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Nasopharyngeal Cancer

If an adult in your life has nasopharyngeal cancer, you may want to learn more about it. This page has information about nasopharyngeal cancer, its types and what to expect.

First, you should understand what cancer is. Cancer is a disease caused by abnormal cells that grow too rapidly. Our bodies are made of cells so tiny you need a microscope to see them. Cancer cells don’t look or act like normal cells, and they don’t allow our normal cells to work properly. There are many different types of cancer that can grow anywhere in the body.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.

Fortunately, nasopharyngeal carcinoma (NPC) is actually quite rare in most parts of the world. But for some reason, more people in southeastern China get this cancer than anywhere else in the world. Actually, it is about 20 to 30 times more common there than in the U.S.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. It is also seen in northern Africa, and it appears in Alaska more than the rest of the U.S.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.

Understanding the anatomy

To understand nasopharyngeal cancer, you need a basic understanding of the anatomy (parts) of the head and neck.

The nasopharynx is the uppermost part of the throat, behind the nasal cavity and above the oropharynx. It’s like a small box, about two to three centimeters front to back and about three to four centimeters top to bottom and side to side. You can’t see it by looking inside your mouth or your nose. It is behind and above the soft palate (the soft part of the roof of your mouth that includes the uvula). Actually, when the soft palate lifts up, it forms the floor of the nasopharynx. The nasopharynx is positioned just under and in front of the base of the skull.

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There are many important structures in and around the nasopharynx:

  • Choanae: This is the entrance from the nose back into the nasopharyx. There is one on each side from the nose, divided by the nasal septum. If one of these gets blocked by a tumor, the person won’t be able to breathe from that side of the nose.
  • Eustachian tubes: The Eustachian tubes, sometimes called the auditory tubes, lie on each side of the nasopharynx. The Eustachian tube helps equalize pressure inside the ears and helps drain mucous from the middle ear. This is important, because if a nasopharynx tumor blocks the Eustachian tube, you can get mucous buildup in the middle ear, which in turn can lead to difficulty hearing and an ear infection. That is one reason why an ear infection, hearing loss or middle ear fluid on one side that occurs in an adult should be evaluated by a specialist.
  • Pharyngeal recess (also called the Fossa of Rosenmuller): This is a slit-like space just on the inside of the Eustachian tube opening in the nasopharynx. This is important because the pharyngeal recess is the most common site for NPC to start. When the tumor grows deep, toward the skull base, there may not be any symptoms related to obstruction in the nasopharynx. This is one reason why NPC can sometimes be picked up only once it has invaded nerves in the skull base.
  • Base of skull: The nasopharynx is located right below and in front of the base of the skull. On the other side of the base of the skull is the brain. NPC, in advanced stages, can destroy the bone at the base of the skull and enter the cranial cavity.
  • Cranial nerves: These are nerves that perform special functions in the head and neck area, like moving muscles, feeling, hearing, tasting, seeing and speaking. The cranial nerves start in the brain and exit through tiny holes in the base of the skull. NPC can damage some of these nerves, either by extending up into the brain or affecting them as they leave the base of the skull.
  • Retropharyngeal space: This is a space behind the pharynx, in front of the spine. NPC can spread to lymph nodes in this space.

Causes of nasopharyngeal cancer

You may want to know what caused the nasopharyngeal cancer. The short answer is that we don’t know. You can be sure that you did nothing to cause it. Also, it is not contagious (you can’t catch it).

By far the most common contributor to most head and neck cancers is using tobacco, particularly smoking it. Drinking too much alcohol also adds to the risk of developing head and neck cancer.

Major factors that increase the chance of developing nasopharyngeal cancer include:

  • Tobacco: Smoking cigarettes, cigars or pipes and using chewing tobacco greatly increase the 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 too much alcohol is strongly linked to getting a throat cancer. And if one both smokes and drinks heavily, the risk more than doubles. This is also linked 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 people 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 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 (EBV): 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, those 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 likely to get nasopharyngeal cancer as well.
  • Certain foods: Lack of some vitamins and poor oral hygiene might be linked with nasopharyngeal 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 the chance of getting cancer of the nasopharynx. For example, formaldehyde and wood dust exposure have been associated 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.

