Nasopharyngeal Cancer

Symptoms of nasopharyngeal cancer include:

• A lump in the neck resulting from swollen lymph nodes
  
• Trouble opening the mouth
  
• Trouble breathing and speaking
  
• Trouble swallowing
  
• The feeling of a stuffy nose
  
• Nose bleeds
  
• Frequent ear infections
  
• Hearing problems, including difficulty hearing and tinnitus, a persistent ringing in the ears.
  
• Vision problems, including blurred and double vision
  
• Frequent headaches
  

Like all cancers, it is important for nasopharyngeal cancer to be diagnosed as early and accurately as possible. This helps increase your chance for a successful treatment while maintaining your quality of life, including the ability to speak and swallow.

If you have symptoms that may signal nasopharyngeal cancer, your doctor will examine you and ask you questions about your health and lifestyle, including smoking habits, drinking habits and family medical history.

The following tests can be used to diagnose nasopharyngeal cancer and find out if it has spread. Tests also may be used to monitor the disease and how it is responding to treatment.

Biopsy

In a biopsy, doctors retrieve suspected cancer tissue for study under a microscope. A biopsy is the only way to definitively diagnose nasopharyngeal cancer. Different methods are used to obtain this tissue, depending on where the tumor is located. Common biopsy methods for nasopharyngeal cancer include:

• Fine-needle-aspiration biopsy (FNA): This type of biopsy may be used if you have a lump in your neck that can be felt from the outside. A thin needle is inserted into the area, and cells are withdrawn and examined under a microscope. This is often coupled with an ultrasound to verify the placement of the needle.
  
• Conventional incisional biopsy: The doctor surgically removes part of the tissue where cancer is suspected.
  
• Endoscopic biopsy: During this procedure, an endoscope (a long, thin tube with a light and lens through which the doctor can view organs and tissue) is inserted through the mouth, nose or an incision. The endoscope has a tool to remove tissue samples.
  

Blood tests

Doctors use blood tests to help diagnose the disease and monitor how the patient is responding to treatment. Epstein Barr Virus DNA levels are recorded through a blood test to help diagnosis the cancer, monitor treatment effects and monitor cancer levels. Pituitary hormone levels recorded before treatment future comparison. 

Imaging exams

Imaging exams can help locate the suspected cancer and show whether it has spread. They can also be used to monitor the disease’s progression and how it is responding to treatment.

Throat cancer imaging exams may include:

• MRI (magnetic resonance imaging) scans 
  
• CT or CAT (computed axial tomography) scans
  
• PET (positron emission tomography) scans
  
• Ultrasound
  
• Chest and dental X-rays

Learn more about imaging exams.

Swallowing tests

Doctors use swallowing tests to understand how the patient’s throat is performing and help them plan treatment. There are different types of swallowing tests.

Barium swallow: The patient drinks liquid barium, which makes certain areas of the body show up more clearly during X-rays. This study evaluates the passage from the throat to the stomach. It is used to look for changes in structure and muscle movement. 

Modified barium swallow: During a modified barium swallow, the patient ingests liquid, pudding and solid food, all containing barium. A speech pathologist and radiologist observe the swallowing in real time using a specialized X-ray exam, called a fluoroscopy. They then evaluate the structures and movements associated with swallowing.

Fiberoptic endoscopic examination of swallowing (FEES): FEES relies on a small, flexible endoscope that is inserted through the nose. It allows the doctor or speech pathologist to examine swallowing.

Staging is a way of determining how much disease is in the body and where it has spread. This information helps your doctors decide the best type of treatment for you and the outlook for your recovery.

Nasopharyngeal cancer stages

Source: National Cancer Institute

Stage 0

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 the cancer:

• 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, one of the following is true:

• Cancer has spread to one or more lymph nodes on one side of the neck and/or to one or more lymph nodes on one or both sides of the back of the throat. The affected lymph nodes are 6 centimeters or smaller. Cancer is found:
  
  • in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity; or
    
  • only in the lymph nodes in the neck. The cancer cells in the lymph nodes are infected with Epstein-Barr virus (a virus linked to nasopharyngeal cancer).
    
• Cancer has spread to the parapharyngeal space and/or nearby muscles. Cancer may have also spread to one or more lymph nodes on one side of the neck and/or to one or more lymph nodes on one or both sides of the back of the throat. The affected lymph nodes are 6 centimeters or smaller.
  

Stage III

In stage III, one of the following is true:

• Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller. Cancer is found:
  
  • in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity; or
    
  • only in the lymph nodes in the neck. The cancer cells in the lymph nodes are infected with Epstein-Barr virus (a virus linked to nasopharyngeal cancer).
    
• Cancer has spread to the parapharyngeal space and/or nearby muscles. Cancer has also spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller.
  
