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Nasopharyngeal Cancers

What to Expect at Your Doctor’s Visit

Step 1: History

First, your head and neck specialist will take a thorough history of your health and address any specific concerns you may have.

Your doctor might ask questions such as:

  • How long has the problem been there?
  • Is it getting worse, better or staying the same?
  • Does it come and go?
  • Have you tried anything to make it better?
  • Is it painful?
  • Do you have any lumps or bumps in your neck?
  • Are you having difficulty with hearing?
  • Do you have any lumps or bumps anywhere else in your body?
  • Are you losing weight?
  • Are there any other problems associated with your main problem?
  • Do you have any other medical issues?
  • Have you had any surgeries in the past?
  • What medications do you take? And do you have any allergies?
  • Have you ever been exposed to radiation in the area?
  • What do you (or did you) do for a living?
  • Do you have a family history of cancer?

Step 2: Physical Exam

Next, your doctor will examine you. Typically, if you’re seeing a specialist in head and neck disorders, you will get a thorough physical examination focused on the area of concern. Your doctor will see how wide you can open your mouth and then look and feel inside your mouth. Then the doctor will thoroughly feel your neck to check for any lumps or bumps. This is especially important for nasopharynx cancer because most patients with nasopharyngeal cancer actually present to their doctor with a neck mass. Your doctor may also look inside your ear to see if there is any fluid behind the eardrum. The doctor will be particularly interested to see if fluid is only on one side, which can sometimes be the case for a nasopharynx tumor if it blocks the Eustachian tube.

Of course, the doctor will want to look inside your nose and way back into your nasopharynx. The nasopharynx typically requires a specialist to examine it. There are a few different ways to examine the nasopharynx. Usually, you will get some medicines placed into your nose (either by a spray or a cotton pledget) to open up the passages and numb your tissues. Then a tiny camera will go in.

  • Flexible nasopharyngoscopy: This method uses a tiny flexible camera (the same one as for flexible laryngoscopy). This is inserted into one of the nostrils and carefully slid all the way back (straight back) to look at your nasopharynx. Usually, the entire nasopharynx can be seen by putting the camera into just one nostril, but sometimes to get a really good look at a certain area, your doctor might look through both nostrils. He or she will look at the back wall of the nasopharynx and the areas around the Eustachian tubes, with a focus on the Fossa of Rosenmueller, which is where most nasopharynx cancers start.
  • Rigid nasopharyngoscopy: In this method, a thin steel rod telescope is inserted into one of the nostrils. Then the exact same examination as flexible laryngoscopy is done. The advantage of this technique is that it is easier for your doctor to use another forcep and take a nasopharyngeal biopsy if necessary. If your doctor uses a special angled telescope, he or she might be able to look up into your nasopharynx through your mouth (behind your soft palate) as well.

Step 3: Reviewing Tests

After getting your history and performing a physical exam, your doctor will review any imaging, laboratory work and pathology results you may have already had. Be sure to bring all of these with you to your appointment. Bring actual discs of any scans you’ve had, as well as any reports of those scans. If you are seeing a head and neck cancer specialist after a lesion was removed by a non-cancer specialist, you need a thorough review of the pathology to discuss whether additional treatment is necessary. Try to obtain the actual glass slides that were prepared by the pathologist with the specimen taken during your biopsy procedure so your doctor can conduct a complete review. You might need more tissue removed or further treatment.

Finally, your doctor will make recommendations about your next steps. This will likely include reviewing some of the studies you’ve already had done or ordering more tests. Once your doctor has all the necessary information, you should be given a preliminary stage and discuss treatment plans.

If the tumor is very large and is putting your breathing at risk, your doctor might recommend you undergo a tracheotomy, which is a breathing tube placed into the front part of your neck directly into your windpipe.

Also, if you are just not able to get enough nutrition by mouth because of the tumor, your doctor might recommend that you undergo placement of a feeding tube. This will help ensure that you are in good shape to undergo the treatment that you will need to beat the cancer.

References

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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.

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