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Nasopharyngeal Cancers

Deciding on a Treatment Plan

Your doctors will typically use National Comprehensive Cancer Network® (NCCN®)Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers to decide on the appropriate treatment course.18Referenced 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. If these guidelines are not followed, they will discuss it with you and explain why your situation might be special.

Before starting treatment, your doctor will make sure that the following steps are completed.

Pretreatment evaluation

  • A full history and physical examination, including a complete head and neck exam (mirror exam if needed)
  • An evaluation by the members of a head and neck cancer team
  • Nasopharyngeal fiberoptic examination
  • A biopsy of primary site or FNA of the neck to confirm a diagnosis of cancer
  • Imaging of the primary tumor and the neck with CT and/or MRI
  • Chest imaging as needed
  • Maybe a PET-CT for advanced cancers
  • Evaluation of the chest, liver and bones to check for spread of disease that is N2 or N3
  • A dental evaluation as needed
  • Nutrition, speech and swallowing evaluation and maybe even a hearing evaluation
  • Epstein-Barr virus DNA testing may be considered
  • Ophthalmologic and endocrine evaluation as needed
  • Pretreatment medical clearance and evaluation of the risks of anesthesia

Then your doctor will recommend a course of treatment for you, depending on a number of factors. As with all cancers in the head and neck, there are three general options to consider:

For nasopharynx cancer, surgery plays less of a role than in other cancers of the head and neck region. You should have an extensive discussion with your cancer team to decide upon the best treatment course for you personally. The options that your doctor will recommend will likely be as followed based on the NCCN Guidelines® for Head and Neck Cancers, depending on the stage of cancer you have.18Referenced 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.

T1, N0, M0 For these small cancers, the recommended treatment is radiation to the nasopharynx and maybe to the neck.
T1, N1-3 

T2-4, Any N

For cancers that fit into these stages, the options are:

  • Chemotherapy along with radiation, with or without additional chemotherapy
  • For select patients: Induction chemotherapy[NM1] , followed by chemotherapy along with radiation
  • A clinical trial

If there is evidence of cancer still in the neck, then a neck dissection should be done.

Any T, Any N, M1  When the disease has spread outside of the head and neck region, the treatment recommendations are either:

  • Chemotherapy, followed by radiation to the nasopharynx and to the neck
  • Chemotherapy, followed by chemotherapy along with radiation as indicated
  • Chemotherapy along with radiation
  • A clinical trial (preferred)
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.

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.