Surgical Procedures: Surgery and Staging for Nasopharyngeal Cancer
What is the nasopharynx?
The nasopharynx is the upper part of your throat. It lies just behind your nose (nasal cavity) and above the soft part of the roof of your mouth (soft palate). This part of your pharynx lets air pass from your nose down your throat. The nasopharynx is also made up of your Eustachian tubes in your ears. The Eustachian tubes connect the throat to the ears.
What is nasopharyngeal cancer?
When there are cancer cells in the nasopharynx, it is called nasopharyngeal cancer. Most nasopharyngeal cancers start in the thin cells (squamous cells) that line the inside of your nasopharynx.
The most common type of nasopharyngeal cancer is squamous cell carcinoma (called nasopharyngeal carcinoma, or NPC). There are a few types of NPC:
- Keratinizing squamous cell carcinoma: The most common type in areas that have low rates of NPC, like the United States.
- Non-keratinizing differentiatedcarcinoma: Less common in areas that have high rates of NPC. This kind is often linked with the Epstein-Barr Virus (EBV).
- Non-keratinizing undifferentiated carcinoma: The most common type in areas with high rates of NPC. This kind is also linked with EBV.
- Basaloid squamous cell carcinoma: Rare and very aggressive.
Some type of lymphoma and salivary gland cancers can also start in the nasopharynx. This article will focus on nasopharyngeal carcinoma.
What is staging and how is it done?
Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For nasopharyngeal cancers, these tests may include:
Physical Exam: This is a general exam to look at your body and to talk about past health issues.
Imaging: Radiology tests can look inside your body to look at the cancer and figure out if it has spread. These tests can include:
- CAT scan (CT scan).
- Positron emission tomography scan (PET scan).
- Magnetic resonance imaging (MRI).
- Bone scan.
- Barium swallow.
Procedures: These may include:
- Endoscopy: An endoscope (lighted tube) is used to look for any abnormal areas. If needed, the endoscope can get tissue for a biopsy.
- Indirect nasopharyngoscopy: Small mirrors and bright lights are used to look at the nasopharynx.
Nasopharyngeal cancer can spread to other parts of the body through the tissue, lymph, and blood systems. The cancer stage describes how extensive the cancer is, how far it has spread, and helps guide what treatment should be used. Nasopharyngeal cancer is described as stages 0 through stage IV (four).
Surgical Procedures Used for Nasopharyngeal Cancer
Surgery may be used to treat nasopharyngeal cancer. Surgery is most often used when the cancer comes back (called recurrence) or to remove lymph nodes that may have cancer in them. The goal of surgery is to remove as much of the cancer as possible while sparing healthy tissue or organs near the tumor. There are a few surgeries that may be used to treat cancer of the nasopharynx:
- Direct nasopharyngoscopy: A thin fiberoptic scope with lights at the end looks at the lining of the nasopharynx. Long, thin surgical tools are then used to remove all or some of the tumor. This procedure is used for smaller and early-stage cancers, and for recurrence.
- Lymph Node Dissection: One or a few lymph nodes, nerves, and/or muscle is removed. Your surgeon will determine what needs to be removed based on the size and location of the tumor and if the nodes were larger than normal on imaging tests.
What are the risks of surgery to treat nasopharyngeal cancer?
As with any surgery, there are risks and possible side effects. These can be:
- Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure).
- Blood clots.
- A change in how you look.
- Meningitis (swelling of the brain and spinal cord membranes).
- Fluid in your inner ear.
- Numb or watery eyes.
- Lockjaw (neck and jaw muscles get tight).
Before surgery, your provider will talk to you about any other risks based on your health and the surgery you are having.
What is recovery like?
Recovery from surgery nasopharyngeal cancer depends on the procedure you have had. You may have to stay in the hospital.
You will be told how to care for your surgical incisions (cuts) if you have any, and will be given any other instructions before leaving the hospital. Instructions will include details about if you need to change your diet, as well as the need for rehabilitative and/or speech therapy.
Your medical team will talk with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention, and/or other conditions.
Your provider will talk to you about any changes to activity level and nutritional needs you may have, depending on the surgery you had.
How can I care for myself?
You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.
Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.
There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.
Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.
- Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.
Álvarez-Marcos, C., Benito, A.V., Fernández, A.G. et al. Asymptomatic swallowing disorders may be present in individuals with laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy. Eur Arch Otorhinolaryngol 279, 995–1001 (2022). https://doi-org.proxy.library.upenn.edu/10.1007/s00405-021-06861-y
Kuo DY, Chang MH, Wang SY, Hsieh PY, Shueng PW. Unusual axillary metastasis of recurrent nasopharyngeal cancer: A case report. Medicine (Baltimore). 2017 May;96(20):e6854. doi: 10.1097/MD.0000000000006854. PMID: 28514301; PMCID: PMC5440138.
Peng, G., Wang, T., Yang, KY, et al. A prospective, randomized study comparing outcomes and toxicities of intensity-modulated radiotherapy vs. conventional two-dimensional radiotherapy for the treatment of nasopharyngeal carcinoma. Radiother Oncol, 104 (2012), pp. 286-293
Wang, Dong et al. “Salvage Treatments for Locally Recurrent Nasopharyngeal Cancer: Systematic Review and Meta‐analysis.” Head & neck. 45.2 (2023): 503–520. Web.
You, R., Zou, X., Hua, Y.-J., Han, F., Li, L., Zhao, C., Hong, M.-H., & Chen, M.-Y. (2015). Salvage endoscopic nasopharyngectomy is superior to intensity-modulated radiation therapy for local recurrence of selected T1–T3 nasopharyngeal carcinoma – A case-matched comparison. Radiotherapy and Oncology, 115(3), 399–406. https://doi.org/10.1016/j.radonc.2015.04.024