Nasopharyngeal Carcinoma

Diagnosis

• Physical exam. The doctor will perform a physical assessment, symptom analysis and palpate the neck to check for any swollen lymph nodes.
• Nasal endoscopy. A small, flexible tube with a camera is inserted inside the nasal cavity using local anesthesia to look for the abnormalities if the doctor suspects nasopharyngeal carcinoma.
• Biopsy. A small sample of suspected cancer tissue is removed using an endoscope or other instruments for examination under a microscope in the laboratory to look for any cancerous cells.

Tests to determine the extent of the cancer

The doctor will stage the cancer using these tests:

• X-ray
• Computerized Tomography (CT) Scan
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET)
• Epstein-Barr virus DNA levels test

After the doctor has checked the extent of cancer, it will be staged by using Roman numerals from I to IV. The lower stages means that the cancer is localized within the nasopharynx, while stage IV means that the cancer is in its advanced stage and has spread to other parts of the body. Staging will help find out which treatment is appropriate and monitors the prognosis of the disease.

Treatment

The treatment of choice is based on the cancer stage, the patient’s general health and the patient’s own decision of treatment options.

Radiation therapy

Radiation therapy uses strong energy beams through X-rays or protons to fight cancer cells. The most common radiation therapy approach for nasopharyngeal cancer is called external beam radiation, which focuses radiation directly on the area where the cancer is, using a machine that is navigated over the patient’s body while the patient is lying on the table. This can be used for smaller tumors or can be combined with chemotherapy.

In certain cases, internal radiotherapy (also called brachytherapy) may be needed if nasopharyngeal cancer was recurrent after initial treatment. Radioactive seeds or wires are implanted in the tumor or near the tumor.

Chemotherapy

Chemotherapy is administered orally or intravenously to destroy cancer cells. There are 3 types of chemotherapy to treat nasopharyngeal carcinoma:

• Chemoradiation or concomitant therapy. Chemotherapy given at the same time as radiation therapy. This is used to strengthen the effect of radiation therapy, but the side effects of both are more potent and less tolerable for the patient.
• Chemotherapy after radiation therapy. Chemotherapy may be applied after radiation therapy to kill the remaining cancer cells or those that have spread.
• Chemotherapy before radiation therapy (Neoadjuvant chemotherapy). Chemotherapy is done before radiation or concomitant therapy. Although further research has to be done to prove the efficacy of neoadjuvant chemotherapy.

Surgery

Surgery is not a common treatment for nasopharyngeal cancer but may be used to remove cancerous lymph nodes in the neck. Sometimes, the doctor removes a nasopharyngeal tumor by reaching this area through the roof of the mouth to access the area to remove the cancer.