Nasopharyngeal Cancer Complete

About Nasopharyngeal Cancer
Overview and Types
If you have been diagnosed with nasopharyngeal cancer or are worried about it, you
likely have a lot of questions. Learning some basics is a good place to start.
● What Is Nasopharyngeal Cancer?

Research and Statistics
See the latest estimates for new cases of nasopharyngeal cancer in the US and what
research is currently being done.
● What Are the Key Statistics About Nasopharyngeal Cancer?

● What's New in Nasopharyngeal Cancer Research and Treatment?
What Is Nasopharyngeal Cancer?

Nasopharyngeal cancer is a cancer that starts in the nasopharynx, the upper part of the
throat behind the nose and near the base of skull. To understand nasopharyngeal
cancer, it helps to know about the structure and function of the nasopharynx.
About the nasopharynx

The nasopharynx is the upper part of the throat (pharynx) that lies behind the nose. It is
a box-like chamber about 1½ inches on each edge. It lies just above the soft part of the
roof of the mouth (soft palate) and just in back of the nasal passages.
The nasopharynx serves as a passageway for air from the nose to the throat (and
eventually to the lungs).
Nasopharyngeal tumors
Several types of tumors can develop in the nasopharynx. Some of these tumors are
benign (non-cancerous), but others are malignant (cancerous). It is important to discuss
what type of tumor you might have with your doctor.
Benign nasopharyngeal tumors
Benign tumors of the nasopharynx are fairly rare and tend to develop in children and
young adults. These tumors do not spread to other parts of the body and are usually not
life-threatening. They include tumors or malformations of the vascular (blood-carrying)
system, such as angiofibromas and hemangiomas, and benign tumors of minor salivary
glands within the nasopharynx.
Treatment of these benign tumors (if it is needed) is different from that for cancerous
nasopharyngeal tumors and is not covered further in this document. If you have one of
these tumors, you and your doctor will talk about what treatments might be appropriate
for you.
Nasopharyngeal cancers
These tumors can invade surrounding tissues and spread to other parts of the body.
Nasopharyngeal carcinoma (NPC): This is by far the most common malignant tumor
of the nasopharynx. A carcinoma is a cancer that starts in epithelial cells – the cells
lining the internal and external surfaces of the body. Most of the rest of this document
refers to NPC.
There are 3 types of NPC, based on how the cancer cells look under the microscope:
● Keratinizing squamous cell carcinoma

● Non-keratinizing differentiated carcinoma
● Undifferentiated carcinoma
Each of these types is seen more often in some areas of the world than in others. In
southern China, where NPC is much more common, nearly all cases are the
undifferentiated type. In the United States, where NPC is rare, about 1 out of 5 cases
are the keratinizing type.
Even though these types look different when seen under a microscope, studies have
shown they start from the same cell type – the epithelial cells that line the surface of the
nasopharynx. The treatment is also usually the same for all types of NPC. The stage of
the cancer – how far it has grown and spread – is often more important than its type in
predicting a person's outlook (prognosis).
Many NPCs also contain lots of immune system cells, especially lymphocytes. The term
lymphoepithelioma is sometimes used to describe an undifferentiated NPC with many
lymphocytes among the cancer cells. The presence of these cells does not usually
affect the choice of treatment options. But they may be a clue to developing new
treatments since they may represent the body's attempt to “reject” the tumor. (For more
information, see the section What's New in Nasopharyngeal Cancer Research and
Treatment?)
Other cancers in the nasopharynx: Other types of cancers can arise in the
nasopharynx.
Lymphomas can sometimes start in the nasopharynx. They are cancers of immune
system cells called lymphocytes, which are found throughout the body, including in the
nasopharynx. These cancers are discussed in our document Non-Hodgkin Lymphoma.
Adenocarcinoma and adenoid cystic carcinoma are cancers that can develop in the
minor salivary glands in the nasopharynx, but these cancers are more commonly found
in the nose (nasal cavity) or mouth (oral cavity). More information on these cancers can
be found in our documents Oral Cavity and Oropharyngeal Cancer, Nasal Cavity and
Paranasal Sinuses Cancer, andSalivary Gland Cancer.
●References
See all references for Nasopharyngeal Cancer
Last Medical Review: January 15, 2015 Last Revised: August 8, 2016
American Cancer Society medical information is copyrighted material. For reprint

requests, please see our Content Usage Policy.
What Are the Key Statistics About

Nasopharyngeal Cancer?
Nasopharyngeal cancer (NPC) is fairly rare. In most parts of the world (including the
United States), there is less than one case for every 100,000 people each year. In 2015,
about 3,200 cases will occur in the United States.
This cancer is, however, much more common in certain parts of Asia and North Africa,
particularly in southern China. It is also more common among Inuits of Alaska and
Canada, and among some immigrant groups in the United States, such as recent
Chinese and Hmong immigrants.
The risk of NPC increases slowly throughout life, but it can occur in people of any age,
including children. About half of the people with NPC in the United States are younger
than 55 years old.
●References

What's New in Nasopharyngeal Cancer

Research and Treatment?
Research into the causes, prevention, and treatment of nasopharyngeal cancer (NPC)
is being done in many university hospitals, medical centers, and other institutions
around the world.
Causes, prevention, and early detection

