Nasopharyngeal carcinoma

Overview

Nasopharyngeal carcinoma is cancer that starts as a growth of cells in the nasopharynx. The nasopharynx is the upper part of the throat. It sits behind the nose.

Nasopharyngeal (nay-zoh-fuh-RIN-jee-ul) carcinoma is rare in the United States. It happens much more often in other parts of the world, mainly Southeast Asia.

Nasopharyngeal carcinoma is hard to find early. That's most likely because the nasopharynx isn't easy to examine. And there may be no symptoms at first.

Treatment for nasopharyngeal carcinoma usually involves radiation therapy, chemotherapy or a mix of the two. Work with your healthcare professional to find the approach that's right for you.

Symptoms

Nasopharyngeal carcinoma may not cause signs or symptoms at first. When it does cause symptoms, they might include:

• A lump in your neck caused by a swollen lymph node.
• Bleeding from the nose.
• Bloody saliva.
• Double vision.
• Ear infections.
• Facial numbness.
• Headaches.
• Hearing loss.
• Nasal stuffiness.
• Ringing in the ears, called tinnitus.
• Sore throat.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

Causes

The exact cause of nasopharyngeal carcinoma often isn't known.

Nasopharyngeal carcinoma is a kind of cancer that starts in the upper part of the throat, called the nasopharynx. It happens when cells in the nasopharynx develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell cells to die at a set time.

In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a growth called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Risk factors

Researchers have found some factors that seem to raise the risk of getting nasopharyngeal carcinoma. They include:

• Certain ancestries. Nasopharyngeal carcinoma is more common in parts of China, Southeast Asia, northern Africa and the Arctic. People who live in these areas or have ancestry that comes from these parts of the world may have an increased risk of nasopharyngeal carcinoma.
• Middle age. Nasopharyngeal carcinoma can occur at any age. But most often it's diagnosed in adults between the ages of 30 and 60.
• Salt-cured foods. Chemicals released in steam when cooking salt-cured foods might raise the risk of nasopharyngeal carcinoma. The steam from foods such as fish and preserved vegetables may enter the nose during cooking. Contact with these chemicals at an early age may raise the risk even more.
• Epstein-Barr virus. This common virus most often causes mild symptoms like those of a cold. Sometimes it can cause infectious mononucleosis. The Epstein-Barr virus also is linked to some cancers, including nasopharyngeal carcinoma.
• Family history. Having a family member with nasopharyngeal carcinoma raises the risk of the disease.
• Alcohol and tobacco. Heavy alcohol intake and tobacco use can raise your risk of nasopharyngeal carcinoma.

Complications

Nasopharyngeal carcinoma complications can include:

• Cancer that grows into nearby structures. Advanced nasopharyngeal carcinoma can grow large enough to go into nearby structures, such as the throat, bones and brain.
• Cancer that spreads to other areas of the body. Nasopharyngeal carcinoma often spreads beyond the nasopharynx. It typically spreads to the lymph nodes in the neck first. When it spreads to other parts of the body, nasopharyngeal carcinoma most often goes to the bones, lungs and liver.

Prevention

There's no sure way to prevent nasopharyngeal carcinoma. But, if you're worried about your risk of this cancer, think about giving up habits that have been linked with the disease. For instance, don't use tobacco. You may choose to cut back on or not eat salt-cured foods.

Tests to screen for nasopharyngeal carcinoma

In the United States and in other areas where the disease is rare, there's no routine screening for nasopharyngeal carcinoma.

In places where nasopharyngeal carcinoma is much more common, such as some areas of China, people at high risk of the disease may have screening. Screening may involve blood tests to detect the Epstein-Barr virus.

Diagnosis

Nasopharyngeal carcinoma diagnosis often begins with an exam by a healthcare professional. The health professional may use a special scope to look inside the nasopharynx for signs of cancer. To confirm the diagnosis, a sample of tissue might be removed for testing.

Physical exam

A healthcare professional may do a physical exam to look for signs of cancer. This might include looking in your nose and throat. The health professional also may feel your neck for swelling in the lymph nodes. The health professional may ask about your symptoms and your habits.

Endoscopy

A healthcare professional who suspects nasopharyngeal carcinoma may do a procedure called a nasal endoscopy.

This test uses a thin, flexible tube with a tiny camera on the end, called an endoscope. It lets your healthcare professional see inside your nasopharynx. The endoscope might go through your nose to see your nasopharynx. Or the endoscope might go through the opening in the back of your throat that leads up into your nasopharynx.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. For nasopharyngeal carcinoma, a healthcare professional might take the sample during a nasal endoscopy procedure. To do this, the health professional puts special tools through the endoscope to remove some tissue. If there is swelling in the lymph nodes in the neck, a needle might be used to draw out some cells for testing.

Tests to find the extent of the cancer

Once the diagnosis is confirmed, other tests can find the extent, called the stage, of the cancer. These might include imaging tests such as:

• CT scan.
• MRI scan.
• Positron emission tomography scan, also called a PET scan.
• X-ray.

The stages of nasopharyngeal carcinoma range from 0 to 4. A lower number means the cancer is small and is mostly in the nasopharynx. As the cancer grows larger or spreads beyond the nasopharynx, the stages go up.

A stage 4 nasopharyngeal carcinoma can mean the cancer has grown into nearby structures, such as the area around the eye or the lower parts of the throat. Stage 4 also can mean the cancer has spread to the lymph nodes or other parts of the body.

Your healthcare team uses the stage and other factors to plan your treatment and understand the likely course of the cancer, called the prognosis.

