Nasopharyngeal Cancer Treatments, Stages, Causes & Symptoms

Key points

Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasopharynx.
Ethnic background and being exposed to the Epstein-Barr virus can affect the risk of nasopharyngeal cancer.
Signs of nasopharyngeal cancer include trouble breathing, speaking, or hearing.
Tests that examine the nose and throat are used to detect (find) and diagnose nasopharyngeal cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.

Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasopharynx.

The nasopharynx is the upper part of the pharynx (throat) behind the nose. The pharynx is a hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). Air and food pass through the pharynx on the way to the trachea or the esophagus. The nostrils lead into the nasopharynx. An opening on each side of the nasopharynx leads into an ear. Nasopharyngeal cancer most commonly starts in the squamous cells that line the nasopharynx.

Nasopharyngeal cancer is a type of head and neck cancer.

Ethnic background and being exposed to the Epstein-Barr virus can affect the risk of nasopharyngeal cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for nasopharyngeal cancer include the following:

Having Chinese or Asian ancestry.
Being exposed to the Epstein-Barr virus: The Epstein-Barr virus has been associated with certain cancers, including nasopharyngeal cancer and some lymphomas.
Drinking large amounts of alcohol.

Nasopharyngeal Cancer Risk Factors

Epstein-Barr Virus (EBV)

The Epstein-Barr virus (EBV) is a member of the herpes virus family (human herpesvirus 4). EBV is found worldwide and is a common cause of viral pharyngitis, especially in young adults. EBV is transmitted from person to person and then infects human B cells, which in turn spread the infection throughout the entire reticuloendothelial system (RES, or the liver, spleen, and peripheral lymph nodes). About 50% of the population has antibodies to the virus by age 5; about 12% of susceptible adults (college-age) develop antibodies to the virus, and one half of those adults develop the disease termed mononucleosis (also termed infectious mononucleosis, mono, glandular fever, and kissing disease), which produces symptoms of lymph node, spleen, and liver swelling, fever, inflamed throat, malaise, and rash.

Signs of nasopharyngeal cancer include trouble breathing, speaking, or hearing.

These and other signs and symptoms may be caused by nasopharyngeal cancer or by other conditions. Check with your doctor if you have any of the following:

A lump in the nose or neck.
A sore throat.
Trouble breathing or speaking.
Nosebleeds.
Trouble hearing.
Pain or ringing in the ear.
Headaches.

Tests that examine the nose and throat are used to detect (find) and diagnose nasopharyngeal cancer.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as swollen lymph nodes in the neck or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The tissue sample is removed during one of the following procedures:
- Nasoscopy: A procedure to look inside the nose for abnormal areas. A nasoscope is inserted through the nose. A nasoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
- Upper endoscopy: A procedure to look at the inside of the nose, throat, esophagus, stomach, and duodenum (first part of the small intestine, near the stomach). An endoscope is inserted through the mouth and into the esophagus, stomach, and duodenum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples. The tissue samples are checked under a microscope for signs of cancer.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. PET scans may be used to find nasopharyngeal cancers that have spread to the bone. Sometimes a PET scan and a CT scan are done at the same time. If there is any cancer, this increases the chance that it will be found.
Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the blood sample made up of red blood cells.
Epstein-Barr virus (EBV) test: A blood test to check for antibodies to the Epstein-Barr virus and DNA markers of the Epstein-Barr virus. These are found in the blood of patients who have been infected with EBV.
Hearing test: A procedure to check whether soft and loud sounds and low- and high-pitched sounds can be heard. Each ear is checked separately.

QUESTION

Cancer is the result of the uncontrolled growth of abnormal cells anywhere in the body.
See Answer

After nasopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the nasopharynx or to other parts of the body.

The process used to find out whether cancer has spread within the nasopharynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose nasopharyngeal cancer are often also used to stage the disease. (See the General Information section.)

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

Tissue. The cancer spreads from where it began by growing into nearby areas.
Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if nasopharyngeal cancer spreads to the lung, the cancer cells in the lung are actually nasopharyngeal cancer cells. The disease is metastatic nasopharyngeal cancer, not lung cancer.

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Treatment options by stage

Stage I Nasopharyngeal Cancer

Treatment of stage I nasopharyngeal cancer is usually radiation therapy to the tumor and lymph nodes in the neck.

Stage II Nasopharyngeal Cancer

Treatment of stage II nasopharyngeal cancer may include the following:

Chemotherapy given with radiation therapy, followed by more chemotherapy.
Radiation therapy to the tumor and lymph nodes in the neck.

Stage III Nasopharyngeal Cancer

Treatment of stage III nasopharyngeal cancer may include the following:

Chemotherapy given with radiation therapy, which may be followed by more chemotherapy.
Radiation therapy.
Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy.
A clinical trial of chemotherapy given before, with, or after radiation therapy.

Stage IV Nasopharyngeal Cancer

Treatment of stage IV nasopharyngeal cancer may include the following:

Chemotherapy given with radiation therapy, followed by more chemotherapy.
Radiation therapy.
Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy.
Chemotherapy for cancer that has metastasized (spread) to other parts of the body.
A clinical trial of chemotherapy given before, with, or after radiation therapy.

Treatment options for recurrent nasopharyngeal cancer

Treatment of recurrent nasopharyngeal cancer may include the following:

Intensity-modulated radiation therapy, stereotactic radiation therapy, or internal radiation therapy.
Surgery.
Chemotherapy.
A clinical trial of chemotherapy.
A clinical trial of stereotactic radiation therapy.

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Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer (whether it affects part of the nasopharynx, involves the whole nasopharynx, or has spread to other places in the body).
The type of nasopharyngeal cancer.
The size of the tumor.
The patient’s age and general health.