It is important to look after your health before treatment begins. This will help you cope with side effects and can improve treatment outcomes. 

• Stop smoking – aim to quit before starting treatment. See your doctor or call the Quitline on 13 7848.
• Begin or continue an exercise program – exercise will help build up your strength for recovery.
• Improve your diet and nutrition – a dietitian can suggest ways to maintain your weight during treatment, which will help improve your strength and may mean the treatment works better. 
• Avoid alcohol – alcohol can irritate mouth sores caused by the cancer or treatment.
• See a dentist – treatments for head and neck cancer can affect your mouth, gums and teeth. Your specialist may refer you to a special needs dentist who understands the treatments you will be having. You will need a full check-up and an oral health care plan covering any dental work you need and how to care for your mouth.  
• Consider the costs – there can be lots of extra costs during cancer treatment. Your health care providers should talk to you about how much you’ll pay for tests, treatments, medicines and hospital care. This is called informed financial consent.

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 so the surgeon can 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 reach and 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 in many situations.

After open surgery, you may need reconstructive surgery to help with your swallowing and to improve how the area looks. It is usually part of the same operation but is sometimes done later.

Reconstructive surgery uses a combination of skin, muscle and occasionally bone 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. 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 radiation therapy 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. Different types of pharyngeal surgery include:

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

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, 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.

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.

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.

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

Radiation therapy side effects vary depending on the area treated, the number of sessions, and whether it is combined with chemotherapy. Side effects may include fatigue, mouth sores, swallowing difficulties and skin redness, among others.

Side effects often get worse 2–3 weeks after treatment ends and then start to improve. Some side effects may last longer, be ongoing or appear several months or years later, such as muscle stiffness, neck swelling, appetite and weight loss and hair loss, among others.

• Aspiration – some people develop a temporary or ongoing problem where fluid or food enters the windpipe 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), which 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, and it affects about 5–7% of people who have radiation therapy to the head and neck. It can occur months or years later, most commonly after having dental work. Treatment for ORN may include antibiotics, other medicines or surgery.

It is important to see a dentist before your cancer treatment and to tell them if you've had radiation therapy in the past.