Nasopharyngeal Cancer

Overview

What is nasopharyngeal cancer?

Nasopharyngeal cancer affects the tissue that connects the back of your nose to the back of your mouth. This area is called the nasopharynx, and it’s located just above the roof of your mouth, at the base of your skull. When you breathe in through your nose, air flows through your nose, nasopharynx and into your throat before it reaches your lungs. Nasopharyngeal cancer begins when cells in this area start to grow out of control.

Is nasopharyngeal cancer rare?

In the United States, nasopharyngeal cancer is extremely rare. Less than 1 out of 100,000 people are diagnosed with this condition every year.

Nasopharyngeal cancer occurs more often in certain parts of the world, including Asia, North Africa and the Middle East. The condition can develop at any age and can even affect children. About half of those diagnosed with the disease are younger than 55.

What’s the difference between nasopharyngeal cancer and lymphoma?

Lymphoma is a type of cancer that affects your immune system. This condition can start anywhere in your body that has lymph tissue, including the nasopharynx. Nasopharyngeal cancer is different because it starts in the squamous cells that line the nasopharynx.

How does nasopharyngeal cancer affect my body?

While this type of cancer starts in the nasopharynx, it often spreads to other parts of the body. Cancer cells may travel to nearby lymph nodes (again, different from a type cancer of the immune system like lymphoma) or other organs, such as the lungs and liver.

Symptoms and Causes

What causes nasopharyngeal cancer?

Experts aren’t exactly sure what causes nasopharyngeal cancer. However, certain risk factors can increase your chance of developing the disease, including:

  • Epstein-Barr virus (EBV). This is the same virus that causes mononucleosis. EBV is common in people diagnosed with nasopharyngeal cancer. Even though the link between the two conditions is widely known, not all people who’ve had EBV will develop nasopharyngeal cancer.
  • Salt-cured foods. People who eat diets rich in salt-cured meat and fish have a higher chance of developing nasopharyngeal cancer.
  • Alcohol and tobacco use. Heavy smoking or drinking can increase your risk of nasopharyngeal cancer.
  • Age. Though nasopharyngeal cancer can occur at any age, it’s most commonly diagnosed in people between the ages of 30 and 50.
  • Race. Nasopharyngeal cancer is more common in people living in Southeast Asia, southern China and northern Africa. People who have immigrated to the United States from Asia also have a higher risk compared to American-born Asians.
  • Sex. Men are about three times more likely than women to develop nasopharyngeal cancer.
  • Family history. If you have a family member with nasopharyngeal cancer, you are more likely to develop the condition.

What are some common nasopharyngeal cancer symptoms?

In most cases, people with nasopharyngeal cancer notice a lump on the back of their neck. There may be one or multiple lumps, and they're usually not painful. These masses appear when cancer spreads to the lymph nodes in the neck and causes them to swell.

There are also several other warning signs such as:

Many nasopharyngeal cancer symptoms are similar to symptoms of other, less serious illnesses. As a result, this disease can be difficult to detect in the early stages. That’s why it’s important to schedule a check-up with your healthcare provider if you notice any of these issues.

How does nasopharyngeal cancer spread?

Once the main tumor has formed in the nasopharynx, cancer cells usually spread to nearby lymph nodes in the neck. Next, cancer spreads to distant areas of the body, such as the liver, lungs, bones or other lymph nodes.

Nasopharyngeal cancer staging is determined by several factors, including the size and location of the tumor and how far the cancer cells have spread. Here’s a general outline of the nasopharyngeal cancer stages:

  • Stage 0: Cancer only affects the top layer of cells inside the nasopharynx.
  • Stage 1: The tumor has grown into nearby structures, such as the back of the throat or the nasal cavity.
  • Stage 2: At this stage, cancer has spread to one or more lymph nodes on one side of the neck.
  • Stage 3: Cancer has spread to lymph nodes on both sides of the neck.
  • Stage 4: The tumor has spread to the skull, eye, cranial nerves, salivary glands or lower part of the throat. At stage 4, nasopharyngeal cancer may also spread to distant parts of the body.

Diagnosis and Tests

How is nasopharyngeal cancer diagnosed?

In the United States, nasopharyngeal cancer is usually diagnosed when a person visits their healthcare provider due to symptoms like a stuffy nose or a lump in the neck.

What tests will be performed to diagnose nasopharyngeal cancer?

