General Information About Nasopharyngeal Cancer

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 oropharynx (the part of the throat behind the mouth).

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

Anything that increases your risk of getting a disease is called a risk factor. Risk factors may include the following:

• Chinese or Asian ancestry.

• Exposure to the Epstein-Barr virus: The Epstein-Barr virus has been associated with certain cancers, including nasopharyngeal cancer and some lymphomas.

Possible signs of nasopharyngeal cancer include trouble breathing, speaking, or hearing.

These and other symptoms may be caused by nasopharyngeal cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• 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 of the throat: An exam in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.

• 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.

• 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.

• Head and chest x-rays: An x-ray of the skull and organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

• 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 malignanttumorcells in the body. A small amount of radioactiveglucose (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.

• Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.

• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

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.

Stages of Nasopharyngeal Cancer

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.

The following stages are used for nasopharyngeal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0 nasopharyngeal cancer, cancer is found only in the lining of the nasopharynx. Stage 0 cancer is also called carcinoma in situ.

Stage I

In stage I nasopharyngeal cancer, cancer is found only in the nasopharynx.

Pea, peanut, walnut, and lime show tumor sizes.

Stage II

Stage II nasopharyngeal cancer is divided into stage IIA and stage IIB as follows:

• Stage IIA: Cancer has spread from the nasopharynx to the oropharynx (the middle part of the throat that includes the soft palate, the base of the tongue, and the tonsils), and/or to the nasal cavity.

• Stage IIB: Cancer is found in the nasopharynx and has spread to lymph nodes on one side of the neck, or has spread to the area surrounding the nasopharynx and may have spread to lymph nodes on one side of the neck. The involved lymph nodes are 6 centimeters or smaller.

Stage III

In stage III nasopharyngeal cancer, the cancer:

• is found in the nasopharynx and has spread to lymph nodes on both sides of the neck and the lymph nodes are 6 centimeters or smaller; or

• has spread into the soft tissues (oropharynx and/or nasal cavity) and to lymph nodes on both sides of the neck and the lymph nodes are 6 centimeters or smaller; or

• has spread beyond the soft tissues into areas around the pharynx and to lymph nodes on both sides of the neck and the lymph nodes are 6 centimeters or smaller; or

• has spread to nearby bones or sinuses and may have spread to lymph nodes on one or both sides of the neck and the involved lymph nodes are 6 centimeters or smaller.

Stage IV

Stage IV nasopharyngeal cancer is divided into stage IVA, stage IVB, and stage IVC as follows:

• Stage IVA: Cancer has spread beyond the nasopharynx and may have spread to the cranial nerves, the hypopharynx (bottom part of the throat), areas in and around the side of the skull or jawbone, and/or the bone around the eye. Cancer may also have spread to lymph nodes on one or both sides of the neck, and the involved lymph nodes are 6 centimeters or smaller.

• Stage IVB: Cancer has spread to lymph nodes above the collarbone and/or the involved lymph nodes are larger than 6 centimeters.

• Stage IVC: Cancer has spread beyond nearby lymph nodes to other parts of the body.

Recurrent Nasopharyngeal Cancer

Recurrent nasopharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the nasopharynx or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with nasopharyngeal cancer.

Different types of treatment are available for patients with nasopharyngeal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may test the thyroid gland before and after therapy to make sure it is working properly. It is also important that a dentist check the patient’s teeth, gums, and mouth, and fix any existing problems before radiation therapy begins.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Surgery

Surgery is a procedure to find out whether cancer is present, to remove cancer from the body, or to repair a body part. Also called an operation. Surgery is sometimes used for nasopharyngeal cancer that does not respond to radiation therapy. If cancer has spread to the lymph nodes, the doctor may remove lymph nodes and other tissues in the neck.

New types of treatment are being tested in clinical trials. These include the following:

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Intensity-modulated radiation therapy

Intensity-modulated radiation therapy (IMRT) is a type of 3-dimensional radiation therapy that uses computer-generated images to show the size and shape of the tumor.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

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 combined with radiation therapy.

• 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 combined with radiation therapy.

• Radiation therapy to the tumor and lymph nodes in the neck.

• 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 before, combined with, or after radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Stage IV Nasopharyngeal Cancer

Treatment of stage IV nasopharyngeal cancer may include the following:

• Chemotherapy combined with radiation therapy.

• Radiation therapy to the tumor and lymph nodes in the neck.

• 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 before, combined with, or after radiation therapy.

• A clinical trial of new radiation therapy such as intensity-modulated radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Treatment Options for Recurrent Nasopharyngeal Cancer

Treatment of recurrent nasopharyngeal cancer may include the following:

• External radiation therapy plus internal radiation therapy.

• Surgery.

• Chemotherapy.

• A clinical trial of biologic therapy and/or chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Changes to This Summary (07/26/2007)

The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Images were added to this summary.

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PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

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A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

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