Nasopharyngeal cancer (cancer of the nasopharynx)

Nasopharyngeal cancer (cancer of the nasopharynx) is a type of head and neck cancer.

 

I hope this information answers your questions. You may find it helpful to read it alongside our general information about head and neck cancers.

If you have any further questions, you can ask your doctor or nurse at the hospital where you are having your treatment.

The nasopharynx

 

The nasopharynx is an air cavity lying at the back of the nose and above the soft part of the palate (roof of the mouth) - see diagram below. It connects the nose to the back of the mouth (oropharynx), allowing you to breathe through your nose and swallow mucus produced by the lining membranes of the nose.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Side view of structures in the head and neck 

View a large copy of the side view of structures in the head and neck image 

 

Nasopharyngeal cancer

 

This type of cancer is rare in the West, but is much more common in the Far East.

It can occur at any age, but is more likely to be found in people aged 50-60. It affects more men than women.

There are different types of nasopharyngeal cancer. They are named after the specific type of cell within the nasopharynx that has become cancerous.

Most nasopharyngeal cancers are squamous cell carcinomas. They develop in the cells that line the nasopharynx. The more common types, which are all treated in a similar way, are:

keratinising squamous cell carcinoma (type 1)

non-keratinising carcinoma: differentiated (type 2) and undifferentiated (type 3)

basaloid squamous carcinoma.

There are other types of cancer that can develop in the nasopharynx, such as melanoma, lymphoma and sarcoma. These are much rarer and are treated in different ways.

Causes and risk factors of nasopharyngeal cancer

 

The exact cause of nasopharyngeal cancer is unknown. In some areas of the world, such as China and North Africa, dietary factors (such as the cooking of salt-cured fish and meat, which releases chemicals known as nitrosamines) are thought to increase a person's risk of developing the disease.

The Epstein-Barr virus (which causes glandular fever) has also been linked to an increased risk of developing nasopharyngeal cancer. As with other cancers, nasopharyngeal cancer isn't infectious and can't be passed on to other people.

 

Signs and symptoms of nasopharyngeal cancer

 

One of the first symptoms is often a painless swelling or lump in the upper neck. Other symptoms may include any of the following:

a headache

a blocked nose

nosebleeds

changes in hearing

ringing in the ears (tinnitus).

These symptoms are common in conditions other than cancer and most people with these symptoms won't have nasopharyngeal cancer. However, like most cancers, nasopharyngeal cancer is best treated when diagnosed at an early stage. Therefore, it’s important to have any of these symptoms checked out by your GP if they don’t improve after a few days.

 

How nasopharyngeal cancer is diagnosed

 

Your GP will examine your mouth, throat and ears. They will refer you to a hospital for any further tests and for specialist advice and treatment.

The specialist will examine your nasopharynx by using a very thin, flexible tube with a light at the end (nasendoscope). The tube will be passed into your nostril to get a better view of the back of your nose. This can be uncomfortable and you may be given a local anaesthetic spray to numb your nose and throat. If you do have a local anaesthetic to your throat, you may be told not to eat or drink anything for about an hour afterwards, or until your throat has lost the numb feeling.

To make a diagnosis, a piece of affected tissue will be removed and examined under a microscope (biopsy). This is carried out under a general anaesthetic so you may need to spend the night in hospital.

 

Further tests for nasopharyngeal cancer

 

You may have blood tests and a chest x-ray to check your general health. There are several other tests that may be used to help diagnose nasopharyngeal cancer and to check whether it has spread. Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body's defence against infection and disease. It’s made up of a network of lymph nodes or glands that are linked by fine ducts containing lymph fluid.

The results of these tests will help the specialist to decide on the best type of treatment for you.

 

CT (computerised tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10–30 minutes. It may be used to identify the exact site of the tumour, or to check if the cancer has spread. CT scans use a small amount of radiation, which is very unlikely to harm you and won't harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. If you’re allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it's important to let your doctor know beforehand.

 

MRI (magnetic resonance imaging) scan

This test uses magnetism to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have the scan.

Before having the scan, you’ll be asked to remove any metal belongings, including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you'll be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones.

 

Staging and grading of nasopharyngeal cancer

 

Staging

The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type and stage of the cancer helps the doctors to decide on the most appropriate treatment for you.

 

TNM staging

The most commonly used staging system is called the TNM system:

T refers to the size or position of the primary tumour (where the cancer first starts in the body).

N refers to which lymph nodes are affected, if any.

M refers to metastatic disease (when the cancer has spread to other parts of the body).

The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue.

The exact details of the T, N and M will depend on the type of cancer.

 

Number staging

In addition to TNM staging, you’ll probably hear the doctors use a number staging system. There are usually three or four number stages for each cancer type. Stage 1 describes a cancer at an early stage when it’s usually small in size and hasn’t spread, whereas stage 4describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in between these stages.

The number stages are made up of different combinations of the TNM stages. So a stage 1 cancer may be described as either: T1, N0, M0 or T2, N0, M0.

