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Cancer Removal

Cancer removal surgery

Someone you care about has been diagnosed with head and neck cancer and probably needs surgery. This may be a scary time for both of you, so it is important to have as much information as possible to help your loved one go through the surgery itself and the recovery. Having the correct information is also important to help you feel less afraid of what is to come; the biggest fear is always of what you do not know, so knowing the truth can help you be prepared.

The main kinds of surgery for head and neck cancer are:

  • Craniofacial resection. A craniofacial resection is a major surgery for tumors involving the ethmoid sinus, frontal sinus, nasal cavity and the area around the eye. It is usually done along with a neurosurgeon.
  • Evisceration, enucleation and exenteration. Each of these procedures is a slightly different level of eye and eye socket removal. Each is done for a different reason. An evisceration is the removal of the contents of the eye while leaving the outer layer of the eyeball intact. Enucleation is the removal of the eyeball while leaving the orbit (eye socket) intact. Exenteration involves removing the entire eye and surrounding structures in the orbit. Eye surgeons perform eviscerations and enucleations, and exenterations are done by a head and neck surgeon, with or without an eye surgeon.
  • Glossectomy. A glossectomy is the removal of all or part of the tongue, done mainly for cancers of the tongue. However, cancers from other parts of the mouth and throat that grow into the tongue may require a glossectomy, especially floor of mouth cancers.
  • Laryngectomy. A laryngectomy is the removal of some or all of the voice box, or larynx. If some of the larynx is removed, it is a partial laryngectomy. If all of the larynx is removed, it is a total laryngectomy.
  • Total laryngopharyngectomy. A total laryngopharyngectomy is the removal of the entire voice box and the pharynx. After the voice box and pharynx are removed, a permanent breathing hole will be made in that area because there will be no direct connection between the mouth and trachea (or windpipe). To eat again, some sort of reconstructive procedure will be needed to recreate the tube connecting the mouth to the esophagus.
  • Mandibulectomy. A mandibulectomy is the removal of all or part of the jawbone (mandible).
  • Maxillectomy. Maxillectomy is the removal of all or part of the maxilla bone for tumors of the hard palate, nose, maxillary sinus or other tumors that have grown into the maxilla.
  • Neck dissection. A neck dissection is removal of an entire group of lymph nodes from the neck.
  • Parotidectomy. Parotidectomy is the removal of part or all of the parotid gland on one side of the face.
  • Pharyngectomy. A pharynectomy is the removal of part of the pharynx.
  • Submandibular gland resection. A submandibular gland resection is the removal of a salivary gland that is located just underneath the jaw. A salivary gland produces saliva to moisten the mouth and aid in food digestion and swallowing.
  • Transoral robotic surgery (TORS). Transoral robotic surgery uses a robot controlled by a doctor to remove a tumor from the mouth or throat.

Finding out your loved one needs surgery

Surgery to remove cancer sounds scary, but it is very important to keep the lines of communication open between you and your loved one so you can support each other. Do not be afraid to ask questions and find answers on your own. Your family, your school guidance counselor and trusted friends are great resources. They can help you understand what is happening as your loved one goes through surgery and recovery for head and neck cancer, especially if you are not ready to talk directly to that person about it. Again, it is very important to have someone to talk to about what you’re feeling and thinking—you do not have to go through this alone.

Preparing for surgery

The doctor and care team will let your loved one know what to do to prepare for surgery. In general, he or she will not be able to eat or drink anything (except essential medications) after midnight prior to surgery.

On the day of surgery, it is important to arrive at the hospital or surgery center a few hours before the operation. This allows the nurses and anesthesiologist to make sure everything is in order so the surgery proceeds properly.

What to expect

Most surgeries for head and neck cancer are done with general anesthesia, so the patient is completely asleep. If the cancer is small and in a place that is easy to see, medication can be injected directly into the spot so that the patient doesn’t feel anything.

Because most head and neck cancers are in areas that affect swallowing and breathing, a tracheotomy may be performed. A tracheotomy is a cut or opening in the windpipe (trachea). The surgeon puts a tube into the opening so that the patient can breathe.

In preparing for the surgery, the patient will be shaved in the area of the surgery to make sure the area is clean. The doctors will then use a special soap, which helps to make everything sterile.

Your loved one will probably have stiches in the area where the cancer was removed and may have some bruising. This is normal and will go away in time.

Depending on where the cancer is, your loved one may also look different. It can be alarming to see him or her right after the surgery, but know that the person may be embarrassed and upset. Do your best to set him or her at ease, but understand emotions will probably be high. Know that it is often possible to perform reconstructive surgery later to restore a person’s appearance. Though your loved one may never look exactly the way he or she did before cancer removal surgery, much can be done to improve appearance and function. Also remember that your loved one is still the same person you know and love, no matter how his or her appearance might change. Focus on who the person is and treat him or her the same as you always did. Eventually, you will both become more accustomed to any changes in appearance.

Recovery and aftercare

Recovery will depend on the size of the surgery and reconstruction. The recovery course can happen in a few different parts of the hospital; it might include trips to the recovery room, intensive care unit, step-down-unit and a shared or private “floor” bed.

Minimal activity and bed rest will likely be required for a few days after surgery. The timeframe will depend on the type of procedure performed.

