Nasopharyngeal cancer is a type of cancer that originates in an area of the head called the nasopharnyx which is located between the back of the nose and the top of the throat. Unfortunately, it is quite difficult to detect nasopharyngeal carcinoma early on because it is hidden in an area that is not seen on routine physical exam and the cancer can grow for a long time before causing any symptoms. Also, many of the symptoms of nasopharyngeal cancer can be caused by common and benign (not dangerous) conditions. DNA normally controls how the cells grow and reproduce. In cancer, the DNA of certain cells has a mutation that allows them to grow and reproduce at a very high rate. Instead of dying like a normal cell would, these cells live a particularly long time. These abnormal cells group to make a mass (growth) in the nasopharnyx. The exact cause of these genetic mutations leading to cancer is unknown, but risk factors are known. Risk factors for having nasopharyngeal carcinoma include: being male, being of Asian or Northern African or native Alaskan descent, being between the ages of 30 and 55, eating a lot of salt cured foods or preserved meats, having the Epstein-Barr virus, and having a family history of nasopharyngeal carcinoma. Because nasopharyngeal carcinoma hides for so long without causing symptoms, it has frequently metastasized (invaded other areas in the body) at the time that it is diagnosed including the lymph nodes, liver, lungs and bones. For some people, nasopharyngeal carcinoma will cause something called paraneoplastic syndrome where chemicals put out by the tumor affect the body, causing neurologic and joint problems as well as abnormalities in the white blood cells (the cells which fight infection).
Lump in the neck, bloody nose, nasal congestion (especially limited to one side of the nose for a long time), one-sided hearing loss, pain in the face, pain in the neck, double vision, headaches, fatigue
The diagnosis of nasopharyngeal cancer is usually made after a careful history and physical exam. Because the rate of nasopharyngeal cancer is so low, doctors don’t routinely screen for it unless a person is having symptoms. As you can see, telling your doctor about your symptoms is extremely important. When your doctor is doing the general examination, he or she will look in your nose with small light and feel your neck for any lymph nodes. If your symptoms do not resolve on their own, you will likely be referred to an Ear, Nose and Throat (ENT) doctor to have them look back into your nasopharynx with a thin tube with a camera on the end. If the ENT doctor sees a mass, he or she will take a biopsy (small sample) of the mass to look at under a microscope o determine if the mass is cancerous and which type of carcinoma it is. Sometimes your doctor will also want to biopsy any lymph nodes in your neck and look at them under a microscope as well. If you end up having cancer, your doctor will want to take pictures of your body using a CT scan, MRI or PET scan to see if the cancer has spread anywhere else beyond the nasopharynx.
The treatment of nasopharyngeal carcinoma will be decided by you and your doctor. You will likely work with both an ENT doctor and an Oncology doctor. Your treatment will depend on both the type of cancer and the stage of your cancer (a measure of how far the it has spread in the body). If the cancer has spread, it is more difficult to treat successfully. Generally, treatment for nasopharyngeal cancer is either with radiation therapy or a combination of radiation therapy and chemotherapy. Radiation therapy involves focusing beams of radiation at the site of the cancer. Radiation therapy is done locally at the site of the growth to shrink the cancer which generally both provides relief of symptoms as well as makes the cancer easier for the chemotherapy to fight. Radiation has the side effect of causing a local burn to the skin in the area where the radiation is given. Radiation therapy is particularly successful for nasopharyngeal carcinoma, so your doctor will almost always recommend it as part of your treatment regimen. A special type of radiation therapy called brachytherapy may also be used. In brachytherapy, small seeds of radiation are planted at the site of the cancer that release radiation over a longer period of time. Chemotherapy is chemical medicine given to the patient that helps halt and kill cancerous cells in the body. Your oncologist will tell you what kinds of side effects your specific chemotherapy treatment options have but most have at least some associated nausea. Chemotherapy is also particularly useful if the cancer has spread in the body (become metastatic). Surgery may also be a treatment choice for you. Surgery may be done both to remove the primary cancer mass as well as the diseased lymph nodes from the neck. If surgery is done to remove the cancer mass, the surgeon may need to make an incision in the roof of your mouth to get to the nasopharynx. You should discuss all of your treatment options with your doctors to decide what treatment option is best for you.
