Types of surgery for nasopharyngeal cancer

Surgery is not a common treatment for nasopharyngeal cancer. This is because the area is difficult to reach and surrounded by important nerves and blood vessels.

You are most likely to have surgery to remove lymph nodes in your neck after radiotherapy if your surgeon thinks they may contain cancer cells.

Surgery to remove cancer in the nasopharynx

Your surgeon might suggest you have surgery to remove the cancer in your nasopharynx. This is called a nasopharyngectomy. You might have this if the cancer is small and has come back after previous treatment such as radiotherapy.

You might have more radiotherapy or chemoradiotherapy after your surgery.

Types of surgery  

You might have endoscopic surgery to remove the cancer. Your surgeon uses a special instrument called an endoscope to reach the nasopharynx through the mouth or nose. The endoscope has a camera and a light. Small instruments pass through the endoscope to remove the cancer.  

If endoscopic surgery isn’t possible you might have open surgery. This means your surgeon makes and cut (incision) in the skin to reach the cancer. This might be on your face, your neck, or through the roof of your mouth. 

Sometimes surgeons use nearby healthy tissue to replace the tissue removed. The tissue has its own blood supply. This is called a flap or graft. It’s a type of reconstructive surgery, and can improve the look of the area. It can also help you to breathe, chew, and swallow more easily. 

As with most types of surgery, this is very complex. You might also need more than one operation. Your surgeon and specialist nurse will explain what's involved in as much detail as you want. They will also explain the possible risks and what they can do to help manage them. 

Removing lymph nodes in your neck (neck dissection)

Lymph nodes are small bean shaped glands found throughout the body, including the head and neck area. They are part of the lymphatic system that filters body fluid and fights infection. They also trap damaged or harmful cells such as cancer cells.  

Nasopharyngeal cancer often spreads to the lymph nodes in your neck. Radiotherapy to the area usually works well in treating early stage nasopharyngeal cancer. But sometimes the cancer can come back in the lymph nodes. If this happens your surgeon might suggest surgery to remove them.

Surgery to remove lymph nodes in the neck is called a neck dissection.

Types of surgery to remove lymph nodes in the neck

The type of neck surgery to remove lymph nodes in the neck depends on the number and size of the lymph nodes affected by the cancer. Your surgeon might recommend a:

• partial or selective neck dissection
• modified radical neck dissection
• radical neck dissection

Selective neck dissection

In a selective neck dissection, your surgeon only removes the lymph nodes in the area affected by the cancer.

Modified radical neck dissection

There are different types of modified radical neck dissection.

Your surgeon removes most of the lymph nodes between your jawbone and collarbone on one side of your neck. But tries to keep the nerves and muscles.

Your surgeon also needs to remove one or two or three of the following structures:

• a muscle at the side of your neck called the sternocleidomastoid
• a nerve called the accessory nerve
• a vein called the internal jugular vein

Radical neck dissection

If you have a radical neck dissection, your surgeon removes most of the nodes on one side of your neck. They also remove:

• all of the muscle on that side of your neck (the sternocleidomastoid muscle)
• the accessory nerve
• the internal jugular vein

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.

Pain

You may have some pain. Taking painkillers can help. Physiotherapy exercises can also reduce pain. Your surgeon 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 surgeon 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 side effects

You might have other side 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. 

Surgery to relieve symptoms

Your surgeon 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.

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