• Cancer has spread to the bones at the bottom of the skull, the bones in the neck, jaw muscles, and/or the sinuses around the nose and eyes. Cancer may have also spread to one or more lymph nodes on one or both sides of the neck and/or the back of the throat. The affected lymph nodes are 6 centimeters or smaller.
  

Stage IV

Stage IV is divided into stages IVA and IVB.

• In stage IVA:
  
  • Cancer has spread to the brain, the cranial nerves, the hypopharynx, the salivary gland in the front of the ear, the bone around the eye, and/or the soft tissues of the jaw. Cancer may have also spread to one or more lymph nodes on one or both sides of the neck and/or the back of the throat. The affected lymph nodes are 6 centimeters or smaller; or
    
  • Cancer has spread to one or more lymph nodes on one or both sides of the neck. The affected lymph nodes are larger than 6 centimeters and/or are found in the lowest part of the neck.
    

In stage IVB: Cancer has spread beyond the lymph nodes in the neck to distant lymph nodes, such as those between the lungs, below the collarbone, or in the armpit or groin, or to other parts of the body, such as the lung, bone, or liver.

MD Anderson customizes your nasopharyngeal cancer treatment to maximize the chances of cure while also paying special attention to your quality of life. Because of the nasopharynx’s location, nasopharyngeal cancer can impact vision, hearing, speaking, smell, taste and swallowing. Accuracy and precision are especially important when developing treatment plans.

The following treatments are used for nasopharyngeal cancer:

Radiation therapy 

Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.  

Learn more about radiation therapy. 

The types of radiation therapy used to treat nasopharyngeal cancer include:

• Intensity modulated radiation therapy (IMRT): This treatment focuses multiple radiation beams of different intensities directly on the tumor for the highest possible dose. One type of IMRT is Volumetric modulated arc therapy (VMAT), which uses a rotating treatment machine to deliver radiation at multiple angles. 
  
• Proton therapy: Proton therapy is similar to standard radiation therapy, but it uses a different type of particle that may allow doctors to reduce the radiation dose and limit damage to healthy nearby tissue. Learn more about proton therapy. 
  
• MR LINAC radiotherapy: This approach uses a specialized device to adjust treatment on a daily basis. These adjustments can reduce side effects and effectively treat changing tumors.
  
• Stereotactic body radiation therapy (SBRT): SBRT, also known as stereotactic ablative radiotherapy and stereotactic ablative body radiation, precisely targets tumors with very high doses of radiation. SBRT achieves this by using several radiation beams of various intensities aimed at the tumor from different angles. Learn more about SBRT.
  

Chemotherapy

Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing. 

Chemotherapy is sometimes combined with radiation therapy to treat nasopharyngeal cancer. 

Learn more about chemotherapy. 

Immune checkpoint inhibitors 

Immune checkpoint inhibitors are a type of immunotherapy. They stop the immune system from turning off before cancer is eliminated. 

For nasopharyngeal cancer, immune checkpoint inhibitors are currently approved only for stage IV cancer. They can be used alone or with other treatments, including surgery, radiation therapy and other cancer drugs.

Learn more about immune checkpoint inhibitors. 

Surgery

Because the nasopharynx is located so close to other key structures, surgery is rarely used to remove primary nasopharynx tumors. If the cancer has spread to the lymph nodes, these may be removed with surgery. 

Specialized care for nasopharyngeal cancer patients

Throat cancer and its treatments can impact a person’s ability to eat, drink and speak, as well as their appearance. MD Anderson offers therapies and services to help throat cancer patients adjust to and overcome these challenges as much as possible.

Speech therapy: MD Anderson speech pathologists and audiologists offer patients the most advanced techniques for restoring speech after throat cancer and its treatment.

Swallowing therapy: Experts in MD Anderson’s Speech Pathology and Audiology Section are dedicated to evaluating and treating patients who have difficulty eating, drinking and swallowing after treatment. MD Anderson’s swallowing service is one of the leaders in this field and serves as a model for the management of patients treated for throat cancers. 

Reconstructive surgery: Throat cancer treatment can impact a patient’s appearance. MD Anderson is home to renowned reconstructive surgeons who can perform procedures to help restore appearance. 

Dental care: The teeth and jaw of throat cancer patients can be damaged by the disease and its treatments. MD Anderson dentists specialize in designing implants and performing procedures to help throat cancer patients restore appearance and function. 

Survivorship: MD Anderson has a survivorship clinic dedicated to the needs of head and neck cancer patients.

Regular follow-up and screenings are vital due to the high risk of throat cancer returning to the throat or other areas in the head and neck region. Patients need to see their doctors every three to six months for the first two years after treatment, since most cancers that recur, or come back, do so within that time. 

Throat cancer patients are also strongly urged not to smoke or drink alcohol during and after treatment. Drinking and smoking can make treatments less successful and worsen side effects during treatment. They can also greatly increase the chance of the cancer returning.