What is Nasopharyngeal Cancer?
The nasopharynx is the upper part of the throat (pharynx) that lies behind the nose. It is a box-like chamber about one and a half inches on each edge. It lies just above the soft part of the roof of the mouth (soft palate) and just in back of the entrance into the nasal passages.
Several types of tumors can develop in the nasopharynx. Some of these tumors are benign but others are malignant. Benign tumors of the nasopharynx are fairly rare and tend to occur in children and young adults. They include tumors or malformations of the vascular (blood-carrying) system, such as angiofibromas and hemangiomas, and benign tumors of the minor salivary glands that are found within the nasopharynx. Treatment of these tumors (if it is needed) is different from that for cancerous nasopharyngeal tumors.
Malignant Nasopharyngeal Tumors
Malignant tumors can invade surrounding tissue and spread to other parts of the body. If your cancer spreads to the bone, visit our bone metastases page.
Following are the most common malignant nasopharyngeal tumors:
Nasopharyngeal Carcinoma - This is the most common malignant tumor of the nasopharynx. A carcinoma is a cancer that starts in epithelial cells -- the cells lining the internal and external surfaces of the body. This tumor has three types: The Keratinizing Squamous Cell Carcinoma, the Non-Keratinizing Differentiated Carcinoma and the Undifferentiated Carcinoma.
These types all start from the same cell type – the epithelial cells that cover the surface lining of the nasopharynx. The treatment is also usually the same for all types of nasopharyngeal cancer.
Lymphoma - Lymphomas can sometimes start in the nasopharynx. They are cancers of immune system cells called lymphocytes, cells that are normally found in the nasopharynx.
Adenocarcinoma and Adenoid Cystic Carcinoma - These are cancers that can develop in the minor salivary glands found in the nasopharynx.
Research is increasing regarding what we know about nasopharyngeal cancer. Scientists are learning more about its causes. Following are common risk factors for the disease:
- 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.)
- Drinking large amounts of alcohol
- Smoking tobacco
- Diets with very high salt content such as cured fish and meat
- Family history of Nasopharyngeal cancer
Signs and Symptoms
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
- Trouble hearing
- Pain or ringing in the ear
- Double vision
- If a patient has symptoms that could be nasopharyngeal cancer, the doctor will test for fever and high blood pressure and check general signs of health. The patient will likely have one or more of the following tests:
- An exam in which the doctor feels for swollen lymph nodes in the neck and looks down
- A procedure to look inside the nose for abnormal areas. A nasoscope is inserted through the nose. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
- A procedure to look inside the nose for abnormal areas. A nasal endoscope is inserted through the nose. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
- 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.
- 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).
- 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.
- 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 and other areas that are metabolically active such as working muscle or brain tissue show up brighter in the picture because they take up more glucose than normal cells do. PET scans may be used to find nasopharyngeal cancers that have spread to the bone or other parts of the body.
- 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.
- The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
If nasopharyngeal 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.
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 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 primary cancer may be more advanced, with the tumor extending to bony structures of the skull base, cervical vertebra, pterygoid plates and/or the nasal sinuses. Some less advanced primary cancers can also be stage III when cancer spreads 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.
Stage IV - Stage IV nasopharyngeal cancer is divided into stages IVA and IVB
Stage IVA: The primary cancer is very advanced and 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. Less advanced primary tumors can also be stage IVa if they have spread to lymph nodes between the collarbone and the top of the shoulder and/or the affected lymph nodes are larger than six centimeters. These cancers have not spread to other parts of the body.
Stage IVB: These cancers have spread to other parts of the body such as distant metastases to the lungs or bone.
Knowing the stage assists the doctor in determining a prognosis. It also better helps you understand the care and treatment that will be required.
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. (A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer)
Your treatment options depend on the stage of cancer, your overall health and your preferences about treatment. In metastatic disease, the location and extent of the cancer is also an important consideration.
While timely treatment of any cancer is important, you should not rush your decision and should consider your options carefully. Ask questions if you do not understand any aspect of treatment or the terms your doctors are using. Research shows that cancer survivors of all educational levels and backgrounds can have a hard time communicating with their health care team. One of the best ways to improve communication with your health care team is to prepare your visits so that you can best make use of the time.
A treatment plan is a way to deal with both the short and long term goals of managing your nasopharyngeal cancer. There are several treatment options, depending on the cancer stage and the patient’s age and general health. Patients have time for second opinions and to talk through all of their options with their doctors and develop a treatment plan that best fits their needs.
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Treatment Options & Side Effect Management of Nasopharyngeal Cancer
Surgery is a treatment for nasopharyngeal cancer. 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.
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.
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). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Side Effects Management
It helps to learn more about the side effects from your treatment(s) before you begin, so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment.
There are effective and readily available medications to address traditional side effects from cancer treatment (such as nausea, diarrhea, constipation and mouth sores.) Also, as newer 'targeted therapies' become available, they tend to leave people with fewer traditional side effects.
Keep in mind that everyone reacts differently to treatment and experiences side effects differently. There are coping mechanisms and strategies that can help.
Side Effects from Nasopharyngeal Treatments
If a neck dissection is necessary, side effects will occur. The most common side effects of any neck dissection are numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. These side effects are caused by injury during the operation to certain nerves that supply these areas. You may also get swelling, or lymphedema, to the area of the neck above the neck incision.
Side effects of external radiation therapy may include skin changes, nausea and vomiting, diarrhea, fatigue, painful sores in the mouth and throat and dry mouth, thick saliva and taste disturbance. Most side effects of radiation are temporary, but some rare serious side effects can be permanent. In some cases, radiation to the chest can also cause lung damage, which may lead to problems breathing and shortness of breath.
Chemotherapy has different side effects depending on the type and dose of drugs given and the length of time they are taken. These side effects can include hair loss, hearing loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, increased chance of infections (due to low white blood cell counts), easy bruising or bleeding (due to low blood platelet counts) and fatigue (due to low red blood cell counts.)