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 might suggest surgery to remove your tumour if:
- your cancer 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 improves the look of the area after your first operation. It also helps you to breathe, chew and swallow more easily too.
Removing lymph nodes in your neck (neck dissection)
Naospharyngeal cancer often spreads 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.
When you might have it
Surgery is not usually part of your initial treatment for nasopharyngeal cancer. This is because radiotherapy usually works well and removes the cancer.
But sometimes the cancer can come back in the lymph nodes. If this happens your specialist might suggest surgery to remove them.
How you have it
The area of the neck dissection may vary depending on the number and the size of the lymph nodes involved. 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 maintains the nerves and muscles.
You can read more about these muscles and nerves below.
Side effects of neck dissection
These operations are important for getting the best chance of stopping the cancer from spreading or coming back. But there are some side effects. These depend on which of the following nerves or muscles have to be removed.
The accessory nerve controls shoulder movement. So if you have it removed, your shoulder becomes stiffer and more difficult to move. Raising your arm over your head on that side can also become more difficult.
After a selective neck dissection, the weakness in your arm is usually temporary.
But if the surgeon completely removes your accessory nerve, the damage is permanent. Usually you see a physiotherapist, who teaches you exercises to help improve the movement in your neck and shoulder. It is important to do these exercises regularly.
Some people still have problems with pain and movement a year after surgery, despite doing their exercises. If this happens, a referral to a shoulder surgery specialist may be considered.
Removing all of your sternocleidomastoid muscle doesn't usually cause a problem. But it does make your neck look thinner and sunken on that side.
After a neck dissection on both sides in which both of these muscles are removed, you do have some difficulty bending your head forward. Physiotherapy can help to improve movement and prevent stiffness.
Cranial and spinal nerves
The cranial and spinal nerves supply the head and neck area. A neck dissection can damage some of these nerves. If this happens you might 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
When you have surgery to remove lymph nodes from your neck, you are at risk of getting swelling. This is called lymphoedema and happens in your neck or face.
Lymphoedema in the head or neck area can also cause symptoms inside your mouth and throat. This might include swelling of your tongue and other parts of your mouth.
Tell your doctor if you:
- have any swelling in the head or neck area
- have a feeling of fullness or pressure in the head or neck area
- have changes in your voice
- find it difficult to swallow
Surgery to relieve symptoms
You 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 your 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.