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Nasopharyngeal Cancer - Introduction

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

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Nasopharyngeal Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

Cancer begins when healthy cells in the body change and grow out of control, forming a mass or growth of tissue called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

There are several types of benign nasopharyngeal tumors, including:

  • Angiofibromas and hemangiomas that involve the vascular, or blood-carrying, system.

  • Tumors that develop in the lining of the nasopharynx, including the minor salivary glands.

About nasopharyngeal cancer

Nasopharyngeal cancer may also be called nasopharyngeal carcinoma or NPC. It is 1 of 5 main types of cancer in the head and neck region, a grouping called head and neck cancer.

NPC is a disease of the nasopharynx, which is the air passageway at the upper part of the pharynx, or throat, behind the nose. The nostrils lead through the nasal cavity into the nasopharynx, and an opening called the Eustachian tube, which is located on each side of the nasopharynx, leads into the middle ear on each side (see Medical Illustrations).

The nasopharynx contains several types of tissue, and each tissue type contains several types of cells. Different cancers can develop from each kind of cell. For example, many types of NPC contain white blood cells, called lymphocytes. The cancer is named after these lymphocytes: lymphoepithelioma. These differences are important because they determine the seriousness of the cancer and the type of treatment needed.

Subtypes of NPC

According to the World Health Organization (WHO), NPC is classified into 3 subtypes:

  • Keratinizing squamous cell carcinoma (WHO type 1)

  • Nonkeratinizing squamous cell carcinoma (WHO type 2)

  • Undifferentiated or poorly differentiated carcinoma, including lymphoepithelioma and anaplastic variants (WHO type 3)

Recently, doctors have found that other factors, such as the presence of Epstein-Barr virus (EBV; see Risk Factors), can be more important for determining the seriousness of NPC and how to treat it. This means that the WHO types are being used less often in the treatment of NPC.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to head and neck cancer. This free fact sheet is available as a PDF, so it is easy to print out.

  • Cancer.Net Blog: Read an ASCO expert’s opinion about what newly diagnosed patients should know about head and neck cancer.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert in head and neck cancers that provides basic information and areas of research.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with NPC and general survival rates. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Statistics

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

ON THIS PAGE: You will find information about the number of people who are diagnosed with NPC each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

NPC is uncommon in the United States. Less than 1 person out of 100,000 people is diagnosed with NPC each year. NPC is more common in Asians/Pacific Islanders, who are diagnosed 6 times more often than white people and Hispanic people. Alaska Natives are also more likely to develop NPC. The disease can occur at any age, including in children. About 50% of people with the disease are 55 or younger.

During the past few years, the rate at which Americans have been developing this cancer has been slowly decreasing. NPC is much more common in certain parts of North Africa, the Middle East, and Asia, particularly southeast China.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with NPC is 60%.

For the earliest stage of NPC, stage I (1), the 5-year survival rate is 72%. About 9% of people with NPC are diagnosed at this stage. The 5-year survival rate for stage II (2) disease is 64% and for stage III (3) disease is 62%. Combined, 83% of people with NPC are diagnosed at these stages. The 5-year survival rate for stage IV (4) NPC is 38%. About 39% of people with NPC are diagnosed at this stage.

Survival rates depend on many factors, including the location of the tumor and if or where it has spread, called the stage. Talk with your doctor about what to expect with your specific diagnosis.

It is important to remember that statistics on the survival rates for people with NPC are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts and Figures 2017: Special Section – Rare Cancers in Adults, and the ACS website (January 2019).

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by NPC. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Medical Illustrations

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

ON THIS PAGE: You will find a drawing of the head and neck region, including the location of the nasopharynx. Use the menu to see other pages.

This illustration show the nasopharynx region in the head and neck, which is the air passageway at the upper part of the throat behind the nose. The nostrils lead into the nasal cavity, which is above the hard palate and the soft palate, which make up the roof of the mouth. The nasal cavity leads into the nasopharynx and down the throat towards the trachea (windpipe) and esophagus. A flap of tissue called the epiglottis helps protect the airway and prevent food from entering the trachea. Copyright 2003 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors and Prevention. It explains the factors that may increase the chance of developing NPC. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Risk Factors and Prevention

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

ON THIS PAGE: You will find out more about the factors that increase the chance of developing NPC. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often 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.

