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Overview
What is Head & Neck Cancer?
Head and neck cancer refers to cancers that develop in areas like the mouth, throat, nose, sinuses, and salivary glands. These cancers often start in the lining of these regions.
What Causes It?
- Tobacco use (smoking or chewing)
- Alcohol consumption
- Human papillomavirus (HPV) infection
- Poor oral hygiene
- Exposure to harmful chemicals or radiation
Who is at Risk?
- Smokers and tobacco users
- Heavy alcohol users
- People with HPV infection
- Age over 50 years
- Poor nutrition or oral hygiene
Symptoms
- Persistent sore throat
- Difficulty swallowing
- Hoarseness or voice change
- Lump in neck or mouth
- Change in taste
- Unexplained weight loss
Diagnosis
- Physical examination
- Imaging (CT, MRI, PET scan)
- Biopsy (tissue sample test)
Treatment Options
- Surgery
- Radiation therapy
- Chemotherapy (uses medicines to kill or control cancer)
- Targeted therapy (attacks cancer cells to control the disease)
- Immunotherapy (uses immune system to kill cancer cells)
What is Robotic Surgery (TORS)?
Robotic surgery uses advanced robotic arms controlled by a surgeon to remove tumours with high precision through small openings, often through the mouth (no external cuts).
Why is it Done?
- To remove tumours safely
- To preserve speech and swallowing
- To avoid large cuts in the face/neck
- To improve recovery and outcomes
Types of Surgery
Open surgery: Done using a larger cut in the neck, jaw, or face.
Endoscopic: Uses a camera and instruments through the mouth or nose (no external cuts).
Robotic-assisted surgery (TORS): Uses robotic arms for high-precision surgery through the mouth.
| Feature | Open | Endoscopic | Robotic (TORS) |
|---|---|---|---|
| Cut | Large | No external cut | No external cut |
| Blood Loss | Higher | Moderate | Lower |
| Healing | Slower | Faster | Fastest |
| Precision | Moderate | Good | Highly precise |
| Risk of Scars | Visible scars | No visible scars | No visible scars |
Benefits of Robotic Surgery
- No visible scars (often through the mouth)
- Less pain
- Faster recovery
- Better speech and swallowing outcomes
- Reduced blood loss
- Shorter hospital stay
Procedure Details (Transoral Robotic Surgery)
Instructions Before the Procedure
- Stop smoking and alcohol
- Inform doctor about medications
- Fasting for 6–8 hours before surgery
- Routine blood tests and scans
Step-by-Step Overview
- Patient is given anaesthesia (put to sleep)
- Surgeon uses robotic arms controlled from a console
- Tumour is removed through the mouth (no external cuts in many cases)
- Surrounding tissues are preserved as much as possible
- Area is checked and cleaned before completing surgery
Risks & Complications
Common Risks
- Pain or swelling
- Temporary difficulty swallowing
- Mild bleeding
- Infection
Rare but Serious Complications
- Haemorrhage
- Inability to regain normal function
- Inability to tolerate a regular diet
Red Flag Symptoms (Seek Immediate Care)
- Difficulty in swallowing, speech and taste
- Heavy bleeding
- Tongue swelling
- An abnormal hole between the surgical area and neck skin causing leakage
Hospital Stay & Recovery
Instructions on the Day of Procedure
- Do not eat or drink before surgery
- Arrive early at hospital
- Remove jewellery/dentures
- Bring medical records
Post-Procedure Monitoring
- Checking how well the treatment has worked
- Finding any return of cancer early
- Detecting any new cancers early
- Monitoring and managing any complications
- Supporting recovery (speech, swallowing, etc.)
Recovery Timeline
- Hospital stay: 2–3 days
- Return to normal activities: after 2–3 weeks
Benefits and Outcomes
Benefits
- Early recovery
- Shorter operating time
- Lower risk of speech or swallowing difficulty
Expected Results
- Removal of tumour
- Improved quality of life
- Reduced symptoms
Success Rates
Depends on cancer stage, but robotic surgery shows comparable or better outcomes than open surgery in early cancers.
