Surgery for nasopharyngeal cancer

Surgery is rarely used to treat nasopharyngeal cancer because it is difficult to reach tumours in the nasopharynx. The type of surgery you have depends mainly on the size of the tumour and stage of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your age and overall heath.

Surgery may be done for different reasons. You may have surgery to:

• remove lymph nodes in the neck (cervical lymph nodes)
• place a feeding tube (called a gastrostomy)
• place a breathing tube (called a tracheostomy)
• completely remove a small nasopharyngeal tumour that has not spread beyond the nasopharynx
• remove a small tumour that comes back (recurs) after radiation therapy

The following types of surgery are used to treat nasopharyngeal cancer. You may also have other treatments before or after surgery.

A neck dissection is surgery to remove lymph nodes in the neck (cervical lymph nodes). It is the surgery most commonly used to treat nasopharyngeal cancer. It may be used when cancer in the cervical lymph nodes doesn’t respond to radiation therapy or chemotherapy. A neck dissection may also be done if nasopharyngeal cancer recurs in the cervical lymph nodes.

Depending on which lymph nodes the cancer has spread to, you may have one of the following types of neck dissection. Each type removes a different amount of tissue.

• A selective neck dissection, also called a partial neck dissection, removes only the lymph nodes closest to the site of the primary tumour.
• A modified radical neck dissection removes the lymph nodes from one side of the neck between the jaw and collarbone, along with some muscle and nerve tissue.
• A radical neck dissection removes nearly all the lymph nodes from one side of the neck, along with more muscle, nerve tissue and veins.

If the tumour is only on one side of the nasopharynx, the surgeon will only remove the lymph nodes on the same side of the neck as the tumour. If the tumour is near the centre of the nasopharynx, the surgeon will remove the lymph nodes on both sides of the neck in case the tumour has spread to both sides.

Find out more about neck dissection.

A nasopharyngectomy is surgery to remove part of the nasopharynx. This surgery is used to remove small tumours that have not spread beyond the nasopharynx. It may also be used to treat nasopharyngeal cancer that is left behind or recurs after radiation therapy.

During a nasopharyngectomy, the surgeon reaches the nasopharynx through the upper jaw bone, roof of the mouth or nose. Depending on the size and location of the tumour and how far it has grown into surrounding tissues, the surgeon may use open or endoscopic surgery to reach the nasopharynx. In open surgery, the surgeon makes a cut (incision) to reach the tumour. In an endoscopic nasopharyngectomy, the surgeon passes an endoscope into the nasopharynx to reach the tumour. An endoscope is a tube-like instrument with a light and a lens on the end that the surgeon can pass instruments through.

A gastrostomy is surgery to make an opening into the stomach. A feeding tube is passed directly into the stomach through the gastrostomy opening. A gastrostomy tube will let in foods and liquids (called enteral feeding) when you find it too difficult to eat or drink.

You may need a gastrostomy tube if you are going to have radiation therapy or surgery for nasopharyngeal cancer. These treatments can cause the throat to swell and make it difficult or painful to eat or drink. The surgeon may place a gastrostomy tube before radiation therapy starts to make sure you can have good nutrition during treatment. Most of the time, a gastrostomy tube is only needed for a short period of time.

A tracheostomy is surgery to make an opening in the neck and place a small tube into the trachea (windpipe) to help you breathe. This surgery may be done if a tumour or swelling after surgery or radiation therapy makes it difficult for you to breathe normally.

Side effects can happen with any type of treatment for nasopharyngeal cancer, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery, the effect of other treatments and your overall health.

Surgery for nasopharyngeal cancer may cause these side effects:

• pain
• infection
• bleeding
• lymphedema causing swelling of the face and neck
• difficulty speaking
• difficulty swallowing
• a feeling of weakness in the lower lip
• feeling weak when raising your arm above your head

Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.