Nasopharyngeal Cancer


General Information

What is 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.

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 or by other conditions. 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 examination of the throat: An examination 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. Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.

Nasoscopy: A procedure in which a doctor inserts a nasoscope (a thin, lighted tube) into the patientís nose to look for abnormal areas.

Neurological tests: An examination in which the doctor tests hearing and nerve function.

Head and chest x-rays: Brief exposure of the skull and chest to radiation to produce images of internal organs and structures.

MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).

CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

Laboratory tests: Medical procedures that involve testing samples of blood, urine, or other substances or tissues in the body to help determine the diagnosis, plan and check treatment, or monitor the course of disease over time.

Biopsy: The removal of cells, tissues, or fluid to view under a microscope and check for signs of disease.

Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on 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, and the patient's age and general health.

Stages of Nasopharyngeal Cancer

The following stages are used for nasopharyngeal cancer:

Stage 0 (Carcinoma in Situ)
Stage I
Stage II
Stage III
Stage IV

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 the best 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 in the lining of the nasopharynx only. Stage 0 cancer is also called carcinoma in situ.

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

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 cancer has spread to the area surrounding the nasopharynx and may have spread to lymph nodes on one side of the neck.

Stage III
Stage III nasopharyngeal cancer may include the following:

-Cancer is found in the nasopharynx and has spread to lymph nodes on both sides of the neck.
-Cancer has spread to the oropharynx and/or the nasal cavity and to lymph nodes on both sides of the neck.
-Cancer has spread to nearby bones or sinuses, with or without spreading to lymph nodes on one or both sides of the neck.

Stage IV

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

Stage IVA: Cancer has spread to other areas in the head and may have spread to lymph nodes on one or both sides of the neck, and the involved lymph nodes are smaller than 6 centimeters (less than 2 inches).

Stage IVB: Cancer has spread to lymph nodes above the collarbone and/or the involved lymph nodes are larger than 6 centimeters (more than 2 inches).

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. Recurrent nasopharyngeal 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. 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 the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Nasopharyngeal cancer is treated with external and internal radiation. Radiation may be used alone or in addition to chemotherapy or surgery.

External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may wish to test the thyroid gland before and after therapy to make sure it is working properly. Having a dentist evaluate dental health and correct any existing problems is particularly important prior to beginning radiation therapy.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Surgery
Surgery is removing the cancer in 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.

Other types of treatment are being tested in clinical trials:

Biological therapy
Biological therapy is treatment to stimulate the ability of the 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 disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

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 persist 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.

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 persist 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.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

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 biological 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.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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