Signs and symptoms of nasopharyngeal cancer

In many cases, nasopharyngeal cancers get quite large before patients become aware of symptoms. The exact symptoms depend on where the tumor is located, how large it has gotten and whether it has spread before being detected. In general, the patient may have had nasal symptoms, ear symptoms, cranial nerve symptoms or neck symptoms.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.

The most common symptoms of nasopharyngeal cancer include:

  • A lump in the neck: One of the most common ways a nasopharyngeal cancer is detected is after it has spread to the lymph nodes in the neck. Up to 80 percent of people with NPC first come to their doctor with a lump in the neck.14 Neel HB, 3rd. Nasopharyngeal carcinoma: diagnosis, staging, and management. Oncology (Williston Park). Feb 1992;6(2):87-95; discussion 99-102.
  • A blocked-up nose: Difficulty breathing from one or both sides of the nose (obstruction) can be caused by a large tumor blocking the nasal breathing passage.
  • Bleeding from the nose or mouth: This can be caused by a tumor in the back of the nose.
  • Ear problems: Ear-related problems, such as hearing loss on one side, ringing in the ear on one side, an ear infection in an adult or fluid behind the eardrum can be caused by a tumor mass blocking the Eustachian tube.
  • Cranial nerve (CN) problems: A problem with the cranial nerves can be caused by a tumor extending into the skull or along the skull base where the nerves exit. A tumor growing into one of these nerves can cause a variety of problems, depending on which nerve is affected:
    • Slurred speech: CN XII is called the hypoglossal nerve, and it controls the muscles of the tongue.
    • Double vision: CN III, IV and VI are three different oculomotor nerves, and they control the muscles that move the eye.
    • Loss of feeling in part of the face: CN VIII is the third division of the trigeminal nerve, and it sends sensation signals from the lower part of the face to the brain.
    • Difficulty with shoulder movement: CN XI is called the spinal accessory nerve, and it controls movement of some of the shoulder and neck muscles.
    • Change in voice and swallowing: CN IX and X are called the glossopharyngeal nerve and vagus nerve, and have a number of different functions, some of which include controlling muscles of the voice and swallowing.
  • Headache: A bad headache can be caused by a tumor growing into the skull.
  • Difficulty with mouth opening (trismus): This can happen when the tumor invades into muscles that move the jaw.

In rare cases, the cancer may not be detected until a patient has severe bone pain (in the legs or spine), and tests show a cancer. Then further tests find the nasopharyngeal cancer.16 Sham JST, Cheung YK, Chan FL, Choy D. Nasoparyngeal carcinoma: pattern of skeletal metastases. Br J Radiol. 1990;63:202-205. Even more rarely, metastases into the lungs or liver can lead to finding a nasopharyngeal cancer.

These symptoms sound scary but don’t jump to conclusions. A person could have one or more of these symptoms but NOT have nasopharyngeal cancer. There are several non-cancerous causes of the same symptoms. That’s why the patient needs to see a specialist.

What will happen at the doctor visit

Step 1: History

First, the doctor will listen to the patient talk about his or her health. The doctor will probably ask many questions, too.

The doctor might ask some of these questions:

  • 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, the doctor will look at and feel the patient’s head and neck. The throat typically requires a specialist to examine it because it is not easy for a general doctor to see and feel. In general, the specialist might do some of the following:

  • Feel the neck extensively and carefully to check for any lumps or bumps
  • Look inside the ears
  • Look inside the front of the nose
  • Check the cranial nerves, do some simple hearing tests and test sense of touch all over the face

Step 3: Reviewing Tests

After getting background information and doing a physical exam, the doctor will look at the results of any tests the patient has already had.

Step 4: Suggestions

Finally, the doctor will make suggestions about next steps. This will probably include more tests and doctor visits.

Diagnosing nasopharyngeal cancer

If the symptoms haven’t been present for very long, or if the history and physical examination make the doctor less worried that the lesion is cancer, the doctor might try some medications and rehabilitation before jumping to a diagnosis of cancer.

However, if the doctor is worried, he or she may choose one or more of the following actions.