Number stages may also be subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer might differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.

 

Other terms used

You may hear other terms used to describe cancer:

Early or local may be used to describe a cancer that hasn’t spread

Locally advanced describes a cancer that has begun to spread into surrounding tissues or nearby lymph nodes

Local recurrence means the cancer has come back in the same area after treatment

Secondary, advanced, widespread or metastatic means the cancer has spread to other parts of the body.

 

Grading

Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop.

Low-grade means that the cancer cells look like normal cells – they are usually slow-growing and are less likely to spread. High-grade means the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.

 

Treatment of nasopharyngeal cancer

 

The treatment you have for your nasopharyngeal cancer will depend on the type and stage of your cancer.

 

Radiotherapy

Radiotherapy is the main treatment for nasopharyngeal cancer. As well as treating the tumour, radiotherapy will usually be given to the lymph nodes in the neck.

Radiotherapy treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal tissue.

External radiotherapy is the most common type of radiotherapy used to treat cancer of the nasopharynx. Occasionally, internal radiotherapy is used.

External radiotherapy is given from a radiotherapy machine, much like an x-ray machine. It does not make you radioactive. Occasionally, specialised techniques are used, such as intensity modulated radiotherapy (IMRT) or three-dimensional IMRT (3D IMRT). With this technique, the high-energy rays are shaped very precisely and allow the dose of radiotherapy to be altered in different parts of the treatment area. The aim is to reduce the side effect of treatment. This treatment is only available in some specialist hospitals.

Internal radiotherapy is given by placing radioactive metal needles or wires close to the tumour while you're under a general anaesthetic. After a few days, the needles or wires are removed.

 

Side effects of radiotherapy

Radiotherapy to the nasopharynx can cause the salivary glands to produce less saliva, so it is important to keep your mouth clean. Your doctors and nurses will tell you how to do this.

If you have a dry mouth, it is important to see a dentist regularly. It's best not to have teeth taken out after radiotherapy to this area, but if it's necessary to have a tooth removed, it should be done by a hospital specialist.

 

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy for nasopharyngeal cancer is usually given in combination with radiotherapy (chemoradiation).  Chemotherapy may also be given if the cancer has spread to other parts of the body.

 

Research trials

You may be offered chemotherapy as part of a research trials. Before any trial is allowed to take place it must have been approved by an ethics committee, which checks that the trial is in the interest of patients. Your doctor must discuss this treatment with you so that you have a full understanding of the trial and what it involves. You may decide not to take part, or withdraw from a trial at any stage. You will still receive the best standard treatment available.

 

Surgery

Occasionally, the doctor may recommend surgery after the radiotherapy treatment, to remove any affected lymph nodes in the neck that may still contain cancer cells. There is a network of lymph nodes (or glands) throughout the body that form part of the body's natural defence against infection. The lymph nodes are connected by a network of tiny tubes known as lymph vessels.

Surgery may also be used to remove the tumour if it comes back in the lymph nodes in the neck.

 

Follow-up

 

After your treatment is completed, you will have regular check-ups and possibly scans or x-rays. These will probably continue for several years. If you have any problems or notice any new symptoms between these appointments, let your doctor know as soon as possible.

 

Your feelings

 

You are likely to experience a number of different emotions, from shock and disbelief to fear and anger. These feelings may be overwhelming and difficult to control, particularly if you have experienced changes in your appearance because of surgery, and feel self-conscious. These feelings are natural and it's important for you to be able to express them.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to get help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope.

You can talk to your doctor or specialist nurse about how you're feeling. They may be able to refer you to a trained counsellor who can listen and help you deal with difficult emotions. Our cancer support specialists can also give you information about where to get counselling.

Many people find it helpful to talk to other people going through a similar experience. We can give you more information about support groups in your area. You may also find ouronline community helpful, where you can talk to people any time about what you’re going through.

 

References and thanks

 

This information has been compiled using a number of reliable sources, including:

National Institute for Health and Clinical Excellence (NICE). Improving Outcomes in Head and Neck Cancers. November 2004.

Souhami, Hochauser. Cancer and its management. 6th edition. 2010. Wiley Blackwell.

Raghavan, et al. The Textbook of Uncommon Cancers. 3rd edition. 2006. Wiley.

DeVita, et al. Cancer: Principles and Practice of Oncology. 7th edition. 2005. Lippincott Williams and Wilkins.

UpToDate. Treatment of locoregional nasophayrngeal carcinomahttp://www.uptodate.com (accessed September 2012).

Head and Neck Multidisciplinary Guidelines 2011. British Association of Otorhinolaryngology, Head and Neck Surgery, The Royal College of Surgeons of England.

UpToDate. Treatment of recurrent and metastatic nasopharyngeal carcinomahttp://www.uptodate.com (accessed  September 2012).

Thanks

With thanks to: Dr Amen Sibtain, Consultant Clinical Oncologist; and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.