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List of All Topics
Nasopharyngeal Carcinoma
Introduction
Nasopharyngeal carcinoma is cancer that occurs in the nasopharynx, which is located behind the nose and above the back of the throat. The nasopharynx is the upper portion of the pharynx — a 5-inch tube that extends from behind the nose to the top of the windpipe and esophagus in your neck.
Nasopharyngeal carcinoma is rare in the United States, comprising only 2 percent of all head and neck cancers. About 2,000 people are diagnosed with nasopharyngeal carcinoma every year in the United States. In other parts of the world — specifically Southeast Asia and northern Africa — nasopharyngeal carcinoma occurs much more frequently.
Men are more likely than women to develop nasopharyngeal carcinoma. It's most commonly diagnosed in people from age 30 to age 60, though nasopharyngeal carcinoma can also occur in older adults and in children.
Nasopharyngeal carcinoma causes signs and symptoms that may suggest a variety of diseases and conditions. That fact, combined with the hidden location of the nasopharynx, means most people aren't diagnosed with nasopharyngeal carcinoma until the cancer has spread. Unfortunately, as nasopharyngeal carcinoma becomes more advanced, it also becomes more difficult to treat.
Signs And Symptoms
Signs and symptoms of nasopharyngeal carcinoma may include:
- A lump in the neck caused by a swollen lymph node.
- Bloody discharge from the nose.
- Nasal congestion on one side of your nose.
- Hearing loss in one ear.
- Frequent ear infections.
- Headaches.
- Double vision.
- Face and neck pain.
- A feeling of fullness in the throat and sinus areas.
All cancers begin with one or more genetic mutations that cause cells to grow out of control, invade surrounding structures and eventually spread (metastasize) to other parts of the body. Nasopharyngeal carcinomas begin in the squamous cells that line the surface of the nasopharynx.
In many cases, it isn't clear what causes the gene mutations that lead to nasopharyngeal carcinoma, though risk factors that increase the risk of this cancer have been identified. However, it isn't clear why some people with all the risk factors never develop cancer, while others who have no apparent risk factors do.
Treatment
You and your doctor work together to devise a treatment plan based on several factors, such as the stage of your cancer, the type of cells involved, your treatment goals and the side effects you're willing to tolerate. Treatment for nasopharyngeal carcinoma usually begins with radiation therapy. While surgery is the mainstay of treatment for many cancers, navigating the nasopharynx with surgical tools is delicate. Nasopharyngeal carcinoma is particularly sensitive to radiation therapy, making it the first line of treatment. Surgery and chemotherapy are used in certain cases.
Radiation
Radiation therapy treats cancer with high-energy beams. Radiation therapy destroys quickly growing cells, including cancer cells, in the area where the beams are focused. During treatment you're positioned on a table and a large machine is maneuvered around you to the precise spot where it can target your cancer. You typically receive radiation treatment five days a week for six or seven weeks. You'll also receive radiation to your neck, even if there's no evidence your cancer has spread beyond your nasopharynx. This reduces the chance that your cancer will spread and the chance that your cancer will recur.
Radiation therapy carries a risk of side effects, including hearing loss, dry mouth, sores in the mouth and throat, and an increased risk of tongue cancer and bone cancer. Your nasopharynx is situated among some delicate organs, such as your brain, spinal cord, thyroid gland, eyes and ears. Your radiation therapy team works to protect these organs, but that can't always be done.
Internal radiation therapy (brachytherapy) is sometimes used in recurrent nasopharyngeal carcinoma. With this treatment, radioactive seeds or wires are positioned in the tumor or very close to it.
Chemotherapy
Chemotherapy uses drugs to treat cancer. Unlike radiation therapy, which is focused on one part of your body, chemotherapy travels throughout your body. Chemotherapy works by attacking quickly growing cells, including cancer cells. Some healthy cells are also killed by chemotherapy, which can cause side effects, including fatigue, hair loss, and nausea and vomiting. Chemotherapy may be used to treat nasopharyngeal carcinoma in three ways:
- Chemotherapy at the same time as radiation therapy (concomitant therapy). Chemotherapy enhances the effectiveness of radiation therapy. Using the two treatments together may reduce the need for high doses of radiation, which reduces the side effects associated with radiation therapy. Chemotherapy also reduces the risk that your body will become resistant to radiation therapy. However, side effects of chemotherapy are added to the side effects of radiation therapy, making concomitant therapy difficult to tolerate.
- Chemotherapy after radiation therapy (adjuvant therapy). Your doctor might recommend adjuvant chemotherapy after radiation therapy alone or after concomitant therapy. Adjuvant chemotherapy is used to attack any remaining cancer cells in your body, including those that may have broken off from the original tumor and spread elsewhere. Some controversy exists as to whether adjuvant chemotherapy actually improves survival in people with nasopharyngeal carcinoma. Many people who undergo adjuvant therapy after concomitant therapy are unable to tolerate the side effects and must discontinue treatment.
- Chemotherapy before radiation therapy (neoadjuvant therapy). Neoadjuvant chemotherapy works in the same way as adjuvant chemotherapy, but it's administered before radiation therapy alone or before concomitant therapy. Some people find they experience fewer side effects if they undergo chemotherapy before the rest of their treatment. However, little research has been done on neoadjuvant chemotherapy, so it's considered experimental.
Surgery
Surgery is usually reserved for recurrent nasopharyngeal carcinoma. Surgery to remove cancerous lymph nodes in the neck is the most common surgery for nasopharyngeal carcinoma. Surgery to remove a tumor from the nasopharynx requires surgeons to make an incision in the roof of your mouth in order to access the area.
Prevention
No sure way exists to prevent nasopharyngeal carcinoma. However, you can take steps to reduce your risk of the disease. For instance, cut back on the amount of salt-cured foods and preserved meats that you eat, or avoid these foods altogether. Chinese people who immigrate to North America and adopt a typical American diet have a reduced risk of nasopharyngeal carcinoma. However, the risk never completely goes away, which indicates that other unknown or uncontrollable risk factors may play a role in developing nasopharyngeal carcinoma.
Information obtained from National Institute of Health