Chapter 01 — The Craft
Speciality 01 · Head & Neck OncologyCuring the cancer while protecting the way you speak, swallow and smile.
Head and neck cancers sit at the crossroads of survival and identity — they affect how we eat, talk, and are seen. Surgery here demands millimetre judgement: remove enough to cure, preserve everything that makes you, you.
What are head & neck cancers?
These cancers begin in the moist surfaces of the mouth, nose and throat, or in the glands of the region — tongue, cheek, voice box (larynx), tonsil, thyroid, parotid and sinuses. In Gujarat, most arise in people who chew tobacco, gutkha or areca nut, smoke, or drink alcohol regularly — but they also occur without any of these.
The encouraging truth: caught early, many are cured with a single well-planned surgery, sometimes without any radiation at all. Even advanced ones respond remarkably to combined treatment when staging is done properly first.
The neck lump rule: any lump in the side of the neck lasting more than three weeks deserves examination — it is often the first signal, and the easiest moment to act on.
Because this region holds the voice box, the swallowing muscles and the facial nerve, every operation here is a negotiation between cure and character. That negotiation deserves a surgeon who does both, daily.
“Most patients tell me afterwards — ‘I wish I had come six months earlier.’ Come now.”
Warning signs that deserve a specialist’s eyes
Any of these lasting more than three weeks — especially with a tobacco history — warrants examination. Most will be innocent; the ones that aren’t are exactly why we check.
- ①A mouth ulcer that hasn’t healed in three weeks, or bleeds when touched.
- ②A growing lump in the neck — painless lumps are the ones people ignore longest.
- ③Persistent hoarseness or voice change beyond three weeks.
- ④Difficulty or pain swallowing, food “sticking” on the way down.
- ⑤One-sided ear pain with a perfectly normal ear examination — a classic throat sign.
- ⑥An unexplained nosebleed or blocked nostril on one side only.
- ⑦White or red patches inside the mouth that refuse to fade.
- ⑧Loose teeth or ill-fitting dentures without dental cause.
Cancers we treat in this region
✳Mouth & Tongue
Oral cavity cancers including buccal mucosa, floor of mouth and alveolus — among the commonest in Gujarat.
✳Throat & Voice Box
Oropharynx, hypopharynx and larynx — with voice preservation prioritised wherever oncologically safe.
✳Thyroid
Papillary, follicular, medullary cancers and complex goitres; recurrent laryngeal nerve preservation is non-negotiable.
✳Salivary Glands
Parotid and submandibular tumours, operated with the facial nerve’s function protected.
✳Nose & Sinuses
Sinonasal malignancies requiring combined skull-base planning.
✳Skin of Face & Neck Nodes
Facial skin cancers, and neck-node masses of unknown origin — finding the hidden primary is a subspecialty in itself.
Preserving the voice box is not generosity — when it is safe, it is part of the cure.
Operations performed here
- ✳Composite resections for oral cancerTumour removal with precise margin control; hemi or total glossectomy as needed, with primary reconstruction.
- ✳Laryngectomy — partial & totalChosen only when voice-preserving options cannot safely cure; tracheo-oesophageal voice restoration planned ahead.
- ✳Transoral laser surgeryNo external cut for selected throat cancers; faster recovery of speech and swallow.
- ✳Neck dissectionsRadical and modified radical — clearing lymph nodes while protecting nerves and vessels.
- ✳Thyroidectomy & parotidectomyNerve identification and preservation as standard practice, with monitoring principles.
- ✳Reconstruction planningLocal flaps and free-flap reconstruction coordinated with microvascular colleagues for large defects.
From first visit to full recovery
Examination & endoscopy
The tumour is seen directly; biopsies taken the right way.
Staging scans
MRI/CT and ultrasound map exactly what surgery must address.
Tumour board plan
Radiation and medical oncology weigh in before — not after — decisions.
Surgery
Curative resection with reconstruction, planned to the millimetre.
Rehabilitation
Speech and swallow therapy begins early — often within days.
Surveillance
Scheduled reviews catch anything early, when it is still easy.
Families usually ask…
In the majority of cases, yes — voice-preservation techniques are the default consideration, not the exception. When total laryngectomy is truly necessary, modern voice restoration gives most patients strong, usable speech again.
Small laser procedures: 1–2 days. Major composite resections: typically 7–10 days including swallow training. You will get a written day-by-day expectation before consenting.
The common types (papillary and follicular) have excellent long-term outcomes — most patients live completely normal lives on hormone tablets. Medullary types need more aggressive, individualised plans which we discuss honestly.
Depends entirely on final pathology — depth, margins, nodes. Early oral and thyroid cancers frequently avoid it altogether. We decide based on evidence, not habit.
Yes — a screening oral examination takes five minutes and can catch precancerous change years before cancer. Quitting support is part of the consultation too, without judgment.