If your healthcare provider thinks that you may have nasopharyngeal cancer, they will ask about your family history and perform a full physical examination. Your nasopharynx will be examined closely as well as your head, neck, mouth, throat, nose, facial muscles and lymph nodes. Your provider may also perform a hearing test. In addition, your healthcare provider may perform a:

  • Biopsy. To find out if your nasopharynx contains cancerous cells, your healthcare provider will remove a small piece of tissue from the area. The sample is then sent to a lab so it can be examined under a microscope.
  • CT scan. A computed tomography (CT) scan is a type of X-ray that takes detailed images inside your body. This scan can show whether or not a tumor is present. It can also give your healthcare provider information about the size, shape and location of a tumor.
  • MRI scan. Magnetic resonance imaging (MRI) uses magnets and radio waves to capture images inside your body. This imaging test tells your healthcare provider if cancer has spread to nearby structures.
  • PET scan. Positron emission tomography (PET) scans are taken after radioactive sugar is put into your blood. Cancer cells grow rapidly, so they absorb a lot of the sugar. As a result, these cells become temporarily radioactive and visible on a PET scan. Once the sugar has been put in your blood, a specialized camera takes pictures of radioactivity in your body. Your healthcare provider can use a PET scan to determine if cancer has spread to your lymph nodes.
  • Chest X-ray. If you’ve already been diagnosed with nasopharyngeal cancer, a chest X-ray can tell you if cancer has spread to your lungs. This usually doesn’t occur unless the cancer is advanced.
  • Epstein-Barr virus DNA levels test. Because nasopharyngeal cancer is often linked to the Epstein-Barr virus, you'll be tested to measure the blood level of Epstein-Barr virus DNA.

Note: Nasopharyngeal cancer screenings aren’t usually performed in the United States because the disease is so rare. However, in other areas of the world, such as Asia, Africa and the Middle East, people are routinely screened for this disease.

Management and Treatment

How is nasopharyngeal cancer treated?

Specific treatment depends on the stage of cancer. Once you receive a diagnosis, your team will explore treatment options with you. Nasopharyngeal cancer treatment may include:

  • Radiation therapy. This treatment uses high-energy X-rays to slow or kill cancer cells. Nasopharyngeal cancer is particularly sensitive to radiation so this type of therapy is often used to treat the disease.
  • Chemotherapy. Anti-cancer drugs given either by mouth or intravenously. Because chemotherapy travels through the bloodstream, it’s useful for cancers that have spread to other parts of the body.
  • Chemoradiation. In many cases of nasopharyngeal cancer, chemotherapy is used in combination with radiation therapy. This can make the effects of radiation stronger, but it can also have more side effects.
  • Surgery. In some instances, the tumor can be surgically removed. However, because the nasopharynx is a difficult area to operate on, surgery usually isn’t the main treatment option. However, surgery is sometimes used to remove lymph nodes in the neck that haven’t responded to other treatments.
  • Targeted drug therapy. Some drugs can target certain types of cancer. People with nasopharyngeal cancer can benefit from cetuximab injections. Cetuximab is a synthetic version of an immune system protein. Targeted drug therapy is most often combined with chemotherapy or radiation therapy.
  • Immunotherapy. This treatment boosts your own immune system to help detect and fight cancer cells. At present, it remains largely experimental.

What are the side effects of nasopharyngeal cancer treatment?

Side effects vary depending on the type of nasopharyngeal cancer treatment you receive. Here are some of the most common side effects of each treatment type:

Radiation therapy

  • Skin redness or irritation.
  • Chronic dry mouth.
  • Nausea.
  • Tiredness.
  • Mouth sores.
  • Difficulty swallowing.
  • Bone pain.
  • Tooth decay.
  • Changes in taste.
  • Hearing loss.

Chemotherapy

Chemoradiation

  • Tiredness.
  • Mouth sores.
  • Flu-like symptoms.
  • Anemia.
  • Nausea and vomiting.
  • Hair loss.
  • Diarrhea.
  • Constipation.
  • Hearing loss.

Surgery

  • Nerve damage.
  • Swelling from fluid buildup.

Targeted drug therapy

Immunotherapy

  • Skin redness.
  • Flu-like symptoms.
  • Headaches.
  • Muscle aches.
  • Shortness of breath.
  • Sinus congestion.
  • Diarrhea.
  • Hormone changes.
  • Swelling of the legs.
  • Cough.

