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Surgery: Procedures and Types

Surgery is one of the main treatment options for head and neck cancer, especially in early stages or when the tumor is localized. Surgical procedures vary depending on the tumor’s location and extent, and may include:

Local resection:
This involves removing the tumor along with a margin of surrounding healthy tissue. It is common for small tumors of the oral cavity, lips, or tongue. The goal is to completely remove malignant tissue while preserving function.
Radical surgery:
Used in more advanced tumors. It includes procedures such as glossectomy (partial or total removal of the tongue), mandibulectomy (removal of part of the mandible), laryngectomy (partial or total removal of the larynx), and maxillectomy (removal of the upper jaw). These procedures may involve significant changes in function and appearance, so they are often accompanied by reconstruction.
Cervical neck dissection:
Many head and neck tumors can spread to lymph nodes in the neck. Neck dissection involves removing these lymph nodes to reduce the risk of metastasis and improve prognosis. It can be selective (only certain nodal levels) or radical (all nodes on one side of the neck).
Reconstructive surgery:
After tumor resection, reconstruction is often required to restore function and appearance. Skin, muscle, or bone grafts (free or local flaps) and microsurgical techniques are used to rebuild affected structures.
Minimally invasive surgery:
In selected tumors of the nasopharynx, larynx, or paranasal sinuses, endoscopic techniques may be used to access the tumor with less damage to surrounding tissues and faster recovery.
Transoral robotic surgery (TORS):
In certain cases of oropharyngeal tumors, robotic technology allows precise resection through the mouth, minimizing external incisions and improving functional recovery.

Radiation Therapy

Radiation therapy uses ionizing radiation to destroy tumor cells. It may be used as the only treatment for small tumors, combined with surgery to reduce the risk of recurrence, or as the main treatment when surgery is not feasible. There are different modalities:

External beam radiation therapy:
The most common method, where radiation is delivered from outside the body toward the tumor.
Brachytherapy:
This involves placing radiation sources directly in or near the tumor site, allowing a high localized dose with less damage to healthy tissues.
Conformal radiation therapy and IMRT:
Advanced techniques that shape the radiation beam to match the tumor, reducing side effects and preserving nearby organs.

Chemotherapy

Chemotherapy uses medications that destroy or inhibit the growth of cancer cells. It is given intravenously or orally and may be used in different settings:

Neoadjuvant chemotherapy:
Given before surgery or radiation therapy to reduce tumor size.
Adjuvant chemotherapy:
Given after surgery to eliminate residual cells and reduce the risk of recurrence.
Concurrent chemoradiotherapy:
Chemotherapy is administered at the same time as radiation therapy, enhancing its effect on the tumor.
Palliative chemotherapy:
In advanced cases where cure is not possible, it helps control symptoms and improve quality of life.

Targeted Therapies and Immunotherapy

Targeted therapies:
They act on specific molecules involved in tumor growth. A well-known example is the use of monoclonal antibodies such as cetuximab, which blocks the epidermal growth factor receptor (EGFR).
Immunotherapy:
It stimulates the immune system to recognize and destroy cancer cells. Checkpoint inhibitors (nivolumab, pembrolizumab) are used in advanced cases or when the disease is resistant to conventional treatments.

Multidisciplinary Care and Comprehensive Support

Treating head and neck cancer requires collaboration among multiple specialists: head and neck surgeons, medical oncologists, radiation oncologists, pathologists, speech-language pathologists, nutritionists, and psychologists. The goal is not only to eradicate the tumor, but also to preserve function (speech, swallowing, breathing) and quality of life. Nutritional support, rehabilitation, and emotional care are essential throughout the entire process.

Considerations for choosing treatment

Tumor location and stage: These determine the feasibility and type of surgery, as well as the need for radiation therapy or chemotherapy.
Overall patient condition: Age, comorbidities, and individual preferences influence therapeutic decisions.
Functional and aesthetic impact: The functional and aesthetic outcomes of each procedure must be considered, prioritizing quality of life.
Resource availability and access: Options may vary depending on the infrastructure and expertise of the medical center.

Conclusion

Treatment options for head and neck cancer are varied and complex, requiring an individualized and multidisciplinary approach. Surgery, in its different forms, remains a cornerstone and is complemented by radiation therapy, chemotherapy, and newer approaches such as immunotherapy. Open dialogue with the medical team is essential to understand the risks, benefits, and expectations of each treatment, with the goal of achieving the best possible outcome both in cure and in quality of life.

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