Nasopharyngeal CancerLast Updated: July 05, 2011 This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/11 Overview
Cancer begins when cells in the body become abnormal and multiply without control or order. These cells form a growth of tissue, called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous). Nasopharyngeal cancer (also called nasopharyngeal carcinoma or NPC) is a disease of the nasopharynx, which is the air passageway at the upper part of the pharynx (throat) behind the nose. The pharynx is a hollow tube approximately five inches long that starts behind the nose and ends on top of the larynx (or voice box) and esophagus (the swallowing tube that goes from the throat to the stomach). The nostrils lead through the nasal cavity into the nasopharynx, and an opening on each side of the nasopharynx (called the Eustachian tube opening) leads into the middle ear on each side. Types of nasopharyngeal cancer There are several types of benign nasopharyngeal tumors, including angiofibromas and hemangiomas that involve the vascular (blood-carrying) system and tumors in the lining of the nasopharynx that include the minor salivary glands. A malignant nasopharyngeal tumor is cancerous. This means it can invade and damage healthy tissues and organs in other parts of the body. The nasopharynx contains several types of tissue, and each contains several types of cells. Different cancers can develop in each kind of cell. The differences are important because they determine the seriousness of the cancer and the type of treatment needed. According to the World Health Organization (WHO), NPC is classified into three subtypes:
NPC is one of five main types of cancer in the head and neck region, a grouping called head and neck cancer. Find out more about basic cancer terms used in this section. Statistics
Nasopharyngeal cancer is uncommon in the United States, with about 2,750 people diagnosed each year. In the last few years, the rate at which Americans have been developing this cancer has been slowly decreasing. NPC is much more common in parts of the world such as Asia and North Africa; for instance, it is a fairly common cancer in Southeast China. Cancer statistics should be interpreted with caution. Estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with nasopharyngeal cancer. Learn more about understanding statistics. Source: American Cancer Society. Medical Illustrations
Risk Factors and Prevention
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. Two risk factors greatly increase the risk of NPC: Tobacco use. Use of tobacco (including cigarettes, cigars, pipes, chewing tobacco, and snuff) is the single greatest risk factor for head and neck cancer. Smokers with NPC are most likely to have the squamous cell type. Alcohol. Frequent and heavy consumption of alcohol is a risk factor for head and neck cancer. Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Using alcohol and tobacco together increases this risk even more. However, the influence of tobacco and alcohol in the development of NPC is less than for other head and neck cancers. Recent research suggests that people who have used marijuana may be at higher risk for head and neck cancer. Secondhand smoke may also increase a person’s risk of head and neck cancer. Other factors that can raise a person’s risk of NPC include the following: Region/ancestry. NPC is most common in people who live in Southeast China and Hong Kong. When people move away from high-risk areas of the world to countries where NPC is less common, subsequent generations of their family have a gradual reduction in their inherited risk of NPC. Epstein-Barr virus (EBV). Exposure to EBV, which is more commonly known as the virus that causes mononucleosis (or “mono”), plays a role in causing nasopharyngeal cancer to develop. Gender. Men are two times more likely than women to develop NPC. Age. The risk of NPC increases as a person gets older. However, about half of the people with nasopharyngeal cancer in the United States are younger than 55. A person of any age can be diagnosed with NPC. Diet. Eating large amounts of salt-cured fish and meats on a regular basis increase the risk of NPC. Environmental exposure. Extensive exposure to dust and smoke may increase the risk of NPC. Prevention Although some of the risk factors of NPC cannot be controlled, such as age, several can be avoided by making lifestyle changes. Stopping the use of all tobacco products is the most important thing a person can do to reduce the risk of NPC, even for people who have been smoking for many years. Symptoms and Signs
People with NPC may experience the following symptoms or signs. Sometimes, people with NPC do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.
