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 lymph nodes Open a glossary item 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.

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

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 lymph nodes from your neck, you are at risk of getting lymphoedema in your neck or face. 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 if you have:

  • any swelling or a feeling of fullness or pressure
  • find it difficult to swallow
  • have changes in your voice

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
Let your doctor or specialist nurse know about any side effects that you have so they can help you to cope with them.

Swelling (lymphoedema)

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

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. 

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.

Information and support

You can contact our Cancer Information Nurses on 0808 800 4040 Monday to Friday, 9am to 5pm, with any questions you might have about having treatment for nasopharyngeal cancer.
Last reviewed: 
22 Feb 2021
Next review due: 
22 Feb 2024
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