Types of surgery for nasopharyngeal cancer
Surgery is not a common treatment for nasopharyngeal cancer. This is because the area is very difficult to get to and is surrounded by important nerves and blood vessels.
You are most likely to have surgery to remove 
if your doctor thinks they may contain cancer cells.
Surgery to remove cancer in the nasopharynx
Your specialist might suggest surgery to remove the cancer in your nasopharynx if:
- the cancer comes back quite soon after treatment with radiotherapy or chemoradiotherapy
- you have a rare type of nasopharyngeal cancer such as adenocarcinoma
If you do have surgery to remove your cancer you may need more than one operation. One to remove the cancer and another to reconstruct the area.
The reconstruction improves the look of the area after your first operation. It also helps you to breathe, chew and swallow more easily too. Your surgeon will talk to you before the operation about what to expect afterwards.
As with any surgery there are possible risks such as:
- infection
- bleeding
- pain
- a build up fluid behind the ear drum (middle ear effusion)
- difficulty swallowing
- numbness in the cheek
Your team will talk to you about the possible risks and what they can do to help manage them.
Removing lymph nodes in your neck (neck dissection)
Nasopharyngeal cancer often spreads to the lymph nodes in your neck. Radiotherapy to the area usually works well and destroys the cancer. But sometimes the cancer can come back in the lymph nodes. If this happens your specialist might suggest surgery to remove them. An operation to remove the nodes on one or both sides of the neck is a called a neck dissection.
Types of operation
The type of neck dissection you have depends on the number and size of the lymph nodes affected by the cancer. Your specialist might recommend a:
- selective neck dissection
- radical neck dissection
- modified radical neck dissection
In a selective neck dissection, your surgeon only removes the lymph nodes in the area affected by the cancer.
In a radical neck dissection, your surgeon removes nearly all of the nodes on one side of your neck. They also remove the muscle on that side of the neck (the sternocleidomastoid muscle) as well as nerves and the internal jugular vein.
In a modified radical neck dissection, your surgeon removes the lymph nodes between your jawbone and collarbone on one side of your neck. But keeps the nerves and muscles.
You can read more about these muscles and nerves below.
Side effects of neck dissection
The side effects depend on which structures have been removed or disturbed during surgery.
Shoulder stiffness and arm weakness
The accessory nerve controls shoulder movement. So if you have this removed, your shoulder will be stiffer and more difficult to move. If you have a partial or modified neck dissection, the weakness in your arm usually lasts only a few months. But if you have your accessory nerve removed, the damage is permanent.
Your doctor will refer you to a physiotherapist. They will show you some exercises to help improve the movement in your neck and shoulder. It is important that you do them.
Some people have problems with pain and movement a year after surgery. In this situation, your doctor may suggest a reconstruction of some of the muscles. But this isn't suitable for everyone.
Pain
You may also have some pain. Taking painkillers can help. Physiotherapy exercises can also reduce pain. Your doctor can refer you to a pain clinic if the pain continues or is not controlled with painkillers.
A thinner, shrunken and stiff neck
Your neck will look thinner and shrunken if you have had the sternocleidomastoid muscle removed.
Your neck might be stiff after the operation and you might need physiotherapy.
Swelling (lymphoedema)
After surgery to remove some or all of the lymph nodes in your neck, the area can be swollen. This can be due to general swelling around the surgical wound. This usually goes down within a couple of weeks. But it can also be a sign of lymphoedema, this swelling doesn’t go away.
Lymphoedema means a build up of lymph fluid that causes swelling. It can develop because surgery interferes with the normal flow of lymph in the lymphatics.
Lymphoedema in the head or neck can also cause symptoms inside your mouth and throat. This may include swelling of your tongue and other parts of your mouth.
Tell your doctor or nurse straight away if you have:
- any swelling or a feeling of fullness or pressure
- find it difficult to swallow
- have changes in your voice
They will refer you to a lymphoedema specialist if they think you might have lymphoedema. It’s important to start treatment early to stop the swelling from getting worse.
Chyle leak
Chyle is tissue fluid (lymph) that contains fat after it has been absorbed from the small bowel (intestine). It gets transported through the lymphatic channels to the bloodstream.
Sometimes one of these channels, called the thoracic duct, leaks after the operation. When this happens, lymph fluid or chyle can collect under the skin.
You may need to stay longer in hospital and go back to the operating theatre to repair the leak.
Blood clot
Sometimes the tubes of the drain that the surgeon puts in during surgery can become blocked. This can cause blood to collect under the skin and form a clot (haematoma). If this happens, you might need to go back to the operating theatre to have the clot removed and the drain replaced.
Other possible effects
You might have other effects due to damage to some of the nerves that supply the head and neck area.
They include:
- numbness of the skin and the ear on the same side as the operation
- loss of movement in the lower lip
- loss of feeling or movement on one side of the tongue
Exercises for lymphoedema
Using your head, neck and shoulder muscles may help to reduce swelling. Your physiotherapist or specialist nurse will usually go through these exercises with you.
These exercises shouldn't be painful. You might have a feeling of stretching as you do them, this is normal. Stop doing the exercises if you have any pain and, if doesn't get better contact your doctor.
Do the exercises slowly and gently, don't rush them. You can rest between exercises. It might help to do them in front of the mirror so you can check that your shoulders are back and relaxed.
Hi, I’m Carla. I’m going to show you how to do head and neck exercises. Remember to do your deep abdominal breathing exercises before and after. Each exercise you will do 5 to 10 times and very important , pain free.
Neck exercises
We’ll start with the head and neck. We’ll do looking to the side, back to the middle and to the other side. It’s normal to feel a bit of stretch sensation.
Next one will be ear to the shoulder, not shoulder to the ear. Go back to the middle and to the other side. If you’re not sure you’re doing it right, sometimes it’s helpful to do it in front of a mirror.
Next one will be chin to the chest and back to start position.
Shoulder exercises
Next one will be shoulders. We’ll go up, relax and down and relax.
Next one will be circles. And we go backwards and then forward.
Mouth exercises
We’ll do as well mouth exercises. We’ll start with open and close. Blowing kisses, blowing candles, exaggerated smile. And then you say the vowels in an exaggerate way
Jaw exercises
And we’ll do as well the jaw exercises. We’ll do side to side first.
And then moving the jaw forward and the back to normal.
Remember to do the deep abdominal breathing at the end, repeat them once a day minimum and if you have any concerns just call your doctor or lymphoedema specialist.
Find out more about lymphoedema on the Cancer Research UK website.
Surgery to relieve symptoms
Your doctor might suggest surgery to relieve symptoms, even if your cancer cannot be cured. This can give you a better quality of life. You are most likely to need this type of treatment if the cancer is blocking any part of your nose and making it difficult for you to breathe.
What changes can surgery cause?
Surgery to the nasopharynx can cause swelling of your face, mouth and throat. This can make it difficult to breathe, and sometimes to chew and swallow. These changes are usually temporary.
Surgery is also likely to change the way you look. It can be very hard to accept sudden changes in your looks. How you look is an important part of your self esteem.
It is not unusual for people who have had surgery to their face to find it very difficult to look in the mirror afterwards. You might feel very angry, confused and upset for some time after surgery. Your doctor and nurse will help support you through this.