Imaging

Imaging refers to radiologic studies, or scans, that make pictures of the structures inside the head and neck. In general, imaging might not be necessary for small tumors that can be easily seen by the doctor. For larger tumors, or tumors in locations difficult to examine, the doctor will probably order some sort of imaging to get more information about the tumor location to see if the tumor has spread to nearby lymph nodes. An important reason to get a scan for sinonasal tumors is to see if there is any evidence of spread into nearby structures. Spread into other structures will influence what treatment the doctor recommends.

Some surgeons also say getting some imaging (pictures of the inside of the head and neck) will lower the chance of surprises in the operating room. Imaging will also give some clues about whether the tumor is really cancer. This will prepare the patient and the surgeon for what to expect during surgery.

There are many different kinds of imaging scans. The doctor may recommend more than one kind of scan to see a better picture of the tumor.

The two main types of imaging used in the U.S. are CT scans and MRI scans.

CT SCAN MRI
 CT Scan  MRI
Advantages A computed tomography (CT) scan is a quick test that shows a great deal of useful information. A CT scan can show the size of the tumor and how far it has spread. It can help a surgeon plan an operation. Magnetic resonance imaging (MRI) is better at showing how the tumor has spread to body parts around it. The patient will not be exposed to radiation during an MRI.
Disadvantages A CT scan uses radiation, which can be dangerous. The pictures might not be clear if the patient moves or has a lot of dental work. Also, a CT doesn’t show damage to nearby body parts as clearly unless the damage is moderate to severe. An MRI takes a lot longer than a CT scan. It requires the patient to lie perfectly still for almost an hour. The patient can’t have an MRI if he or she has metal implants.

For most head and neck cancers, if imaging is required, the doctor will likely start with a CT scan with contrast. Other tests might include an MRI and/or a positron emission tomography (PET) scan.

Biopsy

A biopsy is the main way to find out if a growth is cancer. For a biopsy, the doctor takes out a small piece of the lump or the entire tumor. Another doctor, called a pathologist, then looks at the sample under a microscope to see if it is cancer. Doctors often do biopsies because they can usually be done quickly and safely. The doctor can sometimes do a biopsy during the first visit with very little risk.

Fortunately, biopsies of the skin are more straightforward than for other sites, mainly because they are easier to get to. Typically, skin cancers can be biopsied in the office with a little numbing medicine. It usually takes only a few seconds to do a biopsy. The tissue is then sent to a pathology doctor to see if it is cancer and, if so, what type and how far it has spread.

A biopsy can help the doctor plan the surgery if he or she decides it is needed. A biopsy can also prevent unnecessary surgery.

As good as biopsies sound, there are a few problems. First, biopsies are not 100 percent accurate. A biopsy could show that a growth is NOT cancer when it really is; this is called a false-negative biopsy. A false-positive is also possible when the biopsy seems to show that a growth is cancer but more testing shows it isn’t. Sometimes doctors can’t be completely sure a tumor is cancerous from a biopsy.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.

Serology

Serology involves checking the blood for certain proteins. It is sometimes used, if nasopharyngeal cancer is suspected or confirmed, to see if the body has made proteins to fight the Epstein-Barr Virus. In some cases, checking for DNA of the virus may also help with screening.

Determining the type of nasopharyngeal cancer

After the tumor has been closely looked at, the doctor will need to figure out what type of cancer it is. He or she may be able to tell from biopsy results. The doctor may also want a second opinion from a specialist to be sure. Remember, not all lumps and bumps inside the throat are cancer. Some growths are benign (non-cancerous), and some tumors are on the border between benign and malignant (cancerous).

The World Health Organization divides nasopharynx cancer into three main types, depending on what the cells look like under the microscope. This separation is important because the prognosis (outcome) can be quite different, depending on the type.

  • WHO Type I (Keratinizing squamous cell carcinoma): These are similar to other squamous cell carcinomas and are typically well or moderately differentiated in terms of grade (cell abnormality).
  • WHO Type II (Nonkeratinizing squamous cell carcinoma): These can look like squamous cell carcinomas in other non-head-and-neck sites. These can vary quite a bit in grade.
  • WHO Type III (Undifferentiated or poorly differentiated): These are a diverse group of NPCs seen in younger patients (and are actually the most common type). They can look like lymphomas (blood cancer) under the microscope.

