Nasopharyngeal squamous cell carcinoma (SCC)

Scottish Cancer Network: Clinical Management Pathways
NHS National Services Scotland
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This consensus document is not a rigid constraint on clinical practice, but a concept of good practice against which the needs of the individual patient should be considered. It therefore remains the responsibility of the individual clinician to interpret the application of the Clinical Management Pathway (CMP), taking into account local service constraints and the needs and wishes of the patient. It is not intended that these consensus documents are applied as rigid clinical protocols.

Surgical assessment

Consider flexible nasoendoscopy/EUA and biopsy.

Surgery

  • Surgery is generally reserved for other non SCC nasopharyngeal pathological subtypes, e.g. sarcoma or primary salivary gland malignancy, or for recurrence/residual disease following radical radiotherapy where this is considered resectable.  

  • Consider deploying endoscopic resection where feasible to minimise morbidity.  

  • Where open surgery is considered necessary, consider a combined open-endoscopic procedure to optimise margin visualisation. 

  • Salvage surgery is likely to result in carotid exposure and flap repair should therefore be considered. 

Salvage surgery

Consider prior to initiating any management for salvage:

  1. Balance of chance of long term control/cure versus.
  2. Likely acute and late morbidity from additional treatment.
  3. Likelihood of requiring adjuvant treatment to achieve disease control/cure and patient suitability and likelihood to be offered this depending on patient factors and previous treatment.
  4. Alternative non-curative options.

Counsel patients carefully on all these factors prior to commencing salvage treatment pathway.

  • Salvage surgery may be possible in the event of low volume recurrence at the primary site. Consider endoscopic nasopharyngectomy.

  • Where salvage surgery is likely to result in carotid exposure flap repair should be considered.

  • Patients with relapse at the primary site as well as regional recurrence have a poor prognosis.

  • Patients with a short disease-free interval have a poor prognosis

Editorial Information

Last reviewed: 02/06/2025

Next review date: 02/06/2028

Author(s): Jeremy McMahon, on behalf of the Surgery subgroup.

Version: 1

Reviewer name(s): David Conway.