Stages

If nasophyaryngeal cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

The Spreading of Cancer

There are three ways that cancer spreads in the body:

Through tissue. Cancer invades the surrounding normal tissue.

Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary tumor and travel through the lymph or blood to other places in the body, another, or secondary tumor, may form. This process is called metastasis. The secondary, or metastatic, tumor is the same type of cancer as the primary tumor. For example, if nasopharyngeal cancer spreads to the bones, the cancer cells in the bones are actually nasopharyngeal cancer cells. The disease is metastatic nasopharyngeal cancer, not bone cancer.

Stages of Nasopharyngeal Cancer

Stage 0 (Carcinoma in Situ) - In stage 0, abnormal cells are found in the lining of the nasopharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I - In stage I, cancer has formed and is found in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity.

Stage II - In stage II, the cancer is found in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity. Cancer has spread to one or more lymph nodes on one side of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are six centimeters or smaller. Or, the cancer is found in the parapharyngeal space. Cancer may have spread to one or more lymph nodes on one side of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are six centimeters or smaller.

Stage III - In stage III, the cancer is found in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity. Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are six centimeters or smaller or found in the parapharyngeal space. Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are six centimeters or smaller or it has spread to nearby bones or sinuses. Cancer may have spread to one or more lymph nodes on one or both sides of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are six centimeters or smaller.

Stage IV - Stage IV nasopharyngeal cancer is divided into stages IVA, IVB, and IVC.

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 one or more lymph nodes on one or both sides of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are six centimeters or smaller.

Stage IVB: Cancer has spread to lymph nodes between the collarbone and the top of the shoulder and/or the affected lymph nodes are larger than six centimeters.

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

Knowing the stage assists the doctor in determining a prognosis. It also better helps you understand the care and treatment that will be required. Generally, treatment for the different stages are as follows:

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

Stage II - Treatment of stage II may include chemotherapy combined with radiation therapy and/or radiation therapy to the tumor and lymph nodes in the neck.

Stage III - Treatment of stage III may include chemotherapy combined with radiation therapy and/or radiation therapy to the tumor and lymph nodes in the neck and/or radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy. Clinical trials may also be used to treat the cancer.

Stage IV - Treatment of stage IV may include chemotherapy combined with radiation therapy and/or radiation therapy to the tumor and lymph nodes in the neck and/or radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy. Also chemotherapy for cancer that has metastasized (spread) to other parts of the body may be used and clinical trials of chemotherapy before, combined with, or after radiation therapy.

Following treatment, it is important to have careful head and neck examinations to look for recurrence. Check-ups will be done monthly in the first year, every 2 months in the second year, every 3 months in the third year, and every 6 months thereafter.

In all cases, treatment should be individualized for you. Although cancers are classified into particular stages, each person is unique.

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