Possible problems after nasopharyngeal cancer surgery
There is a risk of problems or complications after any operation.
Possible problems after nasopharyngeal cancer surgery include changes in chewing and eating. Other risks include infection, blood clots and bleeding.
Many problems are minor but some can be life threatening. Treating them as soon as possible is important.
Risk of infection
You are at risk of getting an infection after an operation. This includes a wound, chest or urine infection. You might have antibiotics to reduce the risk of developing an infection after surgery. Tell your doctor or nurse if you have any symptoms of infection.
They include:
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a change in your temperature - 37.5°C or higher or below 36°C
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flu-like symptoms - feeling cold and shivery, headaches, and aching muscles
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pain having a wee, going more often or cloudy or foul-smelling wee
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feeling generally unwell - not able to get out of bed
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a sore throat or sore mouth
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skin changes – redness, feeling hot, swelling or pain
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pain, redness, discharge, swelling or heat at the site of a wound or intravenous line
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feeling sick
Contact your 24 hour advice line straight away if you think you might have an infection. Treating it early can stop it becoming a more serious problem.
Blood clots
Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery because you might not move about as much as usual. Clots can block the normal flow of blood through the veins. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.
There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs, causing a blockage there (a pulmonary embolism). Symptoms include:
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shortness of breath
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chest pain
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coughing up blood
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feeling dizzy or lightheaded
If you have any symptoms of a blood clot when you are at home, you should contact a doctor immediately. This might be your emergency GP service. Or call 999 or go to your nearest accident and emergency department (A&E).
To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.
Your nurse might teach you to do these injections yourself before you go home. Or a district nurse might come to your home to do them.
It's important to continue wearing compression stockings if you have been told to by your doctor.
Blood collecting around the operation site (haematoma)
You might have a wound drain to stop blood and fluid collecting in the area of the operation. This helps your wound to heal and prevents infection. Sometimes the drainage tubes become blocked. This can cause blood to collect under the skin and form a clot (haematoma). This can cause pain and swelling. The area might also feel hard.
The haematoma normally goes away on its own, but it can take a few weeks or months. Tell your doctor or nurse if you have any swelling around the wound.
Changes to speech, chewing and swallowing
Your surgeon will always try to avoid changes to your speech, chewing, or swallowing as much as they can. Sometimes this isn't possible and this can be hard to deal with.
You may see a speech and language therapist (SLT) before you start treatment if surgery is likely to affect your swallowing. Your SLT can assess your swallowing during and after treatment. They can teach you exercises to support you with swallowing difficulties. And they work with a dietitian if you are finding it difficult to eat.
Loss of sense of smell and taste
Your sense of smell can change after some types of surgery. This usually improves over time, but for some people, the loss of smell might be long term.
How things taste may also change. In time, you are likely to recover from this. But this does vary from person to person. Some people might find their sense of taste is permanently dulled.
Bleeding from the wound
If you have a wound you may have a small amount of blood on your wound dressing after surgery, which is normal.
Your nurse will regularly check your dressing after the operation. Tell your doctor or nurse straight away if there is more bleeding.
Numbness around the surgical area
The area around the surgery site might be numb. The sensation usually comes back after a few weeks. But sometimes it can take several months. Or it might be permanently altered.
Changes to your eyesight
If your surgery affects the eye socket, you might have swelling and bruising around the eye. This is usually only a temporary problem.
You might notice your eyes water more often. Or you might have double vision after surgery. This is often temporary but if it persists, you may need treatment.
Changes to your hearing
Sometimes the swelling at the back of the nose caused by surgery can reduce your hearing, due to fluid collecting in the middle ear space. This is usually only a temporary problem while you recover. Your hearing should get back to normal when the swelling goes down but this can be treated if it persists.
Swelling and lymphoedema
After surgery for nasopharyngeal cancer and 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 should begin to settle soon after your surgery, it can sometimes take longer. 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.
Exercises
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 it 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.
Exercises for head and neck lymphoedema
Hi, I’m Carla. I’m going to show you how to do head and neck exercises. Remember to do your deep abdominal breathing exercises before and after. Each exercise you will do 5 to 10 times and very important, pain free.
Neck exercises
We’ll start with the head and neck. We’ll do looking to the side, back to the middle and to the other side. It’s normal to feel a bit of stretch sensation.
Next one will be ear to the shoulder, not shoulder to the ear. Go back to the middle and to the other side. If you’re not sure you’re doing it right, sometimes it’s helpful to do it in front of a mirror.
Next one will be chin to the chest and back to start position.
Shoulder exercises
Next one will be shoulders. We’ll go up, relax and down and relax.
Next one will be circles. And we go backwards and then forward.
Mouth exercises
We’ll do as well mouth exercises. We’ll start with open and close. Blowing kisses, blowing candles, exaggerated smile. And then you say the vowels in an exaggerate way
Jaw exercises
And we’ll do as well the jaw exercises. We’ll do side to side first.
And then moving the jaw forward and the back to normal.
Remember to do the deep abdominal breathing at the end, repeat them once a day minimum and if you have any concerns just call your doctor or lymphoedema specialist.
Find out more about lymphoedema on the Cancer Research UK website.
A stiff jaw
You might have a stiff jaw afterwards and have problems opening your mouth fully. This is called trismus. Your doctor or speech and language therapist will show you exercises to help reduce the stiffness.
Coping
It can be very difficult to cope with some of the changes after surgery for nasopharyngeal cancer. Changes in how you look and how you eat and drink can affect your self esteem. Most changes are temporary, but some can be permanent.
Contact your healthcare team or specialist nurse to let them know how you feel. They can help you and explain what support is available in your area.
