surgery include:

• hypopharyngectomy – removes part of the hypopharynx (lower throat)
• pharyngolaryngectomy – removes all of the larynx and part of the pharynx; this surgery is less common and is similar to a total laryngectomy
• oropharyngectomy – a less common surgery that removes some of the oropharynx (the part of the throat behind the mouth).

If laryngeal cancer is at an early stage, you may have surgery to remove part of the larynx (partial laryngectomy).

The surgery may be minimally invasive or open. It often takes up to six months for the voice to recover. In some cases, the changes to the voice may be permanent.

If the cancer has advanced and chemoradiation isn't an option, you may need open surgery to remove the larynx (total laryngectomy). This operation removes the whole larynx and separates the windpipe (trachea) from the food pipe (oesophagus).

After this surgery, you will permanently breathe through a hole in the front of your neck called a laryngectomy stoma.

Because this surgery removes the voice box, you won’t be able to speak in the same way. A speech pathologist will teach you new ways to talk and communicate.

If you have a total laryngectomy, part or all of your thyroid gland may be removed (thyroidectomy).

The thyroid produces thyroxine (T4), the hormone that controls your metabolism, energy levels and weight, so you may need to take thyroid hormone replacement tablets every day for the rest of your life. Talk to your doctor for more details.

Your doctor may advise you to have surgery if the tumour isn’t too close to your brain or major blood vessels.

The type of surgery will depend on where the tumour is and, if you have paranasal sinus cancer, which sinuses are affected. You will often need to have reconstructive surgery as well.

Nasal and sinus cancers are often close to the eye socket, brain, cheekbones and nose. Your surgeon will talk to you about the most suitable approach and whether any other parts of the head or neck may need to be removed to get the best outcome.

Different types of surgery for nasal and sinus cancer include:

• maxillectomy – removes part or all of the upper jaw (maxilla), which may include the upper teeth, part of the eye socket and/or the nasal cavity.
• skull base surgery – also known as a craniofacial resection, this surgery removes part of the nasal cavity or sinuses. It is often done endoscopically through the nose, but a cut along the side of the nose may be needed.
• orbital exenteration – removes the eye and may also remove tissue around the eye socket.
• rhinectomy – removes part or all of the nose.

The surgeon will consider how the operation will affect how you look, and your ability to breathe, speak, chew and swallow.

If your nose, or a part of it, is removed, you may get an artificial nose (prosthesis) or the nose may be reconstructed using tissue from other parts of your body.

Most salivary gland tumours affect one of the parotid glands, which sit in front of the ears. Surgery to remove part or all of a parotid gland is called a parotidectomy.

The facial nerve runs through the parotid gland. This nerve controls facial expressions and movement of the eyelid and lip.

If it is damaged during surgery, you may be unable to smile, frown or close your eyes. This is known as facial palsy, and it will usually improve over several months.

In some cases, the facial nerve needs to be cut so the cancer can be removed. This will affect how your face looks and moves. There are various procedures that can help improve this, such as using a nerve from another part of the body (nerve graft).

If the cancer affects a gland under the lower jaw (submandibular gland) or under the tongue (sublingual gland), the gland will be removed, along with some surrounding tissue.

Nerves controlling the tongue and lower part of the face may be damaged, causing some loss of function.

Radiation therapy side effects vary depending on the area treated, the number of sessions, and whether it is combined with chemotherapy. Side effects often get worse 1–3 weeks after treatment ends and then start to improve.

Some side effects may last longer, be ongoing or appear several months or years later. Some may be permanent. It is important to talk to your treatment team if you have any concerns or questions on how the treatment may affect you.

The most common short-term and long-term side effects are listed below.

• During or immediately after treatment – Short-term side effects can include fatigue, mouth sores, taste changes, nausea, loss of appetite, mouth infection (oral thrush), dry mouth, thick saliva and phlegm, swallowing difficulties, skin redness, burning and pain in the area treated, breathing difficulties and weight loss.
• Ongoing – Longer-term or permanent side effects may include dry mouth, thick saliva, difficulties with swallowing and speech, changes in taste, fatigue, muscle stiffness, neck swelling, appetite and weight loss, mouth infection (oral thrush), hoarseness, dental problems such as tooth decay and gum disease, difficulty opening the mouth, and hair loss.
• Aspiration – Some people develop a temporary or ongoing problem where fluid or food enters the windpipe (trachea) while swallowing. This is called aspiration and it can cause coughing, lung infections such as pneumonia and, sometimes, difficulty breathing).
• Thyroid damage – If the treatment damages the thyroid, it can cause an underactive thyroid (hypothyroidism). This can be managed with thyroid hormone replacement tablets.
• Osteoradionecrosis of the jaw – Radiation therapy can damage blood vessels, reducing the blood supply to the area treated. Occasionally, the bone starts to die, leading to pain, infection and fractures. This is known as osteoradionecrosis, or ORN. About 5–7% of people who have radiation therapy to the head and neck develop ORN of the jaw. It can occur months or years later, most commonly after having dental work such as the removal of teeth, when the bone is unable to heal itself. This is why you will usually see a dentist before your cancer treatment, so any dental issues can be treated before there is a risk of ORN.

It is very important to tell your dentist that you have had radiation therapy before beginning any dental work. Treatment for ORN may include antibiotics, other medicines or surgery.

To help the bone heal, you may also have hyperbaric oxygen treatment (breathing in concentrated oxygen in a pressurised chamber).

Chemotherapy can affect the healthy cells in the body and cause side effects. Everyone reacts differently to chemotherapy, and effects will vary according to the drugs you are given. Some people may have few side effects, while others have many.

Not all chemotherapy causes nausea. Your medical oncologist or nurse will discuss likely side effects, including how these can be prevented or controlled with medicine.

Common side effects can include tiredness and fatigue; nausea and/ or vomiting; tingling or numbness in fingers and/or toes (peripheral neuropathy); changes in appetite and loss of taste; diarrhoea or constipation; hair loss; low red blood cell count (anaemia); hearing loss; ringing in the ears (tinnitus); lower levels of white blood cells, which may increase the risk of infection; and mouth sores.

Keep a record of the names and doses of your chemotherapy drugs handy. This will save time if you become ill and need to go to the hospital emergency department.