Quality of Life
- Better speech preservation
- Easier swallowing
- Less disfigurement
- Faster return to daily life
Lifestyle & Prevention
Activity Restrictions
- Avoid heavy lifting for 2–3 weeks
- Gradually resume normal activity
Wound Care / Precautions
- Maintain oral hygiene
- Follow doctor's cleaning instructions
- Watch for signs of infection
Diet
- Start with liquids, soft foods and normal diet
- Avoid spicy or hard foods initially
Exercise
- Light walking early
- Avoid strenuous activity
Long-Term Care
- Regular follow-ups
- Speech/swallow therapy if needed
Preventing Recurrence
- Avoid alcohol
- Avoid spicy seasonings in food
- Maintain oral hygiene
Follow-Up Schedule
- 1st year: every 1–3 months
- 2nd year: every 2–6 months
- 3–5 years: every 4–8 months
- After 5 years: every 12 months
Myths vs Facts
Surgery is the only treatment for head & neck cancer.
Treatment may include surgery, radiation, chemotherapy, targeted therapy, or immunotherapy, depending on the case.
All head & neck cancers can always be removed by surgery.
Some cancers cannot be removed with surgery and may require other treatments like radiation or chemotherapy first.
Robotic surgery means the robot performs the surgery on its own.
The surgeon fully controls the robotic system, guiding instruments with precision during the procedure.
Robotic surgery is the same as traditional open surgery.
TORS is a minimally invasive procedure done through the mouth, allowing access to hard-to-reach areas with better precision and faster recovery compared to traditional surgery.
Frequently Asked Questions
How is head & neck cancer diagnosed?
It is diagnosed using tests like biopsy (tissue testing) and other lab tests to understand the type of cancer and plan treatment.
Can treatment affect speech or eating?
Yes, some treatments may affect speech and swallowing, but rehabilitation and reconstructive procedures can help improve these functions.
How long does transoral robotic surgery (TORS) take?
TORS usually takes about 1.5 to 2 hours, but the total operating time (including additional procedures like neck surgery) may be around 4–5 hours.
What happens after TORS surgery?
After surgery, doctors closely monitor breathing and recovery, manage pain and may provide feeding support (like a feeding tube) until swallowing improves.
References
- 1. Head and neck cancers. Available from https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet/
- 2. Head and Neck Cancer. Diagnosis. Available from https://www.mayoclinic.org/diseases-conditions/head-and-neck-cancers/diagnosis-treatment/drc-20558359/
- 3. Liu HH, Li LJ, Shi B, et al. Robotic surgical systems in maxillofacial surgery: a review. Int J Oral Sci. 2017;9(2):63–73.
- 4. Jaw surgery. Available from https://my.clevelandclinic.org/health/procedures/jaw-surgery/
- 5. Nasal endoscopy. Available from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/nasal-endoscopy/
- 6. Arens C. Transoral treatment strategies for head and neck tumors. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2012;11:Doc05.
- 7. Handa A, Gaidhane A, Choudhari SG. Role of Robotic-Assisted Surgery in Public Health. Cureus. 2024;16(6):e62958.
- 8. Your guide before your operation. Available from https://www.uhsussex.nhs.uk
- 9. Shah S, Goldenberg D. Robotic surgery for oropharyngeal cancer. Rambam Maimonides Med J. 2014;5(2):e0014.
- 10. Brady JS, Desai SV, Crippen MM, et al. Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck. JAMA Facial Plast Surg. 2018;20(3):188–195.
- 11. Trans oral robotic surgery. Available from https://www.mayoclinic.org/tests-procedures/transoral-robotic-surgery/about/pac-20384803/
- 12. Sethi RKV, Chen MM, Malloy KM. Complications of Transoral Robotic Surgery. Otolaryngol Clin North Am. 2020;53(6):1109–1115.
- 13. Before surgery. Available from https://www.nhs.uk/tests-and-treatments/having-surgery/preparation/
- 14. Simo R, Homer J, Clarke P, et al. Follow-up after treatment for head and neck cancer. J Laryngol Otol. 2016;130(S2):S208–S211.
- 15. TORS. Available from https://my.clevelandclinic.org/health/procedures/transoral-robotic-surgery-tors/
- 16. Weinstein GS, O'Malley BW Jr, Snyder W, et al. Transoral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg. 2007;133(12):1220–6.
- 17. TORS post-operative instructions. Available from https://www.mountsinai.org/locations/head-neck-institute/postoperative/transoral/
- 18. Surveillance education. Available from https://www.ahns.info/survivorship_intro/surveillance-education/