There are 2 substances that greatly increase the risk of developing NPC:

  • Tobacco. Tobacco use, including cigarettes, cigars, pipes, chewing tobacco, and snuff, is the single greatest risk factor for head and neck cancer. Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Smokers with NPC are most likely to have the squamous cell type. Secondhand smoke may also increase a person’s risk of developing head and neck cancer.

  • Alcohol. Frequent and heavy consumption of alcohol is a risk factor for head and neck cancer. Using alcohol and tobacco together increases this risk even more, although the influence of this in NPC is less than that for other head and neck cancers.

Other factors that may raise a person’s risk of NPC include:

  • Geography/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, the following generations of their family have a slow lowering in their inherited risk of NPC.

  • Epstein-Barr virus (EBV). Exposure to EBV plays a role in causing NPC. EBV is more commonly known as the virus that causes mononucleosis or “mono.”

  • Gender. Men are 2 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 diagnosed with NPC in the United States are younger than 55. A person of any age can be diagnosed with NPC.

  • Eating habits. Eating large amounts of salt-cured fish and meats on a regular basis increases a person's risk of developing NPC.

  • Environmental exposure. Extensive exposure to dust and smoke may increase the risk of NPC.

  • Marijuana. Recent research suggests that people who have used marijuana may be at higher risk for head and neck cancer.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause NPC, including ways to prevent it. Although there is no proven way to completely prevent NPC, you may be able to lower your risk. Talk with your health care team for more information about your personal risk of cancer.

Although some of the risk factors of NPC cannot be controlled, such as ancestry, 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 their risk of NPC, even for people who have used tobacco products for many years.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Screening

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

ON THIS PAGE: You will find out more about screening for NPC. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for NPC

Regular health and dental screenings are important for people who routinely drink alcohol, currently use tobacco products, or have used tobacco products in the past. 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 1 or more of the diagnostic procedures described in the Diagnosis section. When detected early, cancer of the head and neck has a much better chance of being cured.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems NPC can cause. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Symptoms and Signs

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

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with NPC may experience the following symptoms or signs. Sometimes, people with NPC do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

  • A lump in the neck, which is the most common symptom

  • Nasal obstruction or stuffiness

  • Trouble hearing or hearing loss

  • A sense of fullness or pain in the ear that is caused by a buildup of fluid in the middle ear, especially if it does not go away and occurs in just 1 ear

  • Pain and ringing in the ear

  • A sore throat that doesn't seem to go away

  • Trouble breathing or speaking

  • Frequent nosebleeds

  • Pain, numbness, or paralysis in the face

  • Frequent headaches

  • Difficulty opening the mouth

  • Blurred or double vision

  • Fatigue

  • Unexplained weight loss

If you are concerned about any changes you experience, please talk with your doctor or dentist. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Diagnosis

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

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This section describes options for diagnosing NPC. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

The following tests may be used to diagnose NPC:

  • Physical examination and blood test. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. The doctor will look for any abnormalities in the nose, mouth, throat, and tongue, often using a light and/or mirror to get a clearer view. A blood test to check for antibodies against the EBV virus may be done at the same time. See the Risk Factors and Prevention section for more information about EBV.

  • Endoscopy. An endoscopy 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. Sedation is giving medication to become more relaxed, calm, or sleepy. 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. A pathologist then analyzes the sample(s). A pathologist is 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.

    During a fine needle aspiration, cells are removed using a thin needle inserted directly into the tumor. The cells are examined under a microscope during cytologic examination for signs of cancer. The biopsy may be performed using local anesthesia or general anesthesia. Local anesthesia is an injection that numbs the area where a procedure is being done, while general anesthesia makes a person unconscious during a major procedure, such as surgery.

  • X-ray. An x-ray is a way to create a picture of the structures inside of the 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 takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • 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 any possible spread to nearby tissues or lymph nodes. MRI can be used to measure a tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • 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 lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image.

