Nasopharyngeal Cancer

The pharynx is an area of the neck and throat which is divided into three sections:

  • Nasopharynx is the top section
  • Oropharynx is the middle section
  • Hypopharynx is the lowest section

The nasopharynx is the space above the soft palate (roof of the mouth) at the back of the nose. It connects the nose to the back of the mouth and allows people to breathe through the nose.

Symptoms

The first symptom of nasopharynx cancer is usually a lump in the upper part of the neck. Other signs and symptoms may include:

  • Swelling of the neck
  • Persistent headaches
  • Nasal congestion (a blocked nose)
  • Facial pain
  • Nosebleeds
  • Changes in hearing
  • Ringing in the ears
  • Many people have no symptoms

These symptoms are also common in conditions that are not cancer.


Causes and Risk Factors 

The exact cause is not known.

  • Occurs more often in ages 50 to 60, but can occur at any age.
  • It affects more men than women.
  • Exposure to the Epstein-Barr virus increases the risk of developing nasopharyngeal cancer.
  • Cooking salt-cured fish and meat releases a chemical called nitrosamine and might increase the risk of developing the disease.

Diagnosis

The doctor will examine your mouth, throat, ears and will use a small lighted mirror to examine your nasopharynx. The doctor will pass a thin flexible tube with a light at the end (flexible endoscope) into the nostril to look at the back of the nose. A local anesthetic spray might be used to numb your nose and throat. You will be instructed not to eat or drink anything for an hour afterwards, or until your throat is no longer numb.

If a tumor is suspected, the doctor will take a biopsy and a pathologist will examine the tissue under a microscope.

Pathologists classify nasopharyngeal cancer by the type of cell. There are three types:

  • Keratinizing squamous cell carcinoma
  • Non-keratinizing squamous cell carcinoma
  • Undifferentiated or poorly differentiated carcinoma

The doctor also may order other tests, such as:

  • Blood tests
  • Imaging studies to determine if the tumor has invaded nearby tissue or other organs in the body
    • Orthopantomography (Panorex) is a panoramic X-ray of the upper and lower jaw. It shows a view from ear to ear and it helps determine if a tumor has grown into the jaw bone.
    • CT scan. A special type of x-ray that makes a series of detailed pictures, with different angles, of areas inside the mouth and neck. A computer is linked to the x-ray machine. A dye may be injected into a vein or swallowed in a pill to help highlight the organs or tissues on the x-ray. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
    • MRI (magnetic resonance imaging). A machine that uses a magnet, radio waves, and a computer to make detailed pictures of areas inside the mouth and neck. This procedure is also called nuclear magnetic resonance imaging (NMRI).
    • PET scan. During a positron emission tomography scan (PET), a small amount of radioactive glucose (sugar) is injected into a vein. The scanner makes computerized pictures of the areas inside the body. Cancer cells absorb more radioactive glucose than normal cells, so the tumor is highlighted on the pictures.

Treatments

Radiation therapy combined with chemotherapy (chemoradiation) is the most common treatment. In most cases, surgery is only required if the tumor returns after chemoradiation therapy.

Radiation Therapy

Radiation therapy, including intensity modulated radiation therapy, stops cancer cells from dividing and slows the growth of the tumor. Radiotherapy also destroys cancer cells and can shrink or eliminate tumors. Intensity modulated radiation therapy allows the use of more effective radiation doses with fewer side effects than conventional radiotherapy techniques.

Radiation therapy involves 5-6 weeks of daily treatments.


Chemotherapy

Chemotherapy is prescribed for different reasons:

  • Together with radiotherapy as an alternative to surgery (called chemoradiation)
  • After surgery to decrease the risk of the cancer returning
  • To slow the growth of a tumor and control symptoms when the cancer cannot be cured (palliative treatment)


Surgery

If the tumor is small, the surgeon can perform transoral laser microsurgery. The laser is on a small metal scope (tube). The patient is given anesthesia before the surgery begins. The laser is inserted into the mouth and the beam from the laser is used to excise the tumor, and one centimeter (2.5 inches) of tissue around it.

After the surgery, a small nasogastric feeding tube (NG tube) is inserted through a nostril and into the stomach because the patient cannot eat until the surgical area heals. Healing takes about two weeks. During this time, the patient will receive liquefied food through the NG tube. The patient can go home three to five days after surgery with the NG tube in the nostril.

Larger tumors require a traditional incision with a scalpel. The patient is given anesthesia before the surgery begins. The surgeon makes an incision in the neck, under the chin, to locate and remove the tumor. The open area is then reconstructed and closed with a flap of skin or muscles from the arm or other part of the body.

If the lymph nodes in the neck are affected, a neck dissection may be needed to remove the nodes.