The nasal cavity includes the nostrils and the area behind the nose. Surgery in this area is very specialised and only a specialist surgeon can do it. They will try to remove the cancer and some surrounding tissue but will also try to change your appearance as little as possible.
How the surgeon decides on treatment
The amount of surgery you need depends on the position of the cancer in the nasal cavity.
The type of surgery also depends on the stage of your cancer. This means the size of the cancer and whether it has spread. Your doctor might not be able to tell you exactly what stage your cancer is until after surgery.
Removing the cancer
The surgeon removes the whole cancer and a border of normal tissue around it. Doctors call this operation a primary tumour resection or wide local excision. The aim is to remove all visible signs of the cancer and any tissue around it that could contain cancer cells.
The surgeon sends the tumour to the laboratory for examination under a microscope. This is to check that there is a border of healthy tissue with no cancer cells around the tumour. This is called a clear margin.
Sometimes the tumour is in the wall that separates the two sides of the nasal cavity (the nasal septum). In these situations, the surgeon might need to remove part or all of the nasal septum.
Endoscopic nasal surgery
This type of surgery isn't suitable for everyone. It will depend very much on the type and position of the tumour you have and what other options are available. You might have endoscopic surgery if you have:
- any tumour which your surgeon can reach and completely remove with endoscopic surgery
- a larger tumour but it is possible to remove it without damage to surrounding structures and you can have radiotherapy afterwards to reduce the chances of the cancer growing again
- a tumour that is causing problems such as an obstruction and affecting your breathing but you are not fit enough for a big operation. This may make further treatment with radiotherapy or chemoradiotherapy possible
Endoscopic surgery involves putting a thin, rigid tube (an endoscope) into the nose. There are no cuts to the face. The tube has a camera attached with a bright light.
Endoscopic surgery allows removal of the cancer with a border of normal tissue (a margin). It causes less damage to surrounding healthy tissue than some other types of surgery. Because your surgeon has a better view of the tumour, it allows them to use more precise surgery using specialised instruments. This usually helps you to recover quicker after which you can have radiotherapy to the area if needed.
External nasal surgery
Occasionally, it is necessary to open the nose from the side to reach certain areas of the nose. This may involve a cut in the side groove of the nose, called a lateral rhinotomy or medial maxillectomy. If your surgeon uses a cut inside the mouth between the gum and the upper lip it is called a mid facial degloving.
This type of surgery is used if the tumour:
- cannot be reached with an endoscope
- is likely to bleed a lot or is very large
Removal of part or all of your nose
For cancers on the side of the nose affecting the skin, your surgeon can usually remove the affected part. Doctors call this operation a partial rhinectomy.
Your surgeon may need to remove all of your nose if the cancer has spread widely into your nose tissue. This operation is called a total rhinectomy.
In both cases, your surgeon will need to rebuild your nose. They use tissue taken from your face or another part of your body. This may need further operations. Or a prosthetic technician can make a new false nose for you. The false nose is called a prosthesis.
This type of surgery will change your appearance. This can be challenging at first, but there are people who can help you cope.
Side effects of nasal surgery
Depending on the position of your cancer and the type of operation you have, your surgery might:
- reduce your sense of smell
- reduce your sense of taste
- make your eye water
These changes may happen because your nose is swollen and sore after surgery. They will usually reduce or disappear once you start to heal.
After a cut on the outside of the face, swelling might also change how you look but this will usually get better too.
You might have some permanent changes in what you can do and the way you look.
Before you have the surgery, your doctor will discuss the likely side effects with you.
Removing lymph nodes in your neck
If tests have shown that the cancer has spread to lymph nodes in your neck, you will need to have the lymph nodes removed.