The doctors will always be looking to make progress to remove tubes and drains, get the patient disconnected from the lines and get him or her up and out of bed when the time is right. If placed, the tracheotomy tube will often come out during the hospital stay. Once the doctors determine that your loved one is healthy enough to go home, he or she will be ready for discharge. Sometimes the patient can go directly home, while others might go to a rehabilitation or skilled nursing facility for a short while before going home. The doctor and other clinicians will determine the best place once he or she is ready to leave the hospital.

Usually the doctors will set up a follow-up appointment in the office so that they can continue to track the progress. This gives time to recover from the initial surgery and make arrangements for next steps.

Risks

Risks of any type of head or neck cancer surgery vary, depending on the type of cancer, but can include:

  • Infection: Antibiotics are given before the surgery and regularly during and after the surgery to prevent infection, but any time the skin is opened, infection is possible. This must be treated quickly and efficiently and may require surgical drainage.
  • Bleeding: As with any surgery, there is always a chance of bleeding afterward; this might require going back to the operating room to control it.
  • Loss of smell: The nerves for smell are located just above the nose. If these areas need to be cut, your loved one could lose the sense of smell.
  • Facial nerve injury: Depending on the surgery site location, the facial nerves can be injured. This would make it difficult for your loved one to raise his or her forehead, smile or move the face; this could be temporary if the nerve is stretched or permanent if the nerve is cut.
  • Tearing: Your loved one might have chronic tearing problems. If the doctors notice this might be a problem during surgery, it can be prevented by putting tubes into the nasolacrimal duct and having it empty into the nose.
  • Blindness: Even in cases where the eye does not need to be removed, surgery close to the eye can lead to complications.
  • Facial numbness: Numbness of the face can be caused by damage to a nerve that runs just above the eye. The mid-face can be affected if the nerve under the eye is injured.
  • Dysarthria, or difficulty speaking: How much speech is affected will depend on the type of cancer and whether some of or all the tongue is removed.
  • Dysphagia, or difficulty swallowing: Whether a patient has difficulty swallowing will depend on the type of cancer and whether some of or all the tongue is removed.
  • Aspiration: Surgery in the neck or involving the tongue may make it difficult to control the swallowing mechanism. This can lead to saliva, liquids and food falling into the voice box and into the lungs, which can lead to pneumonia.
  • Blood clots: Patients who undergo major surgeries, especially those with cancer, have an increased risk of developing blood clots in their legs (deep venous thrombosis). Sometimes these blood clots can travel through the veins and into the lungs, causing a pulmonary embolus. This can be a serious complication. If this happens, your loved one will be placed on blood-thinning medication to prevent any more clots from forming and ending up in the lungs. This blood-thinning medicine itself might cause another complication such as bleeding, especially right after surgery. Your loved one will probably be given a low dose of blood-thinning medication immediately after surgery to help prevent clots.
  • Enophthalmos: This is a cosmetic deformity in which the eye sinks down into the cheek. A good reconstruction of the orbital floor should help prevent this.
  • Damage to nerves in the head and neck, including those that are responsible for:
    • Raising the arm way up into the air
    • Moving the tongue on one side
    • Moving the lower part of the face
    • Moving the diaphragm when you breath
    • Sensation to various parts of the neck, ear, and ear lobe
    • Moving the vocal cords on one side and controlling other bodily functions
    • Moving the arm
  • Sensory disturbance: A decrease in sensation of skin of the neck occurs when nerves are cut; this is required in most parotidectomy procedures. Over time, the area of numbness will shrink, but the lobule of the ear will probably remain numb forever.

How you can help

Everyone who has surgery, regardless of the type, will need help in the days and weeks after surgery, but especially someone who has had surgery for head or neck cancer. But before you jump in to help, remember:

  • Your loved one’s appearance will most likely have changed from the surgery. It can be scary to think he or she will not look the same, but remember it is the same person who went into the surgery, and he or she is afraid, just as you are.
  • Emotions will be high. Your loved one may be angry because of the changes the surgery has brought. He or she may be depressed and not want anyone around. Being overwhelmed by everything that has happened is common after undergoing major surgery.

Your loved one will need your help and support after surgery, so do not take it personally if he or she lashes out with angry words, cries or tells you to leave. It does not mean you are not loved or needed. Sometimes simply leaving and coming back later is the best decision. Do not give up on trying to help. Over time, your loved one will see you are there to be useful and because of the love you have.

Being there after surgery is important, but there is more you can do to help:

  • If your loved one has problems speaking after surgery, find ways to help him or her communicate such as a dry-erase board, a notebook, a computer tablet or something as simple as a bell or whistle.
  • Offer to run simple errands such as getting ice chips, refilling the water pitcher, taking out the trash, and taking care of dishes or changing bedding.
  • Share stories with your loved one. If he or she cannot speak, reading a favorite book or talking about what you did during the day can help bring you closer together.

As the patient recovers from surgery, life will return to a new normal, but your help is still needed. For more information on how you can help your loved one go through the cancer journey, while taking care of yourself, see The Cancer Journey.

I think now I can look at my scars and be proud of them. Battle scars.Tony L. (oral cancer survivor)