About nasopharyngeal cancer surgery | Cancer Research UK
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About nasopharyngeal cancer surgery

Surgery is not a common treatment for nasopharyngeal cancers. 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 lymph nodes if your doctor thinks they may contain cancer cells. This isn't usually part of your initial treatment as radiotherapy to lymph nodes works well and has fewer long term side effects.

You may have surgery to remove your tumour if your disease comes back quite soon after treatment with radiotherapy. Or if you have a rare type of nasopharyngeal cancer such as adenocarcinoma. You may need more than one operation – one to remove the cancer and another to reconstruct the area.

Removing lymph nodes in your neck

If your cancer comes back in the lymph nodes in your neck, your specialist might suggest surgery to remove them. An operation to remove the neck lymph nodes is called a neck dissection. Your surgeon may only remove a few lymph nodes. Or they may need to remove most of the lymph nodes on one side of your neck, and some muscle and nerve tissue. You may have neck and shoulder stiffness or weakness in your arm after a neck dissection. But you will be shown exercises to do to improve this.

Surgery to relieve symptoms

Your doctor may suggest surgery to relieve symptoms even if your cancer cannot be cured. This may give you a better quality of life. You are most likely to need this type of treatment if your cancer is blocking any part of your nose and making it difficult for you to breathe.
 

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When surgery is used to treat nasopharyngeal cancer

Surgery is not a common treatment for nasopharyngeal cancers. 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 lymph nodes if your doctor thinks they may contain cancer cells.

Your specialist may suggest surgery to remove your tumour if either

  • Your disease comes back quite soon after treatment with radiotherapy
  • 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 will improve the look of the area after your first operation and help you to breathe, chew and swallow more easily too.

 

Surgery to remove lymph nodes in your neck

Cancers of the head and neck often spread to the lymph nodes in your neck. An operation to remove the nodes on one or both sides of the neck is a called a neck dissection. This is not usually part of your initial treatment for nasopharyngeal cancer because radiotherapy usually works well and has fewer long term side effects.

But sometimes the cancer can come back in the lymph nodes, and in this situation your specialist might suggest surgery to remove them. If you have surgery to remove these nodes, your surgeon may recommend a

If you have a partial or selective neck dissection, your surgeon will only remove a few lymph nodes in the area.

If you have a radical neck dissection, your surgeon will remove nearly all of the nodes on one side of your neck. They will also remove the muscle on that side of the neck (the sternocleidomastoid muscle) as well as nerve tissue, and a vein called the internal jugular vein.

Diagram showing the muscle, nerve and blood vessel sometimes removed with a lymph node dissection of the neck

If you have a modified radical neck dissection, your surgeon will remove most of the lymph nodes between your jawbone and collarbone on one side of your neck. They will also remove the sternocleidomastoid muscle, and a nerve called the accessory nerve.

There is information below about these muscles and nerves.

 

Side effects of neck dissection

These operations are vital for getting the best chance of stopping the cancer from spreading or coming back. But there are some side effects. These will depend on which of the following have been damaged or removed

The accessory nerve controls shoulder movement. So if you have this removed, your shoulder will be stiffer and more difficult to move. You may also have more difficulty in raising your arm over your head on that side.

If you have a partial neck dissection, the weakness in your arm usually lasts only a few months. But if the surgeon completely removes your accessory nerve, the damage is permanent. Your doctor will ask you to see a physiotherapist, who will show you some exercises to help improve the movement in your neck and shoulder. It is important that you do these exercises regularly.

If you are still having problems with pain and movement a year after surgery, despite doing your exercises, your doctor may see whether a further operation to reconstruct some of the muscles might help. But this will not be suitable for everyone.

Removing all of your sternocleidomastoid muscle doesn't usually cause a problem. But it will make your neck look thinner and sunken on that side. If you have a neck dissection on both sides and both of these muscles removed, you will have some difficulty bending your head forward. Physiotherapy can help to improve movement and prevent stiffness.

The cranial and spinal nerves supply the head and neck area. A possible side effect of a neck dissection is that there may be damage to these nerves. You may have

  • Numbness in the ear on the same side as the operation
  • Loss of movement in the lower lip
  • Loss of movement on one side of the tongue
  • Loss of feeling on one side of the tongue
 

Surgery to relieve symptoms

You doctor may suggest surgery to relieve symptoms even if your cancer cannot be cured. This may give you a better quality of life. You are most likely to need this type of treatment if your cancer is blocking any part of your nose and making it difficult for you to breathe.

 

Changes that surgery can cause

Surgery to the nasopharynx can cause swelling of the face, mouth and throat, making 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.

How you look is an important part of your self esteem. It can be very hard to accept sudden changes in your looks. 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 may feel very angry, confused and upset for some time after surgery. Your doctor and nurse will help support you through this.

There is information about coping after treatment for nasopharyngeal cancer in the living with nasopharyngeal cancer section.

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Updated: 27 August 2014