Surgery for Nasopharyngeal Cancer

Surgery to remove the main tumor is not usually the first treatment for people with nasopharyngeal cancer (NPC) because the nasopharynx is a hard place to operate on, it is close to other critical structures, and because other types of treatment often work well. Surgery is more often done to remove lymph nodes in the neck that haven’t responded to other treatments.

Quit smoking before nasopharyngeal cancer surgery

If you smoke, you should quit. Smoking during cancer treatment is linked to poor wound healing, more side effects, and less benefit from treatment which can raise your risk of the cancer coming back (recurrence). Smoking after treatment can also increase the chance of getting another new cancer. Quitting smoking for good (before treatment starts, if possible) is the best way to improve your chances of survival.  It is never too late to quit. For help, see How To Quit Using Tobacco.

Surgery to remove the tumor

Since these cancers are not common in the US and are located near many critical structures in your head and neck, it’s very important to go to a cancer center that has experience treating these cancers. This will help coordinate care between cancer specialists to make a complete treatment plan and might help people live longer. 

Endoscopic surgery

For endoscopic surgery, doctors put flexible fiber-optic scopes and long, thin surgical instruments into the nasal cavity through the nostrils to completely remove some nasopharyngeal tumors (an operation called endoscopic nasopharyngectomy). This type of surgery is an option for people as a first treatment for small cancers or for small cancers that have come back after the initial treatment. It can help some people live longer. These complex procedures are done only in specialized centers.

Surgery does have some advantages over other treatments such as radiation therapy – for example, doctors can look at the removed tumor (and nearby tissues) closely in the lab to make sure that no cancer has been left behind.

Surgery to remove lymph nodes

Cancers of the nasopharynx often spread to the lymph nodes in the neck. These cancers often respond well to treatment with radiation therapy (and sometimes chemotherapy). But if some cancer remains after these treatments, an operation called a neck dissection may be needed to remove these lymph nodes. Lymph nodes in the neck might also be taken out to see if there are cancer cells in them.

There are several types of neck dissection surgery. The difference is in how much tissue is removed from the neck. Depending on the location of the tumor, lymph nodes may be removed from both sides of the neck.

• A selective neck dissection: No nerves, veins, or muscles are affected during this type of neck dissection and only lymph nodes in selected parts of the neck are removed. This type of surgery removes fewer normal structures to try to keep your shoulder and neck working normally.

• A comprehensive neck dissection: Some nerves, veins, and muscles might be removed, along with all of the lymph nodes in the neck.

Possible risks and side effects of surgery

The risks and side effects of any surgery depend on the extent of the operation and a person's general health before the surgery. If you are considering surgery, your doctor will discuss the likely side effects with you beforehand. Be sure you understand how surgery may affect how you look and how your body works.

All surgery carries some risk, including the possibility of blood clots, bleeding, infections, complications from anesthesia, and pneumonia. Most people will have some pain for a while after the operation, although this can usually be controlled with medicines. These risks are generally low but are higher with more complicated operations. Rarely, some people do not survive the surgery.

Possible risks and side effects of endoscopic surgery of the nasopharynx area include meningitis, fluid in the inner ear, numbness around the eye, watery eyes, or lockjaw.

Side effects of a neck dissection can include numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip due to nerve damage from surgery. Nerves heal slowly, so sometimes these side effects can improve over time, especially when physical therapists teach you exercises to improve neck and shoulder strength and movement.

If more extensive surgery is needed, the side effects may be permanent.  After more extensive neck dissections, physical therapists can teach you exercises to improve neck and shoulder strength and movement.