Keep in mind that you may have different symptoms than someone else undergoing the same type of treatment. Since side effects vary, it’s important to let your healthcare provider know about any issues you’re experiencing. They can find ways to ease your symptoms.

How long does it take to recover from nasopharyngeal cancer treatment?

The length of your care depends on the stage of cancer and how well your body responds to treatment. Even after your treatment is complete, your healthcare provider will continue to monitor your health with routine tests and examinations.

Prevention

Can nasopharyngeal cancer be prevented?

Most known risk factors for nasopharyngeal cancer can’t be controlled. Therefore, the disease can’t be prevented in most cases.

How can I reduce my risk for nasopharyngeal cancer?

Heavy alcohol and tobacco use have been linked to many types of cancer. Avoiding these habits offers several health benefits and may reduce your risk for developing nasopharyngeal cancer.

Outlook / Prognosis

Is nasopharyngeal cancer curable?

Many nasopharyngeal cancers can be cured if they are found and treated early. Success depends on many factors, including the location and stage of the tumor.

How long can someone live with nasopharyngeal cancer?

The overall five-year survival rate for nasopharyngeal cancer is 61%. That means that 61% of all people newly diagnosed with the condition are still alive after five years. Keep in mind that survival rates are higher when the cancer is treated in the early stages.

It’s important to note that survival rates can’t tell you how long you’ll live, but they can offer insight based on other people’s experiences.

Living With

How can I take care of myself during treatment for nasopharyngeal cancer?

In addition to physical symptoms, many people experience emotional, social and spiritual side effects of nasopharyngeal cancer treatment. Your healthcare provider can help you find ways to manage your symptoms, relieve pain and improve your overall quality of life. Recommendations often include:

  • Eating a healthy, well-balanced diet.
  • Practicing mindfulness or meditation.
  • Joining a local support group.

When should I see my healthcare provider?

You should schedule an appointment with your healthcare provider if you notice symptoms for more than two weeks. Keep in mind that nasopharyngeal cancer symptoms are often similar to cold and flu symptoms and may include headaches, nasal stuffiness and a feeling of fullness in your ear. In addition, if you experience ear infections that won’t go away, especially in only one ear, see your healthcare provider immediately. Ear infections are more common in children than adults. So, if you’re an adult with chronic ear infections, it could mean something else is going on.

What questions should I ask my healthcare provider?

If you’ve been diagnosed with nasopharyngeal cancer, gaining a full understanding of your situation can empower you and help you make informed decisions about your health. Here are some questions to ask your healthcare provider:

  • Has the cancer spread to other areas of my body?
  • What stage of nasopharyngeal cancer do I have?
  • What are my treatment options?
  • Can treatment cure my cancer?
  • How long will my treatment last?
  • What are the chances that my cancer will come back?
  • What will my follow-up care involve?

A note from Cleveland Clinic

Being diagnosed with nasopharyngeal cancer can be scary and frustrating. Fortunately, there are treatments available. Talk to your healthcare provider about your options and consider joining a support group. Staying informed can give you control over your situation and help you take your first step toward healing.

Last reviewed by a Cleveland Clinic medical professional on 06/18/2021.

References

  • Cancer.Net. Nasopharyngeal Cancer: Statistics. (https://www.cancer.net/cancer-types/nasopharyngeal-cancer/statistics) Accessed 8.5.21.
  • Cancer.Net. Nasopharyngeal Cancer: Coping with Treatment. (https://www.cancer.net/cancer-types/nasopharyngeal-cancer/coping-with-treatment) Accessed 8.5.21.
  • Cancer.Net. Nasopharyngeal Cancer: Types of Treatment. (https://www.cancer.net/cancer-types/nasopharyngeal-cancer/types-treatment) Accessed 8.5.21.
  • American Cancer Society. What Causes Nasopharyngeal Cancer? (https://www.cancer.org/cancer/nasopharyngeal-cancer/causes-risks-prevention/what-causes.html) Accessed 8.5.21.
  • American Cancer Society. Key Statistics for Nasopharyngeal Cancer. (https://www.cancer.org/cancer/nasopharyngeal-cancer/about/key-statistics.html) Accessed 8.5.21.
  • American Cancer Society. Living as a Nasopharyngeal Cancer Survivor. (https://www.cancer.org/cancer/nasopharyngeal-cancer/after-treatment/follow-up.html) Accessed 8.5.21.
  • National Cancer Institute. Targeted Cancer Therapies. (https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet) Accessed 8.5.21.

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