Oropharyngeal cancer

Surgery

There are a number of different operations that can help treat oropharyngeal cancer. If surgery is recommended, the type of operation will depend on the person and their cancer.

Whilst some people can be treated with surgery alone, others may need extra treatment after surgery to reduce the risk of the cancer returning. Your cancer care team will help decide whether it is necessary for you, based on a detailed report on the cancer from the pathologist 1–2 weeks after surgery.

Adding another type of treatment after surgery is called adjuvant therapy. This can be either radiation therapy alone or in combination with chemotherapy (chemoradiation), which is typically started about 4 weeks after surgery to allow recovery and for planning purposes. The treatment itself usually lasts about 6 weeks.

How can I prepare for the surgery?

Your doctor will explain details of the surgery, general risks and side effects of surgery. Ask your doctor if you have questions. They may recommend:

  • stopping blood thinners (e.g. aspirin) before surgery to reduce the risk of bleeding

  • special stockings to reduce the risk of blood clots

  • early mobilisation (i.e. not to stay in bed) to reduce the risk of blood clots and chest infection

  • antibiotics to lower the risk of wound infection.

If you smoke, it is important that you consider stopping smoking before starting treatment to help reduce the risk of infection and help you recover after your treatment.

Surgical Procedures

The different options for oropharyngeal cancer include: 

Trans-oral Robotic surgery (TORS)

Sometimes, oropharyngeal cancers can be removed through the mouth without any external cuts using a robotic system or by using laser surgery.

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Neck dissection

This involves removal of lymph nodes from the neck. This is important even when there is no sign of cancer in the lymph nodes on your scan, because there is a risk of microscopic cancer in the lymph glands of the neck.
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MANDIBULOTOMY

Surgery for oropharyngeal cancer may need to be more extensive in some patients. This can be because the cancer is too far back to remove through the mouth or because it is very large. A mandibulotomy involves cutting the jaw bone to allow better access to the cancer in the throat. The jaw is put back together at the end of the operation with titanium plates.
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Free flap reconstructive surgery 

In people, who have had a large area of tissue taken out, they may need reconstructive surgery. This involves taking skin and its blood supply from another part of the body and using that skin to cover the throat. This operation is carried out by a surgeon who specialises in reconstructive surgery, your head and neck surgeon or another surgeon.
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TRACHEOSTOMY

A tracheostomy is used to create an opening in the trachea (windpipe) in the lower neck, where a tube is inserted to allow air to flow in and out, when you breathe. This is used as swelling after major head and neck surgery may affect your ability to breathe. The tracheostomy tube is usually removed within a week of surgery once normal breathing is possible.
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Feeding tubes

  • A gastrostomy tube (called a PEG tube) goes through the skin and the muscles of your abdominal wall into the stomach. Gastrostomy is recommended if feeding is needed for a medium to longer time (months or years).
  • A nasogastric tube goes through the nose down into the stomach. Nasogastric feeding is used for short time (days or weeks).
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Side effects of surgery

Treatment for oropharyngeal cancer may lead to a number of side effects . You may not experience all of the side effects. Speak with your doctor if you have any questions or concerns about treatment side effects.