Surgery
Once a diagnosis is made blood tests are ordered to confirm that the tumor has not spread to the lungs or the liver, then a surgery date is scheduled. The goal of surgery is complete removal of the tumor with aesthetics placing a distant second. However, if possible, minimal distortion of the patient’s physical appearance is also a treatment goal.

Details of surgery will vary depending on the exact site and size of the tumor, but many throat cancer procedures have a common component – the “neck dissection,” or the removal of the lymph nodes in the neck, with preservation of the important nerves and blood vessels. Occasionally a neck dissection includes removal of the large strap muscle in the neck and removal of a nerve that serves the mound of muscle between the shoulder and the neck.

Tongue cancer resections result in the loss of a portion of the tongue. When the cancer is located on the front of the tongue, surgery can cause speech problems. When the cancer is at the back of the tongue, swallowing can become difficult. Back-of-the-tongue tumors can be treated with radiation alone, or with a combination of radiation and chemotherapy. In most cases, the swallowing function can be rehabilitated to some degree with the help of a speech pathologist.

Surgical reconstruction isn’t necessary when small cancers are removed, because the raw surfaces will heal on their own. However, in larger resections a hole or defect in the wall of the throat will require reconstruction. This usually involves the rotation of muscle tissue from the throat into the defective area. In some cases the large chest muscle is released and folded up under the skin to patch a hole in the throat or tonsil region.

Sometimes the preferred procedure is the “microvascular free flap transfer,” in which a muscle, with its blood vessels, is removed from the leg, belly wall, thigh or forearm, and transferred to the defect site. The blood vessels serving the muscle are then sutured to blood vessels in the neck. The procedure is long, but it doesn’t tether the neck to the chest so severely.

In cases requiring bony reconstruction of the jaw, this is the preferred method, although other procedures can be used. The first picture shows a cancer on the left lower gum. It was small but because it was adherent to the bone, it required a jaw reconstruction and replacement with a bone flap from the patient’s leg. The cancer illustrated in the second photo also required bony reconstruction of the jaw.

The microvascular free flap procedure is superior to older methods and greatly improves reconstruction of the throat and jaw. While older methods are still appropriate in many cases, and may be safest for patients who are seriously ill, the free flap method usually results in less contour distortion than rotational flap methods. This method is not without a cost, however. Tissue cannot be removed from one site to another without some loss of function at the site of removal. Sometimes hernias form when muscle flaps are removed from the belly wall. When bone is removed from the leg for a jaw reconstruction, three or four weeks of limping are typical.