Rare cancers found in the nasopharynx include:

  • Salivary gland cancers: There are minor salivary glands located under the lining of the throat. This is why cancers that we typically see in salivary glands can arise in this region. They include diagnoses such as mucoepidermoid carcinomas, adenocarcinomas and adenoid cystic carcinomas, to name a few. See Salivary Gland Cancer for more information.
  • Lymphoma: Lymphoma is cancer of the lymphatic system, which includes lymph nodes, lymph channels, lymphatic fluid and lymphoid tissue. The throat is lined with lymphoid cells. Some major sites of lymphoid tissue include the adenoids in the nasopharynx and palatine tonsils and lingual tonsils in the oropharynx. This is why lymphoma might appear as a lump in the throat area.
  • Mucosal melanoma: These cancers come from skin cells that give skin its color. In rare cases, melanoma can be found in the lining of the mouth, nose and/or throat.

Although extremely rare, these cancers can also develop in the nasopharynx:

  • Sarcomas such as chondsarcoma, liposarcoma and synovial sarcoma
  • Malignant fibrous histiocytoma
  • Peripheral Neuroectodermal Tumor (PNET)
  • Cancer spread from another site

The doctor will determine the treatment for the cancer based on the category (type), grade (abnormality) and stage (severity) of the tumor.

Determining the grade of the tumor

Pathologists will typically report on the grade of the tumor. This is a qualitative interpretation by the pathologist of how much the cancerous cells resemble normal tissue from that site. There are a number of different grading systems that might be used. The most common is as follows:

  • GX: Grade cannot be assessed
  • G1: Well differentiated
  • G2: Moderately differentiated
  • G3: Poorly differentiated
  • G4: Undifferentiated

Differentiation refers to how closely the cells taken from a tumor or lesion resemble normal cells from the healthy tissue surrounding the tumor. “Well differentiated” means that the cells look similar to normal cells in that area. “Undifferentiated” means the cells look nothing like normal cells in that area.

While it is important to report the tumor’s grade, few doctors use this information to make decisions regarding treatment or prognosis for this particular cancer type.

Determining the stage of the cancer

The final step before treatment is identifying the stage or the extent of the cancer. This will be determined by studying the physical exam, imaging studies, laboratory work and biopsies.

Like with all cancers of the head and neck, doctors in the U.S. use the AJCC Cancer Staging Manual (7th Ed) to figure out the stage based on three factors.

Factors that go into determining the stage of the cancer
T Characteristics of the main tumor mass
N Status of the lymph nodes in the neck (i.e., evidence of cancer spread)
M Status of cancer spread to parts of the body outside of the head and neck

T stage: the main tumor

Based on a physical examination and review of any imaging, the doctor should be able to assign a T stage that falls within one of the following categories.

41_1_tonsil

T1 The tumor is just within the nasopharynx, or it has grown into the oropharynx and/or nasal cavity, but there is no extension into the parapharyngeal space (soft tissue space behind and to the side of the pharynx).
T2 The tumor extends into the parapharyngeal space (soft tissue space next to the pharynx).
T3 The tumor has grown into the bone of the head, including the skull base and/or the sinuses.
T4 The tumor has grown into the skull and/or involves the cranial nerves, hypopharynx, or eye socket (orbit). Or it has extended to the infratemporal fossa or masticator space.

N stage: spread of cancer to the lymph nodes in the neck

Next, the doctor will use all the available information to figure out the N stage. This is based on the assessment as to whether the cancer has spread to lymph nodes in the neck.

40_larynx_Nstages

N0 There is no evidence of cancerous spread to lymph nodes in the neck or retropharyngeal space.
N1 There are cancerous lymph nodes on just one side of the neck, where the largest is 6 centimeters or less, and all the lymph nodes are above the supraclavicular fossa. Also, the cancer is at this stage if the lymph nodes are found in the retropharyngeal space (6 centimeters or less in size, one side or both).
N2 There are lymph nodes with cancer on both sides of the neck (where the biggest lymph node is 6 centimeters or less in size, and all the lymph nodes are above the supraclavicular fossa).
N3a There is a lymph node with cancer that is bigger than 6 centimeters.
N3b There is a cancerous lymph node of any size that is far down in the neck, just above the clavicles (supraclavicular fossa).

