Nasopharyngeal Cancer: Types of Treatment

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with NPC. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for NPC. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan, which usually combines different types of treatments. This is called a multidisciplinary team. The team may include:

  • Medical oncologist: A doctor who treats cancer using chemotherapy or other medications.

  • Radiation oncologist: A doctor who specializes in treating cancer using radiation therapy.

  • Surgical oncologist: A doctor who treats cancer using surgery.

  • Otolaryngologist: A doctor who treats ear, nose, and throat problems.

  • Maxillofacial prosthodontist: A specialist who performs restorative surgery in the head and neck areas.

  • Oncologic dentist or oral oncologist: Dentists experienced in caring for people with head and neck cancer.

  • Physical therapist: A health care professional who helps patients improve their physical strength and ability to move.

  • Speech-language pathologist: This professional specializes in communication and swallowing disorders. A speech-language pathologist helps patients regain their speaking, swallowing, and oral motor skills after cancer treatment that affects the head, mouth, and neck.

Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Many cancers of the nasopharynx can be cured, especially if they are found early. Descriptions of the common types of treatments used for NPC are listed below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

The main treatment for NPC is radiation therapy. It is 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 come back after initial treatment.

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 consider how it might affect a person’s quality of life, including how a person feels, looks, talks, eats, and breathes.

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. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for NPC because there are different treatment options. Learn more about making treatment decisions.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

There are different types of radiation therapy that a doctor may recommend for NPC.

  • External-beam radiation therapy. The most common type of radiation therapy used to treat NPC is called external-beam radiation therapy, which aims radiation from a machine outside the body at the tumor. A method of external-beam radiation therapy, known as intensity-modulated radiation therapy (IMRT), allows more effective doses of radiation therapy to be delivered, while reducing damage to healthy cells and causing fewer side effects.

  • Proton therapy. Proton 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 tumors at the base of the skull to lower the radiation dose to nearby structures, such as the optic nerves in the eye and the brainstem. Proton therapy may also be an option for later-stage NPC that is located close to parts of the central nervous system, which includes the brain and spinal cord.

  • Stereotactic radiosurgery. Stereotactic radiosurgery delivers radiation therapy precisely to the tumor. This can be used to treat a tumor that has grown into the base of the skull or a tumor that has recurred at the base of the brain or skull.

  • Brachytherapy. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. To treat NPC with internal radiation therapy, a doctor surgically implants tiny pellets or rods that contain radioactive materials in or near the cancer location. The implant is left in place for several days while the person stays in the hospital. This approach is most often used to treat NPC that has come back after the first treatment, but it may also be used to treat the original tumor.

Before starting radiation treatment for any head and neck cancer, people should receive a thorough examination from a dentist experienced in treating people with head and neck cancer, called an oncologic dentist. 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 cancer treatment begins. After radiation therapy for NPC, dental care should continue to help prevent further dental problems. People may receive fluoride treatment to prevent dental cavities. Read more about dental and oral health.

Other side effects of radiation therapy to the head and neck may include redness or irritation of the skin in the treated area, dry mouth or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue, mouth sores, sore throat, pain or difficulty swallowing, swelling called lymphedema, appetite loss because of changes in a person's sense of taste, hearing loss because of a buildup of fluid in the middle ear, and earwax buildup 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 slows down. The thyroid gland is located in the neck. Hypothyroidism causes people to feel tired and sluggish and to gain weight. As a result, every person 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 manage side effects. Learn more about the basics of radiation therapy.

Chemotherapy

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist.

A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The type of systemic therapy used for NPC is chemotherapy. Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

Common ways to give chemotherapy include:

  • An intravenous (IV) tube placed into a vein using a needle

  • In a pill or capsule that is swallowed (orally)

  • A shot (injection) into a muscle, under the skin, or directly into the cancerous tumor

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A combination of chemotherapy and radiation therapy is commonly used to treat NPC. The use of chemotherapy before 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 become permanent. Side effects of chemotherapy may include fatigue, nausea, vomiting, hair loss, dry mouth, diarrhea, constipation, and loss of appetite, often due to a change in a person's sense of taste.

In addition, chemotherapy 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 these side effects. Nutritional support may be necessary during treatment due to these side effects. Listen to a podcast about managing eating challenges after treatment.

Learn more about the basics of chemotherapy.

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. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Surgery

Surgery is the removal of the tumor and some surrounding healthy 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.

If the doctor suspects that the cancer has spread to the lymph nodes, surgical removal of lymph nodes in the neck may be recommended. This type of surgery is called a neck dissection. For undifferentiated carcinoma of the nasopharynx, neck dissection is sometimes needed.

A neck dissection may cause numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. These side effects are caused by damage to nerves in the area. Depending on the type of neck dissection, weakness of the lower lip and arm may go away after a few months. However, it is possible that weakness will be permanent if a nerve is removed or damaged as part of a dissection. Swelling called lymphedema may also be possible. 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. If there are changes to your appearance, talk with your health care team about ways to cope and finding support services.

Learn more about the basics of cancer surgery.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Metastatic NPC

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of radiation therapy and chemotherapy. Sometimes, surgery may be recommended as well. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Your and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns 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 new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Recurrent NPC is usually treated with radiation therapy and/or chemotherapy, and sometimes with surgery. Chemotherapy is used for NPC that has come back in distant sites and was previously treated only with radiation therapy. Chemotherapy may also be used together with radiation therapy to improve the effectiveness of the radiation therapy. This approach is called chemoradiotherapy. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. For instance, a clinical trial of immunotherapy may be an option. Learn more in the Latest Research section.

Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Recovery from NPC is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.