People who notice any of these warning signs should talk with a doctor and/or dentist right away. When detected early, cancers of the head and neck have a much better chance of cure. Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often. Because many of these symptoms can be caused by other, noncancerous conditions, as well, it is important to receive regular health and dental screenings; this is particularly important for people who routinely drink alcohol or currently use tobacco products or have used them in the past. In fact, people who use alcohol and tobacco should receive a general screening examination at least once a year. This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, then the doctor will recommend a more extensive examination using one or more of the diagnostic procedures mentioned in Diagnosis. If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. Diagnosis
Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
The following tests may be used to diagnose NPC: Physical examination and blood test. The doctor feels for any lumps on the neck, lips, gums, and cheeks. Also, the doctor will inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and/or mirror for a clearer view. A blood test to check for antibodies against the EBV virus (see Risk Factors) may be done at the same time. Endoscopy. This test allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is inserted through the mouth or nose to examine the head and neck areas. When an endoscopy is done to look into the nasopharynx, it is called a nasopharyngoscopy. Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). The type of biopsy performed will depend on the location of the cancer. In a fine needle aspiration biopsy, cells are withdrawn using a thin needle inserted directly into the tumor. The cells are examined under a microscope for signs of cancer (called cytologic examination). The biopsy may be performed using local anesthesia (to numb the area) or general anesthesia. X-ray. An x-ray is a way to create a picture of the structures inside of your body, using a small amount of radiation. Sometimes, a barium swallow may be required before having an x-ray. The barium coats the mouth and throat to enhance the image on the x-ray. An x-ray of the skull and chest may be needed to learn more about the extent of NPC. Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue. An MRI is more sensitive than a CT scan in detecting a tumor of the nasopharynx and its possible spread to nearby tissues or lymph nodes. A contrast medium may be injected into a patient’s vein to create a clearer picture. Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. Neurologic tests. These examinations involve the doctor testing nerve function, especially tactile sensation of the face and motor function of certain nerves in the head and neck area. Hearing test. The doctor may perform a hearing test if he or she suspects there is fluid in the middle ear. Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Learn more about what to expect when having common tests, procedures, and scans. After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. Learn more about the first steps to take after a diagnosis of cancer. Staging With Illustrations
Staging is a way of describing cancer, such as where it is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage and histologic grade of cancer helps the doctor to decide what kind of treatment is to be given and can help predict a patient’s prognosis (chance of recovery). There are different stage descriptions for different types of cancer. One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor in NPC. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below. TX: The primary tumor cannot be evaluated. T0: No evidence of a tumor is found. Tis: This describes a stage called carcinoma (cancer) in situ. This is a very early cancer where cancer cells are found only in one layer of tissue. T1: The tumor has not spread beyond the nasopharynx. T2: The tumor extends into the soft tissue of the middle throat. T3: The tumor extends into bony structure or into the area behind the nose. T4: This describes a tumor that extends inside the head to the area of the brain or into the lower part of the throat. Node. The “N” in the TNM staging system is for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the head and neck are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. In people with NPC, doctors examine lymph nodes in a triangle-shaped area formed by three points: where the neck meets the shoulder, where the collarbone joins the tip of the shoulder, and where the front half of the collarbone meets the base of the neck. NX: The regional lymph nodes cannot be evaluated. N0: There is no evidence of cancer in the regional lymph nodes. N1: Cancer has spread to lymph nodes above the triangular area described above. The lymph nodes are on the same side as the primary tumor, and the cancer found in the lymph nodes is 6 centimeters (cm) or smaller. N2: Cancer has spread to lymph nodes on both sides of the neck, above the triangular area, but the cancer is 6 cm or smaller. N3: Cancer found in lymph nodes is larger than 6 cm or is found in lymph nodes located in the triangle. N3a: Cancer found in the lymph nodes is larger than 6 cm. N3b: Cancer has extended to the triangle region. Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body. MX: Distant metastasis cannot be evaluated. M0: Cancer has not spread to other parts of the body. M1: Cancer has spread to other parts of the body. Cancer stage grouping Doctors assign the stage of the cancer by combining the T, N, and M classifications. Stage 0: A carcinoma in situ (Tis) with no spread to lymph nodes (N0) or distant metastasis (M0).  Larger image Stage IIA: A tumor that has extended beyond the nasopharynx (T2) but has not spread to lymph nodes (N0) or to distant parts of the body (M0).  Larger image Stage IIB: A tumor (T1 or T2) that has spread to lymph nodes (N1) but has not metastasized (M0).  Larger image Stage III: This describes a noninvasive and invasive tumor (T1 or T2) that have spread to lymph nodes (N1 or N2) but have not metastasized (M0), or it describes a larger tumor (T3) with or without nodal involvement (N0, N1, or N2) and no metastasis (M0).  Larger image Stage IVA: This describes any invasive tumor (T4) with either no lymph node involvement (N0) or spread to only a single same-sided lymph node (N1) but no metastasis (M0). It is also used for any cancer (any T) with more significant nodal involvement (N2) but no metastasis (M0).  Larger image Stage IVB: This describes any tumor (any T) with extensive nodal involvement (N3a or N3b) but no metastasis (M0).  Larger image Stage IVC: This describes any tumor (any T, any N) when there is evidence of distant spread (M1).  Larger image Histologic grade (G). Doctors also describe a primary tumor by its grade, which is determined by using a microscope to examine tissue from a tumor (called a histologic examination). The doctor compares the tumor tissue with normal tissue. Histologic grade describes how closely the cancer cells resemble normal tissue under a microscope. Normal tissue contains many different types of cells grouped together, which is called differentiated. Tissue from a tumor usually has cells that look more alike each other (called poorly differentiated). Generally, the lower the grade, the better the prognosis. A tumor's grade is described using the letter "G" and a number. GX: The grade cannot be evaluated. G1: The cells look more like normal tissue (well differentiated). G2: The cells are only moderately differentiated. G3: The cells don’t resemble normal tissue (poorly differentiated). Recurrent: Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (re-staging) using the system above. Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net. Treatment
