Nasopharyngeal Cancer

Cancers of the nasopharynx are rare in the US, affecting less than 1 per 100,000 every year. While anyone of any age can develop nasopharyngeal cancer, in the US it’s most likely to be found in those over 50 years old, and more likely in men. The most common type of this head and neck cancer is a carcinoma that arises from the cells that line the nasopharynx, the section behind the nasal cavity around the upper part of the throat.

Symptoms of Nasopharyngeal Cancer

The early stages of nasopharyngeal cancer often begin with no obvious symptoms. Coupled with this area of the throat being difficult to examine, it may be some time before a diagnosis is made.

The most common sign of nasopharyngeal cancer is a lump in the neck due to swollen lymph nodes. Other early signs and symptoms can include:

• Hearing impairment or tinnitus
• Nosebleeds
• Sore throat
• A sensation of nasal congestion and stuffiness

If the carcinoma progresses and metastasizes (spreads), additional symptoms may include:

• Double vision
• Headaches
• Facial numbness and weakness
• Difficulty swallowing or opening the mouth
• Frequent ear infections

What Causes Nasopharyngeal Cancer?

There is no one factor that directly causes nasopharyngeal cancer.  As with all cancers such as esophageal cancer, mutations of the DNA in the cells are responsible for the uncontrolled growth and spread of these cells, which then damage the tissues they invade.

Research has revealed certain risk factors can increase the likelihood of DNA mutation in the cells of the nasopharyngeal lining. The Epstein-Barr virus is a very common virus responsible for illnesses such as glandular fever (also known as mononucleosis). Though the majority of people who contract this virus recover with no problems, there has been an association made with this viral infection and certain cancers, including nasopharyngeal carcinoma and Hodgkin lymphoma. Other factors known to increase the risk of developing nasopharyngeal cancer include:

• Ethnic heritage from southern China, southeast Asian, North Africa, and Inuit ancestry
• Family history of nasopharyngeal cancer
• Exposure to tobacco smoke, including secondhand smoke
• Excessive alcohol intake
• High intake of salt-cured foods due to the presence of carcinogenic (cancer-causing) chemicals

Although these factors are shown to increase your risk of cancer, having one or more of these factors doesn’t necessarily mean you will develop nasopharyngeal cancer in the future; conversely, not having any of these risk factors doesn’t mean a cancer won’t develop.

Diagnosis and Treatment of Nasopharyngeal Cancer

In the US, there is currently no routine screening program for this type of cancer. If your symptoms or risk factors lead you to having an exam with a doctor, nasopharyngeal cancer can be diagnosed with a physical examination using an endoscope to view the nasopharynx, and a biopsy of tissue from the nasopharynx for lab testing.

If nasopharyngeal cancer is identified, you will need to undergo further tests, such as CT or MRI scans, which will help to determine the stage of the cancer. Additional tests such as a neurological exam, hearing test, or blood tests can also aid diagnosis and staging. Staging the cancer is important to determine the most appropriate treatment approach and also to help guide your prognosis. The classification of the cancer ranges from stage 0 where abnormal cells are noted only in the nasopharynx, up to stage IV where cancerous cells have metastasized to other parts of the body, such as the brain or distant lymph nodes.

Depending on the size of the tumor, stage of the cancer, and how the Epstein-Barr virus may have affected your body, your doctor will discuss what your treatment options might be, such as:

• Radiation therapy: the predominant treatment for small tumors that haven’t spread or if you can’t have chemotherapy
• Chemotherapy: often used alongside radiation therapy for more advanced stages of cancer
• Surgery: used to completely remove tumors in the nasopharynx or affected lymph nodes
• A combination of the above

Even after successful treatment of the initial cancer, nasopharyngeal cancer may recur. In these cases, they can often be treated again with one of the aforementioned therapies.

Every treatment option has possible side effects and a risk of complications. One way to reduce your risk is to quit smoking. Not only does this improve the success of your cancer treatment but can also reduce your risk of the cancer returning.

Nasopharyngeal cancer is often managed with a team of doctors, including an otolaryngologist (ENT doctor), oncologist (cancer specialist), plastic surgeon (to reconstruct parts of the body that may have been damaged from the cancer treatment), and oral and maxillofacial surgeon (a specialist of the mouth, teeth, and jaw).