  • Neurological tests. During these examinations, the doctor tests a person’s nerve function, especially the sense of touch in their face and the 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) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells 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.

After 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.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Stages and Grades

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

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor decide what kind of treatment to recommend and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

There are 5 stages of NPC: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Recently, doctors have found that finding out whether there is Epstein-Barr virus (EBV; see Risk Factors and Diagnosis) present can be useful in staging.

Here are more details of each part of the TNM system for NPC.

Tumor (T)

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. Stage may also be 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.

Tis: This describes a stage called carcinoma (cancer) in situ. This is a very early cancer where cancer cells are found only in 1 layer of tissue.

T0 (T plus zero): No evidence of a tumor is found, but there are lymph nodes in the neck that are positive for EBV.

T1: The tumor has not spread beyond the nasopharynx. Or the tumor has grown into the oropharynx and/or nasal cavity but does not involve the areas around the pharynx.

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: The tumor extends inside the head to an area of the brain or into the lower part of the throat.

Node (N)

The “N” in the TNM staging system is for lymph nodes. These tiny, bean-shaped organs help fight infection. Lymph nodes near where the cancer started are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

For people with NPC, doctors examine lymph nodes in a triangle-shaped area formed by 3 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 (N plus zero): 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 of the neck as the primary tumor. The cancer found in the lymph nodes is 6 centimeters (cm) or smaller. A centimeter is roughly equal to the width of a standard pen or pencil.

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 and/or is found in lymph nodes located in the triangle.

Metastasis (M)

The "M" in the TNM system describes whether the cancer has spread to other parts of the body, called distant metastasis.

M0 (M plus zero): 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 with no spread to lymph nodes and no distant metastasis (Tis, N0, M0).

Stage I: A small tumor with no spread to lymph nodes and no distant metastasis (T1, N0, M0).

Stage II: There is evidence of EBV in lymph nodes in the neck or a tumor found only in the nasopharynx that has spread to lymph nodes but no metastasis (T0 or T1, N1, M0). This stage may also describe a tumor that has extended beyond the nasopharynx but has not spread to lymph nodes or to distant parts of the body (T2, N0, M0). It may also describe a tumor that has spread to lymph nodes but has not spread elsewhere (T2, N1, M0).

Stage III: A noninvasive or invasive tumor that has spread to lymph nodes on both sides of the neck above the triangular area but has not metastasized (T0, T1, or T2; N2; M0). This stage may also describe a larger tumor with or without lymph node involvement and no metastasis (T3; N0, N1, or N2; M0).

Stage IVA: This describes any invasive tumor with either no lymph node involvement or spread to only a single same-sided lymph node but no metastasis (T4, N0 or N1, M0). It is also used for any invasive tumor with more significant lymph node involvement but no metastasis (T4, N2, M0). It also describes any tumor (any T) with extensive lymph node involvement but no metastasis (any T, N3, M0).

Stage IVB: This describes any tumor when there is evidence of distant spread (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

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.

Nasopharyngeal Cancer - About Clinical Trials

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ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with NPC. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Clinical trials are used for all types and stages of NPC. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

People who participate in clinical trials can be some of the first to get a treatment, such as a new chemotherapy drug, before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some people, a clinical trial is the best treatment option available. Because standard treatments are not perfect, people are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating NPC. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with NPC.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. 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.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different than the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people 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 trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for NPC, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, you can find a free video-based educational program about cancer clinical trials in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for NPC. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Latest Research

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ON THIS PAGE: You will read about the scientific research being done to learn more about NPC and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about NPC, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with NPC. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

  • New medications. Immunotherapy, also called biologic therapy, is a type of cancer treatment designed to boost the body's natural defenses to fight the cancer. It uses substances made either by the body or in a laboratory to improve or restore immune system function. Treatment based on the specific biologic characteristics of a tumor is being used more often and is being tested in clinical trials. This is called targeted therapy. People with NPC should talk with their doctors about the availability of these studies. Learn more about the basics of immunotherapy and targeted therapy.

