Close

Nasopharyngeal Cancers

Deciding on a Treatment Plan

 

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.

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 , 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

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 Pathmanathan R, Prasad U, Sadler R, Flynn K, Raab-Traub N. Clonal proliferations of cells infected with Epstein-Barr virus in preinvasive lesions related to nasopharyngeal carcinoma. N Engl J Med. 1995;333(11):693-698. doi:10.1056/NEJM199509143331103

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.

21 Bensouda Y, Kaikani W, Ahbeddou N, et al. Treatment for metastatic nasopharyngeal carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128(2):79-85. doi:10.1016/j.anorl.2010.10.003

22 Blanchard P, Lee A, Marguet S, et al. Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis. Lancet Oncol. 2015;16(6):645-655. doi:10.1016/S1470-2045(15)70126-9

23 Chen L, Hu C-S, Chen X-Z, et al. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2012;13(2):163-171. doi:10.1016/S1470-2045(11)70320-5

24 Chua MLK, Wee JTS, Hui EP, Chan ATC. Nasopharyngeal carcinoma. Lancet (London, England). 2016;387(10022):1012-1024. doi:10.1016/S0140-6736(15)00055-0

25 Ribassin-Majed L, Marguet S, Lee AWM, et al. What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis. J Clin Oncol. 2017;35(5):498-505. doi:10.1200/JCO.2016.67.4119

26 Sun Y, Li W-F, Chen N-Y, et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol. 2016;17(11):1509-1520. doi:10.1016/S1470-2045(16)30410-7

27 Zhang Y, Li W-F, Liu X, et al. Nomogram to predict the benefit of additional induction chemotherapy to concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: Analysis of a multicenter, phase III randomized trial. Radiother Oncol. 2018;129(1):18-22. doi:10.1016/j.radonc.2017.12.002

28 Cohen, E. E., LaMonte, S. J., Erb, N. L., Beckman, K. L., Sadeghi, N. , Hutcheson, K. A., Stubblefield, M. D., Abbott, D. M., Fisher, P. S., Stein, K. D., Lyman, G. H. and Pratt‐Chapman, M. L. (2016), American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA: A Cancer Journal for Clinicians, 66: 203-239. doi:10.3322/caac.21343

29 Banko A V., Lazarevic IB, Folic MM, et al. (2016). “Characterization of the Variability of Epstein-Barr Virus Genes in Nasopharyngeal Biopsies: Potential Predictors for Carcinoma Progression.” PLoS One. 11(4):e0153498.

Important: Privacy Update

Your privacy and the protection of your personal information is important to the THANC (Thyroid, Head and Neck Cancer) Foundation and the Head & Neck Cancer Guide (HNCG). For this reason, we have updated our privacy policy to align with the GDPR (General Data Protection Regulation).

Please click below to see an updated privacy policy that describes how we collect and use your personal information and respect your privacy.

Privacy Policy