What Is Nasopharyngeal Cancer?

Nasopharyngeal cancer is considered a type of head and neck cancer. It originates in the nasopharynx, the area behind the nose and including the upper posterior part of the throat. Like other types of head and neck cancer, nasopharyngeal cancer is frequently associated with a viral infection.

Types of Nasopharyngeal Cancer

There are three types of nasopharyngeal cancer: non-keratinizing undifferentiated carcinoma, non-keratinizing differentiated carcinoma, and keratinizing squamous cell carcinoma. Non-keratinizing undifferentiated carcinoma is the most commonly diagnosed of the three types.

The treatment is the same for all three types of nasopharyngeal cancer, with keratinizing squamous cell carcinoma being the most difficult type to treat.

Nasopharyngeal Cancer Symptoms

The severity of symptoms experienced with nasopharyngeal cancer will vary between individuals and usually correlates with the size and number of tumors present as well as if the cancer has spread to other locations in the body. Symptoms may include:

• Palpable lump in your neck
• Ear problems such as unilateral hearing loss or ringing in your ears
• Fluid in the ears
• Nasal congestion or feeling of fullness or pressure
• Nosebleeds
• Headaches
• Blurry vision
• Areas of numbness in your face
• Weight loss
• Voice changes

Causes

It is not always possible to determine the causes of nasopharyngeal cancer, but it is known that it most frequently occurs in areas where there are high rates of Epstein-Barr virus (EBV) and there is an association with high numbers of EBV in blood samples of individuals with nasopharyngeal cancer.

There may also be a genetic link. Identified risk factors in the development of nasopharyngeal cancer include smoking, alcohol use, and eating a diet high in preserved foods that contain nitrosamines.

Diagnosis

If you have symptoms of nasopharyngeal cancer, it is important that you see a healthcare provider as soon as possible.

Your healthcare provider will likely start by asking you questions about your health history as well as your current symptoms. This interview is typically followed by a physical exam where your healthcare provider may feel your neck and the surrounding area for lumps and look into your nose and throat.

If, after this examination, your practitioner suspects nasopharyngeal cancer, they may order medical imaging tests such as magnetic resonance imaging (MRI). Other tests may be ordered depending on your circumstances.

For example, if growths are detected, a specialist in ear, nose, and throat disorders (an otolaryngologist) can perform a nasopharyngolaryngoscopy. A nasopharyngolaryngoscopy is a procedure in which an instrument with a small camera is inserted into the nasopharynx to allow for direct visualization of this area.

Biopsies can also be done of the growth during a nasopharyngolaryngoscopy to confirm or rule out malignancy. If nasopharyngeal cancer is confirmed and your healthcare provider suspects that it may have spread, they may order a test called a positron emission tomography (PET) scan.

Due to the high incidence of EBV and nasopharyngeal cancer, bloodwork to look for the presence of this virus is an important aspect of diagnosis.

Several conditions can cause symptoms similar to nasopharyngeal cancer or be confused with it, including nasal polyps, enlarged adenoids, hemangiomas, rhabdomyosarcoma, pediatric non-Hodgkin lymphoma, and inverted papillomas.

Staging

Most types of cancer, including nasopharyngeal cancer, are staged. This is how healthcare providers communicate how advanced the cancer is and whether it has spread to other parts of the body. Staging is also an important aspect in determining treatment and prognosis.

The latest method for staging is called TMN staging. T stands for tumor and may also specify the tumor location and affected structures, M for metastasis (whether or not the cancer has spread), and N indicates lymph node involvement by location, number, and/or size.

Each of these categories is assigned numbers (sometimes letters) that indicate the severity of the disease. For example, M0 means there is no metastasis. This is a very brief description of a complex staging system that your healthcare provider should go over with you in detail as well as how your stage of cancer will affect your prognosis and options for treatment.

Treatment

There are three treatments generally used for nasopharyngeal cancer: surgery, radiation, and chemotherapy. These treatments are used alone or in combination depending on the stage of cancer you are experiencing and your individual circumstances.

Early stage cancer (stages 0 and I) are usually treated with radiation, while advanced stages often require chemotherapy in addition to radiation. Participation in a clinical trial may be suggested for people with advanced or widespread nasopharyngeal cancer.

Prognosis

Your chances of surviving nasopharyngeal cancer depend on a number of factors including the type of nasopharyngeal cancer you have, the stage of your cancer at diagnosis, your underlying health condition, and your access to treatment.

The average survival rate for an individual with localized nasopharyngeal cancer five years after diagnosis is 85%. The average survival rate for an individual with widespread (metastasized) nasopharyngeal cancer five years after diagnosis is 49%.