This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current Research sections. Treatment overview In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. The team may include medical oncologists, radiation oncologists, surgeons, otolaryngologists (ear, nose, and throat doctors), maxillofacial prosthodontists (specialists who perform restorative surgery in the head and neck areas), dentists, physical therapists, speech pathologists, mental health professionals, nurses, dietitians, and social workers. Many cancers of the nasopharynx can be cured, especially if found early. The main treatment of NPC is radiation therapy, often given in combination with chemotherapy. This approach may be called concomitant chemoradiotherapy. Surgery for NPC is occasionally used, mainly to remove lymph nodes after chemoradiotherapy or to treat NPC that has recurred (come back after initial treatment). Descriptions of the most common treatment options for nasopharyngeal cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Although curing the cancer is the primary goal of treatment, preserving the function of the nearby organs and tissues is also very important. When doctors plan treatment, they also consider how treatment might affect a person’s quality of life, including how a person feels, looks, talks, eats, and breathes. Learn more about making treatment decisions. Radiation therapy Radiation therapy is the use of high energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation therapy is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. External-beam radiation therapy is conducted with a radiation beam aimed at the tumor. It is the most common type used to treat NPC. A method of external radiation therapy, known as intensity-modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells and causing fewer side effects. Meanwhile, proton therapy (also called proton beam therapy) is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Proton therapy may be used as part of the treatment for some skull-base tumors to further limit the radiation dose to nearby structures, such as the optic (eye) nerves and brainstem; proton therapy may be an option for advanced NPC that is located close to parts of the central nervous system (brain and spinal cord). Learn more about proton therapy. Stereotactic radiosurgery delivers radiation therapy precisely to the tumor using a machine called a gamma knife. This can be used to treat a tumor that has invaded the base of the skull or a tumor that has recurred at the base of the brain or skull. Internal radiation therapy involves tiny pellets or rods containing radioactive materials that are surgically implanted in or near the cancer site. The implant is left in place for several days while the person stays in the hospital. This approach is most often used to treat cancers that have recurred after initial treatment. It may also be used to treat the original tumor. Before beginning radiation treatment for any head and neck cancer, people should receive a thorough examination from an oncologic dentist (a dentist experienced in treating people with head and neck cancer). Since radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning cancer treatment. After radiation therapy for NPC, dental care should continue to help prevent further dental problems. People may receive fluoride treatment to prevent dental caries (cavities). Read more about dental health during cancer treatment. Other side effects of radiation therapy to the head and neck include redness or skin irritation in the treated area, dry mouth or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue, mouth sores, and/or sore throat. In addition, there may be pain or difficulty swallowing; loss of appetite, due to a change in sense of taste; hearing loss, due to buildup of fluid in the middle ear; and buildup of earwax that dries out because of the radiation therapy’s effect on the ear canal. Radiation therapy may also cause a condition called hypothyroidism in which the thyroid gland (located in the neck) slows down and this causes people to feel tired and sluggish. Every patient who receives radiation therapy to the neck area should have his or her thyroid checked regularly. There are numerous studies underway to find ways to reduce or better relieve the side effects of radiation therapy. Talk with your doctor before treatment begins about ways to prevent or reduce side effects, as well as how side effects will be treated by the health care team if they do happen. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. Chemotherapy may be given orally (by mouth), intravenously (in a vein), or through an injection into a muscle, under the skin, or directly into the cancerous tumor. The combination of chemotherapy and radiation therapy is commonly used to treat NPC. The use of chemotherapy as a first treatment before radiation therapy is also being studied. In chemotherapy, each drug or combination of drugs can cause specific side effects, and it is important to talk with your doctor about which side effects to expect and if any may be permanent. Side effects of chemotherapy may include fatigue, nausea, vomiting, hair loss, dry mouth, diarrhea and/or constipation, and loss of appetite, often due to a change in sense of taste. In addition, it can weaken the immune system and cause open sores in the mouth, which can lead to infection. In general, chemotherapy in combination with radiation therapy increases such side effects. Nutritional support may be necessary during treatment due to these side effects. Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases. Surgery Surgery is the removal of the tumor and surrounding tissue during an operation. It is occasionally used for NPC, but it is not a common treatment choice because the area is hard to reach and lies close to cranial nerves and blood vessels. A surgical oncologist is a doctor who specializes in treating cancer using surgery. If the doctor suspects that the cancer has spread to the lymph nodes, a neck dissection (the surgical removal of lymph nodes) may be necessary. In the specific instance of undifferentiated carcinoma of the nasopharynx, neck dissection is occasionally needed. A neck dissection may cause numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. The side effects are caused by injury to nerves in the area. Depending on the type of neck dissection, weakness of the lower lip and arm may go away in a few months. However, it is possible that weakness will be permanent if a nerve is removed or damaged as part of a dissection. Facial disfigurement may need to be addressed using reconstructive (or plastic) surgery. Before your operation, talk with your surgeon in detail about what you can expect and if another surgery will be needed for reconstruction. Learn more about cancer surgery. Recurrent NPC Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear. If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Recurrent NPC is usually treated with radiation therapy, chemotherapy, and/or sometimes surgery. Chemotherapy is used for people whose cancer has recurred in distant sites and who were previously treated with radiation therapy only. Chemotherapy may also be used together with radiation therapy (chemoradiotherapy) to improve the effectiveness of the radiation therapy. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. For instance, a clinical trial of biologic therapy (immunotherapy) may be an option (see Current Research). People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence. Metastatic NPC If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials. Your health care team may recommend a treatment plan that includes a combination of radiation therapy and chemotherapy. Sometimes, surgery may be recommended as well. In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time. If disease-directed treatment is not successful, this may also be called advanced cancer. This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Learn more about advanced cancer care planning. Find out more about common terms used during cancer treatment. About Clinical Trials
Doctors and scientists are always looking for better ways to treat patients with NPC. To make scientific advances, doctors create research studies involving people, called clinical trials. Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments, such as new chemotherapy drugs, before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease. Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating NPC. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with NPC. Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials. To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials. For specific topics being studied for nasopharyngeal cancer, learn more in the Current Research section. Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trials ends, and/or if the patient chooses to leave the clinical trial before it ends. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, lymphedema, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur. Fear of treatment side effects is common after a diagnosis of NPC, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Be sure to talk with your doctor about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with NPC. Learn more about caregiving. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. For many patients, a diagnosis of nasopharyngeal cancer is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your medical care. A side effect that occurs more than five years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor. After Treatment
After treatment for NPC ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed. People treated for NPC should receive regular follow-up medical and dental examinations to check for signs that the NPC has come back (recurred) or there is a secondary cancer (a different type of cancer). During follow-up visits, doctors may check thyroid functioning, vision, and hearing to detect any cranial nerve damage from treatment. They may also take an MRI or CT scan six to eight weeks after treatment, called a baseline study. If NPC comes back, the baseline study will help them track when the changes began. Most recurrences of NPC happen in the first two to three years after treatment, so follow-up visits will be more frequent during those years. People who have had NPC have a higher risk of developing a secondary cancer. Researchers are evaluating the benefits of using chemotherapy as a way to prevent second cancers (called chemoprevention). Follow-up visits will also help manage any late or long-term side effects from cancer treatment, such as buildup of earwax. Periodic ear examinations are necessary to remove buildup of dried earwax. Prevention of dental cavities is also important. Fluoride application is recommended whenever the oral cavity and the salivary glands receive radiation treatment. Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People may receive physical therapy and speech therapy to regain skills, such as speech and swallowing. Supportive care to manage symptoms and maintain nutrition during and after treatment may be recommended. Some people may need to learn new ways to eat or to eat foods prepared differently. People may look different, feel tired, and be unable to talk or eat the way they used to. Many people experience depression. The health care team can help people adjust and connect them with both physical and emotional support services. People recovering from NPC are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes. Find out more about common terms used after cancer treatment is complete. Current Research
Doctors are working to learn more about nasopharyngeal cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you. Biologic therapy. Biologic therapy (also called immunotherapy) is designed to boost the body’s natural defenses to fight cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function. Treatment based on the specific biologic characteristics of a tumor is being used with increasing frequency and being tested in clinical trials. People should talk with their doctors about the availability of these studies. Learn more about immunotherapy. Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current nasopharyngeal cancer treatments in order to improve patients’ comfort and quality of life. Learn more about common statistical terms used in cancer research. Looking for More about Current Research? If you would like additional information about the latest areas of research regarding nasopharyngeal cancer, explore these related items:
Or, choose “Next” (below, right) to continue reading this detailed section. Questions to Ask the Doctor
Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you.
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
