Nasopharyngeal cancer is a is a rare form throat cancer that forms in the nasopharynx in the upper portion of the throat (pharynx). Most of these cancers develop as squamous cell carcinomas (cancers arising from the squamous cells in the tissues that line the pharynx), however some develop as lymphomas (cancers arising from the lymphatic system).
The pharynx/throat is a hollow tube that consists of three main portions: the nasopharynx, the oropharynx, and the hypopharynx. The nasopharynx is located at the uppermost portion of the throat, behind the nose and above the soft palate (muscle in the mouth preventing food from entering the nasal passages). Its primary function is to allow inhaled air to pass through the larynx (voice box) and into the lungs. The middle portion of the throat, the oropharynx, is the area from the soft palate and tongue to the back of the mouth, including the tonsils. This is followed by the hypopharynx, which functions as a guide for food into the oesophagus and not into the larynx and lungs.
Nasopharyngeal cancer is more common in men, and is generally diagnosed in adults over the age of 40. However, anyone can develop this disease.
Treatment
If nasopharyngeal cancer is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for nasopharyngeal cancer may include:
- Radiation therapy, potentially including:
- Intensity Modulated Radiation therapy (IMRT).
- Volumetric Arc Therapy (VMAT).
- Tomotherapy.
- Stereotactic radiation therapy.
- Chemotherapy.
- Surgery, potentially including:
- Endoscopic sinus surgery (a minimally invasive procedure that removes the cancer using a long, thin, flexible tube (endoscope)).
- Maxillary swing (several incisions are made along the face, lip, and mouth. The maxilla (jawbone) is cut and swung out to access the nasopharynx, and remove the tumour).
- Neck dissection (removal of affected lymph nodes from the neck).
- Clinical trials.
- Palliative care.
For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.
Risk factors
While the cause of nasopharyngeal cancer remains unknown, the following factors may increase the risk of developing nasopharyngeal cancer:
- Being diagnosed with the Epstein-Barr virus (EBV).
- Having a history of smoking.
- Eating a diet high in salt, cured fish and meat.
- People of southern Chinese or southern Asian ethnicities.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Early symptoms
Common symptoms of nasopharyngeal cancer may include:
- Persistent blocked nose and/or stuffiness.
- Frequent nose bleeds.
- Hearing loss, ringing or fullness in the ear.
- Ear infections (more common in children).
- Lump in the neck (often painful).
- Frequent headaches.
- Facial numbness and/or pain.
- Blurred and/or double vision.
- Difficulties opening the mouth.
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have nasopharyngeal cancer, they will order a range of diagnostic tests to confirm the diagnosis, and refer you to a specialist for treatment.
Physical examination
Your doctor will collect your overall medical history, as well as your lifestyle/health habits current symptoms. Following this, they may examine your body to check for any abnormalities. More specifically, they will feel your neck to see if there are any swollen lymph nodes, which are indicative of infection.
Imaging & blood tests
The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), and/or positron emission tomography (PET scan), depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and looks for signs of metastasis. Additionally, a blood test may be taken to assess your overall health and help guide treatment decisions.
Nasoendoscopy & biopsy
A Nasoendoscopy is a day procedure often used to examine the lining of the nasal passages, including the nasopharynx. To look for nasopharyngeal cancer, the doctor will place a long, thin tube with a light and a camera attached (endoscope) into your nose to check for any abnormalities.
Once the location(s) of the cancer has been identified, the doctor will perform a biopsy to remove a section of tissue using a needle. The tissue sample will then be analysed for cancer cells. This can be done by a fine needle aspiration (FNA), or a core needle biopsy (CNB).
Prognosis (Certain factors affect the prognosis and treatment options)
While it is not possible to predict the exact course of the disease, your doctor may be able to give you a general idea based on the rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage nasopharyngeal cancers have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis may not be as good and there may be a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis.
References
Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.