Surgery for Head And Neck Cancer
Head and neck cancer include a vast number of cancer types according to the site of origin. The behavior and aggressiveness of these cancers are very different. For example, cancer arising in vocal cords is completely different from the one in the back of the tongue. The symptoms and the complications of each cancer are exclusive. Prognosis also depends on the site of primary origin of cancer. A surgical approach is the first line of treatment in case of head and neck cancers. Some cases involve chemotherapy and radiation therapy started along with the surgical approach.
The surgical treatment will be advised to you by the doctor according to the area of head and neck involved and the stage of cancer. Before performing any surgical procedure, a surgeon has to evaluate the neighboring lymph nodes and has to check the proximity of lymph nodes to prevent metastasis or spread.
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Surgical approaches in Head and Neck cancer are:
- Glossectomy: Cancers arising in the tongue are often aggressive and those occurring on the lower surface (ventral surface) spread very early. This area is in close proximity to many lymph node groups and thus, chances of spread are high. In case of tongue cancer, the surgical procedure usually involves either hemi or complete glossectomy which is the removal of the tongue. This may also involve mandible removal and local neck dissection to remove lymph nodes.
- Laryngectomy: This is a procedure carried out to remove the portion of the voice box (larynx). This may involve a partial or a complete removal. In some cases, where the cancer spread is extensive, it involves removal of some part of pharynx also.
- Total Laryngopharyngectomy: Cancer extent may require a surgical removal of the whole larynx and pharynx (upper throat).
- Mandibulectomy: Many tumors and cancers need removal of the mandible which can be unilateral or hemimandibulectomy or bilateral. There are many types of cancers seen in the jaw. They vary according to origin and type of cells involved.
- Maxillectomy: The surgical procedure taken up to remove the upper jaw is referred to as maxillectomy.
- Neck dissection: Selective neck dissection is the procedure of removal of the lymph nodes to check whether cancer has spread from its primary site of origin or not. And therapeutic neck dissection is performed to remove the known affected lymph nodes.
- Parotidectomy: Under the lower jaw and near the ear, parotid gland is present. Tumors like pleomorphic adenoma most commonly involve this glands and removal is called parotidectomy.
- Submandibular gland resection: Some types of cancers and tumors affect the submandibular glands which lie on the floor of the oral cavity. In this procedure, surgical removal is done.
- Transoral robotic surgery (TOCS): This procedure is used where robotic help is taken and approach is through the head to reach the base of the tongue.
Squamous cell carcinoma involves 90% of the head and neck cancers and is very aggressive. The first line of treatment is surgery to remove the affected part and the affected lymph nodes if any. Usually, a vast area of normal tissue surrounding the cancer is also removed. Surgical treatment is followed by either chemotherapy or a combination of chemotherapy and radiation therapy depending on the grade of cancer.
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