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Nasopharyngeal Cancers

Causes of Nasopharyngeal Cancer

As with most cancers, doctors can’t tell you with certainty what causes nasopharyngeal cancer. It’s a combination of genetic factors and factors in your environment.

By far the most common factor contributing to most head and neck cancers is using tobacco, particularly smoking it. Drinking excessive amounts of alcohol also contributes to the risk of developing head and neck cancer.

  • Tobacco: Smoking cigarettes, cigars or pipes and using chewing tobacco greatly increase your chance of getting a throat cancer. For nasopharyngeal cancer, this is associated mainly with the differentiated type of squamous cell carcinoma.3, Vaughan TL, Shapiro JA, Burt RD, et al. Nasopharyngeal cancer in a low-risk population: defining risk factors by histological type. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. Aug 1996;5(8):587-593.4 Xu FH, Xiong D, Xu YF, Cao SM, Xue WQ, Qin HD, Liu WS, Cao JY, Zhang Y, Feng QS, Chen LZ, Li MZ, Liu ZW, Liu Q, Hong MH, Shugart YY, Zeng YX, Zeng MS, Jia WH. An epidemiological and molecular study of the relationship between smoking, risk of nasopharyngeal carcinoma, and Epstein-Barr virus activation. J Natl Cancer Inst. 2012 Sep.
  • Alcohol: Drinking excessive amounts of alcohol is also very strongly related to getting a throat cancer. Moreover, if you both smoke and drink heavily, the risk more than doubles. For nasopharyngeal cancer, this is associated mainly with the differentiated type of squamous cell carcinoma.3, Vaughan TL, Shapiro JA, Burt RD, et al. Nasopharyngeal cancer in a low-risk population: defining risk factors by histological type. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. Aug 1996;5(8):587-593.5 Pelucchi C, Gallus S, Garavello W, Bosetti C, La Vecchia C. Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism. 2006;29(3):193-198.

One of the great mysteries of NPC is why people in southeastern China (especially in the Guangdong province) get this cancer more than anywhere else. Genetics probably plays a role, but Chinese people born in North America don’t get it as frequently.6 Buell P. The effect of migration on the risk of nasopharyngeal cancer among Chinese. Cancer research. May 1974;34(5):1189-1191. This implies that the environment plays an important role as well.

  • Salted fish: There is a chemical called dimethylnitrosamine that has been found in salted fish. We know this compound can increase the chance of getting cancer. It is thought that eating a great deal of salted fish might contribute to increasing the risk of getting NPC.7 Yu, et al. Cantonese-style salted fish as a cause of nasopharyngeal carcinoma: a report of a case-control study in Hong Kong. Cancer Res. 1986;46:956-961.
  • Epstein-Barr Virus: This virus is quite common. It is so common that it clearly is not the only cause of NPC. However, this virus is frequently found inside NPC tumor cells.8, zur Hausen, et al. EBV DNA in biopsies of Burkitt tumors and anaplastic carcinomas of the nasopharynx. Nature. 1970;228:1056-1058.9 Henle G, et al. EBC specific IgA serum antibodies as an outstanding feature of nasopharyngeal carcinoma. Int J Cancer. 1976;17;1-17. Also, patients who have NPC have higher levels of proteins against EBV than those without NPC.
  • Genetics: NPC is more common in people who have a relative with NPC—actually up to four times as common.10 Yu MC, et al. Occupational and other non-dietary risk factors for NPC in Guangzhou, China. Int J Cancer. 1990;45:1033-1039. A few genes have also been linked to NPC. Certain ethnicities are more prone to get nasopharynx cancer as well.
  • Certain foods: Deficiencies in some vitamins and poor oral hygiene might be associated with nasopharynx cancers.11 Morris RE, Mahmeed BE, Gjorgov AN, Jazzaf HG, Rashid BA. The epidemiology of lip, oral cavity and pharyngeal cancers in Kuwait 1979-1988. The British journal of oral & maxillofacial surgery. Aug 2000;38(4):316-319.
  • Exposure at work: There is evidence that exposure to certain substances at work might increase your chance of getting nasopharynx cancer. For example, formaldehyde and wood dust exposure have been assocated with NPC.3, Vaughan TL, Shapiro JA, Burt RD, et al. Nasopharyngeal cancer in a low-risk population: defining risk factors by histological type. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. Aug 1996;5(8):587-593.12 Decker J, Goldstein JC. Risk factors in head and neck cancer. The New England journal of medicine. May 13 1982;306(19):1151-1155.
References

1 Ho JH. An epidemiologic and clinical study of nasopharyngeal carcinoma. International journal of radiation oncology, biology, physics. Mar-Apr 1978;4(3-4):182-198.

2 Hildesheim A, Levine PH. Etiology of nasopharyngeal carcinoma: a review. Epidemiologic reviews. 1993;15(2):466-485.

3 Vaughan TL, Shapiro JA, Burt RD, et al. Nasopharyngeal cancer in a low-risk population: defining risk factors by histological type. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. Aug 1996;5(8):587-593.

4 Xu FH, Xiong D, Xu YF, Cao SM, Xue WQ, Qin HD, Liu WS, Cao JY, Zhang Y, Feng QS, Chen LZ, Li MZ, Liu ZW, Liu Q, Hong MH, Shugart YY, Zeng YX, Zeng MS, Jia WH. An epidemiological and molecular study of the relationship between smoking, risk of nasopharyngeal carcinoma, and Epstein-Barr virus activation. J Natl Cancer Inst. 2012 Sep.

5 Pelucchi C, Gallus S, Garavello W, Bosetti C, La Vecchia C. Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism. 2006;29(3):193-198.

6 Buell P. The effect of migration on the risk of nasopharyngeal cancer among Chinese. Cancer research. May 1974;34(5):1189-1191.

7 Yu, et al. Cantonese-style salted fish as a cause of nasopharyngeal carcinoma: a report of a case-control study in Hong Kong. Cancer Res. 1986;46:956-961.

8 zur Hausen, et al. EBV DNA in biopsies of Burkitt tumors and anaplastic carcinomas of the nasopharynx. Nature. 1970;228:1056-1058.

9 Henle G, et al. EBC specific IgA serum antibodies as an outstanding feature of nasopharyngeal carcinoma. Int J Cancer. 1976;17;1-17.

10 Yu MC, et al. Occupational and other non-dietary risk factors for NPC in Guangzhou, China. Int J Cancer. 1990;45:1033-1039.

11 Morris RE, Mahmeed BE, Gjorgov AN, Jazzaf HG, Rashid BA. The epidemiology of lip, oral cavity and pharyngeal cancers in Kuwait 1979-1988. The British journal of oral & maxillofacial surgery. Aug 2000;38(4):316-319.

12 Decker J, Goldstein JC. Risk factors in head and neck cancer. The New England journal of medicine. May 13 1982;306(19):1151-1155.

13 Sham JS, et al. serous otitis media. An opportunity for early recognition of nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 1992;118:794-797.

14 Neel HB, 3rd. Nasopharyngeal carcinoma: diagnosis, staging, and management. Oncology (Williston Park). Feb 1992;6(2):87-95; discussion 99-102.

15 Wei WI, Sham JS. Nasopharyngeal carcinoma. Lancet. Jun 11-17 2005;365(9476):2041-2054.

16 Sham JST, Cheung YK, Chan FL, Choy D. Nasoparyngeal carcinoma: pattern of skeletal metastases. Br J Radiol. 1990;63:202-205.

17 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

18 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 7, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

19 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

20 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010.