Treatment

Treatment for nasopharyngeal carcinoma most often begins with radiation therapy or a mix of radiation and chemotherapy.

You and your healthcare team work together to make a treatment plan. Several factors go into making the plan. These may include the stage of your cancer, your treatment goals, your overall health and the side effects you're willing to have.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.

Radiation therapy for nasopharyngeal carcinoma most often involves external beam radiation. During this procedure, you lie on a table. A large machine goes around you. It sends radiation to the precise spot where it can target your cancer.

For small nasopharyngeal carcinomas, radiation therapy may be the only treatment needed. For cancers that are larger or have grown into nearby areas, radiation therapy is typically combined with chemotherapy.

For nasopharyngeal carcinoma that returns, you might have a type of internal radiation therapy, called brachytherapy. With this treatment, a healthcare professional puts radioactive seeds or wires in the cancer or close to it.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.

Chemotherapy may be given at the same time as radiation therapy to treat nasopharyngeal carcinoma. It also may be used before or after radiation therapy.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells.

The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

For nasopharyngeal carcinoma, immunotherapy might be an option if the cancer comes back or spreads to other parts of the body.

Surgery

Surgery is not often used as a first treatment for nasopharyngeal carcinoma. But you might have surgery to remove cancerous lymph nodes in the neck.

Sometimes, surgery may be used to remove cancer from the nasopharynx. Or it might treat cancer that comes back after having radiation or chemotherapy. To get to the cancer, a surgeon may make a cut in the roof of the mouth or in the face near the nose. Sometimes the surgeon can remove the cancer using special surgical tools that go through the nose.

Lifestyle and home remedies

Coping with dry mouth

Radiation therapy for nasopharyngeal carcinoma often causes dry mouth. Dry mouth may last a long time after treatment. For some people, it doesn't go away.

Dry mouth can cause discomfort. It also can lead to infections in your mouth. It can make it hard to eat, swallow and speak. And it can affect the health of your teeth. Ask your healthcare professional about seeing a dentist if you have dry mouth complications.

To help ease dry mouth and its complications:

• Brush your teeth a few times each day. Use a soft-bristled toothbrush. Brush gently. Tell your healthcare team if gentle brushing hurts your mouth.
• Rinse your mouth with a solution after meals. Ask your healthcare team what solution to use.
• Keep your mouth moist with water or sugarless candies. Drink water throughout the day to keep your mouth moist. Also try ice chips, sugarless gum or sugarless candies to help your mouth make saliva.
• Choose moist foods. Don't eat dry foods. Moisten food with sauce, gravy, broth, butter or milk.
• Don't eat acidic or spicy foods and drinks. Choose foods and drinks that won't irritate your mouth. Don't drink caffeinated and alcoholic beverages.

Tell your healthcare team if you have dry mouth. There may be treatments to help you cope with more-severe symptoms of dry mouth. Your healthcare team also may send you to an expert in nutrition, called a dietitian. A dietitian can help you find foods that are easier to eat with dry mouth.

Coping and support

People deal with a nasopharyngeal carcinoma diagnosis in their own ways. With time you'll find what works for you. Until then, it might help to:

Learn enough about your cancer so that you can help make decisions about your care

Write down questions to ask at your next medical appointment. Get a friend or family member to come to appointments with you to take notes. Ask your healthcare team for other sources of information.

Find someone to talk to

It might help to talk to someone about your feelings. This may be a close friend or family member who is a good listener.

It also might help to talk to a social worker or psychologist. Ask your healthcare team for names. You also might talk with a minister, spiritual leader or someone else in your faith community.

Think about joining a support group in your community or online. In the United States, contact the American Cancer Society for more information on support groups.

Take time for yourself when you need it

Let people know when you want to be alone. Quiet time to think or write in a journal can help you sort out your feelings.

Take care of yourself

Get ready for cancer treatment by making healthy lifestyle choices. For instance, if you smoke, quit smoking.

Eat a variety of fruits and vegetables. Get exercise when you feel up to it. But check with your healthcare team before starting a new exercise program.

Find ways to ease stress. And try to get enough sleep. Talk with your healthcare team if you have trouble sleeping.

These healthy choices can make it easier for your body to cope with the side effects of treatment.

Preparing for an appointment

Start by making an appointment with a doctor or other healthcare professional if you have any symptoms that worry you. If your health professional thinks you might have nasopharyngeal carcinoma, you might need to see a specialist. This might be a doctor who specializes in treating cancer, called an oncologist, or a doctor who specializes in ear, nose and throat issues, called an otolaryngologist.

Here are some tips to help you get ready for your appointment.

What you can do

Take a family member or friend with you, if possible. Someone with you can help with details that you miss or forget. Also, take a notebook or recording device with you to get everything you need to know.

Make a list of:

• Your symptoms. Include all your symptoms even if they don't seem linked to the reason you made the appointment. Include when your symptoms began.
• All medicines, vitamins or supplements you take. Include doses and how often you take them.
• Questions to ask your healthcare professional.

For nasopharyngeal carcinoma, some questions to ask include:

• What tests do I need?
• Do I need to do anything to prepare for these tests?
• Are there other possible causes for these symptoms?
• I have other health issues. How will this affect them?
• What treatment do you suggest?
• Is my cancer likely to return?
• Are there clinical trials I might get into?
• Where can I find out more about this type of cancer?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional might ask you:

• How often do you have symptoms?
• How bad are your symptoms?
• Does anything make your symptoms better?
• Does anything make your symptoms worse?
• Do you eat a lot of salt-cured foods, such as fish or preserved vegetables?
• Have you ever been diagnosed with the Epstein-Barr virus or mononucleosis?