M stage: spread of cancer outside the head and neck

Finally, the doctor will identify an M stage. The M stage is based on an examination of the entire body.

M0 No evidence of distant (outside the head and neck) spread.
M1 There is evidence of spread outside of the head and neck (i.e., in the lungs, bone, brain, etc.).

The cancer stage

After TNM staging, the doctor can assign a cancer stage based on the following chart.

Stage 0 Tis N0 M0
Stage 1 T1 N0 M0
Stage 2 T1 N1 M0
T2 N0 M0
T2 N1 M0
Stage 3 T1 N2 M0
T2 N2 M0
T3 N0 M0
T3 N1 M0
T3 N2 M0
Stage 4a T4 N0 M0
T4 N1 M0
T4 N2 M0
Stage 4b Any T N3 M0
Stage 4c Any T Any N M1

The clinical stage

Once the tests are completed, and before deciding on a treatment plan, the patient should be given a clinical stage that looks like this:

CLINICAL STAGE
Site Nasopharynx
Subsite Squamous Cell Carcinoma (WHO Type I)
Type cT2
cT cN1
cN cM0
cM cII
cStage Nasopharynx

Deciding on a treatment plan

Like with all cancers in the head and neck, there are three general treatment options:

For nasopharyngeal cancer, surgery plays less of a role than in other cancers of the head and neck region.

Let’s look at the types of treatments available.

Surgery

One treatment available for nasopharyngeal cancers is complete surgical removal of the tumor. The surgeon will cut out the tumor plus a little bit of normal tissue around it to be sure to get all the cancer. Another doctor, called a pathologist, will look at the entire tumor under a microscope to identify a more exact stage for the tumor. This report, called the pathologic stage, can help the doctor decide if radiation and/or chemotherapy are needed.

Radiation

Radiation therapy kills cancer cells with high-energy radiation such as X-rays or gamma rays. Radiation may be used as a main treatment for tumors that cannot be easily removed. The surgeon will use radiation alone or radiation with chemotherapy, depending on the characteristics of the tumor. Radiation is also often used after surgery to lower the chances that the tumor will come back.

Chemotherapy

Chemotherapy, or “chemo,” uses drugs to kill cancer cells. It is especially helpful when:

  • Cancer has spread beyond the head and neck.
  • There is a T3 or T4 tumor in which surgery cannot remove all of the tumor.
  • There is a T3 or T4 tumor that has certain bad features found under the microscope, such as intermediate or high grade.
  • There are close edges.
  • There is growth into nerves.
  • There is spread into lymph nodes.
  • There is growth into lymphatics or vessels.

Determining the prognosis

The prognosis is a prediction of how the treatment will turn out. How likely is it that a person with cancer will be cured? Will the cancer come back? How will life change? These are the big questions on most people’s minds when they find out that someone they love has naspopharyngeal cancer.

The following characteristics of the cancer may affect the chances of a cure.

Factors That Can Affect the Chances of Being Cured
Stage This is the most important factor that affects the chances of being cured. Cancers in earlier stages usually have better outcomes.
Type and Grade The type and grade of tumor show how aggressive a tumor is.
Spread to Lymph Nodes If there is spread to lymph nodes in the neck, there is a lower chance of a cure.
The Tumor Margins (edges) Some say the ability to completely remove the tumor is the single most important factor in whether a person will be cured.
Spread into Nearby Body Parts Spread into large nerves, skin and bone has been shown to indicate a worse prognosis.

What to expect after treatment is completed

When the person in your life who has cancer has completed treatment, he or she will need to follow up closely with the doctor. Follow-up doctor visits and testing are to make sure the cancer doesn’t come back or to catch it quickly if it does. In general, a person should have regularly scheduled doctor’s visits every one to three months for the first year, every two to six months in the second year and every four to eight months in the third to fifth year. In addition, the doctor will order scans to help in the monitoring process. After making it past the first five years, the person can then see the doctor once a year.


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.

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