Treatment

The treatment of NPC depends on the size and location of the tumor, whether the cancer has spread, and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

Many cancers of the nasopharynx can be cured, especially if found early. Although curing the cancer is the primary goal of treatment, preserving the function of the nearby organs is also very important. When doctors plan treatment, they consider how treatment might affect a person’s quality of life, including how a person feels, looks, talks, eats, and breathes.

Head and neck cancer specialists often form a multidisciplinary team to care for each person, and an evaluation should be done before any treatment begins. 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.

The main treatment of NPC is called concomitant chemoradiotherapy, which is chemotherapy given in combination with radiation therapy. 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.

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.

External-beam radiation therapy is conducted with a radiation beam aimed at the tumor. It is the most common type used to treat nasopharynx cancer. A new 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. Also, proton-beam radiation 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).

Stereotactic radiosurgery delivers radiation therapy precisely to the tumor using a machine called a gamma knife. This can be used to treat tumors that have invaded the base of the skull, or tumors that have 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. Brachytherapy 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.

Radiation therapy to the head and neck may cause the following side effects:

• Redness or skin irritation to the treated area
  
  
• Dry mouth or thickened saliva, from damage to salivary glands
  
  
• Bone pain
  
  
• Nausea
  
  
• Fatigue
  
  
• Mouth sores and/or sore throat
  
  
• Dental problems (usually preventable, see above)
  
  
• Painful 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
  
  
• Buildup of earwax, which 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.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. Chemotherapy may be given orally (by mouth); given intravenously (in a vein); injected into a muscle, under the skin, or directly into the cancerous tumor.

Chemotherapy and radiation therapy are commonly used in combination to treat nasopharyngeal cancer. The use of chemotherapy as an initial treatment or given after surgery and radiation therapy is also being studied.

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. In general, chemotherapy, in combination with radiation therapy, increases these side effects. Nutritional support may be necessary during treatment due to these side effects.

In general, chemotherapy may cause the following side effects:

• Fatigue
  
  
• Nausea
  
  
• Vomiting
  
  
• Hair loss
  
  
• Dry mouth
  
  
• Loss of appetite, often due to a change in sense of taste
  
  
• Weakened immune system
  
  
• Diarrhea and/or constipation
  
  
• Open sores in the mouth; this condition combined with weakened immunity can lead to infections

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 sometimes used for NPC when other treatments fail, 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.

Learn more about cancer surgery.

Recurrent NPC

Recurrent NPC is treated with radiation therapy, chemotherapy, or in some instances, 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. In addition, a clinical trial of biologic therapy may be an option (see Current Research).

Find out more about common terms used during cancer treatment.