  • Chemotherapy for recurrent or metastatic NPC. A recent phase 3 study found that treating recurrent or metastatic NPC with a combination of gemcitabine (Gemzar) and cisplatin (available as a generic drug) worked better than using a combination of fluorouracil (5FU) and cisplatin.

  • Combining therapies. As described in Types of Treatment, doctors continue to research the best combinations of different types of therapies, such as radiation therapy, chemotherapy, and surgery, for different stages of NPC.

  • Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current NPC treatments to improve comfort and quality of life for patients. This includes ways to relieve dry mouth (xerostomia), mouth sores, pain, and other side effects.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding NPC, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Coping with Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment. People who are being treated for head and neck cancer may find it helpful to reach out to support groups that specialize in helping people being treated for this type of cancer.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care" or "supportive care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for NPC are listed in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to explain any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with NPC. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan. Create a caregiving plan with this 1-page fact sheet that includes an action plan to help make caregiving a team effort. This free fact sheet is available as a PDF, so it is easy to print out.

Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • Cancer.Net Mobile: The free Cancer.Net mobile app allows you to securely record the time and severity of symptoms and side effects.

  • ASCO Answers Managing Pain: Get this 36-page booklet about the importance of pain relief that includes a pain tracking sheet to help patients record how pain affects them. The free booklet is available as a PDF, so it is easy to print out.

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on diarrhea and rash that provide a tracking sheet to record the timing and severity of the side effect. These free fact sheets are available as a PDF, so they are easy to print out.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Follow-Up Care

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ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Learn more about the importance of follow-up care.

Watching for recurrence or second cancers

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

People treated for NPC should receive regular follow-up medical and dental examinations to check for signs that the NPC has come back or a second cancer (a different type of cancer) has developed. Your doctor may also recommend an MRI or CT scan 6 to 8 weeks after treatment, called a baseline study. If NPC comes back, the baseline study will help the doctors track when the changes began. Most recurrences of NPC happen within the first 2 to 3 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 second cancer. Researchers are evaluating the benefits of using chemotherapy as a way to prevent a second cancer from developing. This is called chemoprevention.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

For NPC, doctors may check thyroid function, vision, and hearing to detect any cranial nerve damage from radiation therapy or surgery. Periodic ear examinations may also be necessary to remove any dried earwax that has built up. Prevention of dental cavities is also important. Fluoride application is recommended whenever the oral cavity and the salivary glands receive radiation treatment.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Survivorship

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ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from NPC are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation will be a major part of your survivorship care. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible. Rehabilitation can include any of a wide range of services, such as physical therapy, career counseling, pain management, nutritional planning, and emotional counseling.

People may receive physical therapy and speech therapy to regain skills, such as speaking 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 prepare foods 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.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Questions to Ask the Health Care Team

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ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team 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. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What type of NPC do I have?

  • What is the stage of the cancer? What does this mean?

  • Can you explain my pathology report (laboratory test results) to me?

Questions to ask before treatment

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • Should I get an additional consultation or second opinion?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • Can you recommend an oncologic dentist before treatment begins?

  • Should I see a speech pathologist before starting treatment?

  • If I have questions or problems, who should I call?

Questions to ask about managing side effects

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible side effects of each treatment, both in the short term and the long term?

  • What can be done to prevent or manage these side effects?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

Questions to ask about having radiation therapy or therapies using medication

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about having surgery

  • What type of surgery will I have?

  • Will lymph nodes be removed? If so, what type of dissection will be done? What does this mean?

  • Will it be necessary to have reconstruction done to replace lost tissue around the lower jaw bone?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term effects of having this surgery?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs and symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • When can I expect to recover from the treatment effects?

  • Will there be any lasting or late side effects that will need special care?

  • What follow-up tests will I need, and how often will I need them?

  • What type(s) of rehabilitation will I need after treatment has finished?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Nasopharyngeal Cancer - Additional Resources

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ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Nasopharyngeal Cancer. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Nasopharyngeal Cancer. Use the menu to choose a different section to read in this guide.