Many studies are looking at how Epstein-Barr virus (EBV) infection and other risk
factors cause cells of the nasopharynx to become cancerous. Researchers hope these
studies may eventually lead to vaccines to help prevent some cases of NPC by avoiding
EBV infection.
Recent discoveries about EBV, its interaction with nasopharyngeal cells, and the
immune system’s reaction to EBV have led to new blood tests that may help detect
NPC early and better predict the response to treatment. These tests are now being
studied in areas of the world where this cancer is common.
Treatment
New surgical techniques
Advances in the field of skull base surgery such as the use of endoscopes in the nose
now allow doctors to remove some tumors from hard to reach areas like the
nasopharynx. This type of surgery requires a specialized team that has expertise in this
field. It may offer hope for some patients with recurrent NPC and patients with the
keratinizing type of NPC, which often doesn’t respond to radiation therapy.
New radiation therapy techniques
Most types of radiation therapy use radiation in the form of x-rays. Another type of
radiation uses protons to kill cancer cells, instead. Unlike x-rays, which release energy
both before and after they hit their target, protons cause little damage to tissues they
pass through and then release their energy after traveling a certain distance. This
means that proton beam radiation may be able to deliver more radiation to the tumor
and do less damage to nearby normal tissues. Although this approach is promising in
theory, it hasn’t been proven to be better than x-ray techniques like IMRT. Also, the
machines needed for proton therapy are very expensive, and so this treatment is not
widely available.
Doctors are also studying the best schedule for giving radiation therapy. External beam
radiation treatments are usually given once a day, 5 days a week, for many weeks in a
row. Studies are now under way to see if schedules that either give the doses over
fewer days or give smaller doses twice a day might be more effective.
Chemotherapy
Researchers continue to develop new chemotherapy drugs, new drug combinations,

and new ways to give drugs that might be more effective against advanced NPC.
Several drugs that are already used to treat other cancers, such as capecitabine,
oxaliplatin, and gemcitabine, have been studied for use against NPC as well.
Clinical trials are also testing ways to best combine chemotherapy with radiation
therapy. For example, studies are comparing the effectiveness of chemotherapy given
before, during, or after radiation therapy.
Targeted therapy
Drugs that target specific parts of cancer cells may prove to be useful against NPC and
have fewer side effects than standard chemotherapy drugs.
The drug cetuximab (Erbitux), which targets the epidermal growth factor receptor
(EGFR). protein found on the surface of cells, is already being used in some cases of
NPC that recur or keep growing after treatment with chemotherapy. Other drugs that
target EGFR are also being studied for use against NPC, including nimotuzumab and
icotinib.
Other newer drugs target a tumor’s ability to develop new blood vessels, which they
need in order to grow larger. These drugs are called angiogenesis inhibitors. Several of
these drugs are now being tested for use against NPC, including bevacizumab
(Avastin®), sorafenib (Nexavar®), and pazopanib (Votrient®).
Immunotherapy
NPC seems to be caused at least in part by infection with the Epstein-Barr virus (EBV).
Although patients’ immune systems can be shown to have reacted against EBV, this
doesn’t seem to be enough to kill the cancer. Researchers are trying to use different
ways to boost the immune system or help it better target EBV-infected cells.
One way to do this is to remove T lymphocytes (immune system cells) from the blood of
patients with NPC and alter them in the lab to increase their numbers and their power to
kill EBV. The cells are then injected back into the patients. Early results with small
numbers of patients have been promising, and larger studies of this technique are now
under way.
Gene therapy
Scientists have recently discovered how certain gene mutations (changes) in

nasopharyngeal cells may cause them to become cancerous. A clinical trial using a
virus to replace the damaged tumor suppressor gene p53 in the cancer cells had some
promising results. This approach is still being studied.
●References

2016 Copyright American Cancer Society
Nasopharyngeal Cancer Causes, Risk
Factors, and Prevention
Risk Factors
A risk factor is anything that affects your chance of getting a disease such as cancer.
Learn more about the risk factors for nasopharyngeal cancer.
● What Are the Risk Factors for Nasopharyngeal Cancer?

● Do We Know What Causes Nasopharyngeal Cancer?
Prevention
There is no way to prevent all nasopharyngeal cancers. But there are things you can do
that might lower your risk. Learn more.
● Can Nasopharyngeal Cancer Be Prevented?
What Are the Risk Factors for

A risk factor is anything that affects a person’s chance of getting a disease such as
cancer. Different cancers have different risk factors. Some risk factors, like smoking,
can be changed. Others, like a person's age or family history, can’t be changed.
But risk factors don’t tell us everything. Having a risk factor, or even several risk factors,
does not mean that you will get the disease. And many people who get the disease may
have few or no known risk factors.
Scientists have found several risk factors that make a person more likely to develop
nasopharyngeal cancer (NPC). These include:
● Gender
● Ethnicity and where you live
● A certain kind of diet
● Infection with the Epstein-Barr virus
● Genetic factors
● Family history
Smoking, alcohol, and some workplace exposures may also increase the risk of this
cancer.
These risk factors are discussed in more detail below
Gender
NPC is found about twice as often in males as it is in females.
Race/ethnicity and where you live

NPC is most common in southern China (including Hong Kong), Singapore, Vietnam,
Malaysia, and the Philippines. It is also fairly common in Northwest Canada and
Greenland.
People of south China have a lower risk of NPC if they move to another area that has
lower rates of NPC (like the US or Japan), but their risk is still higher than for people
who are native to areas with lower risk. Over time, their risk seems to go down. The risk
also goes down in new generations. Although whites born in the United States have a
low risk of NPC, whites born in China have a higher risk.
In the United States, NPC is most common in Asian and Pacific Islanders (particularly
Chinese Americans), followed by American Indian and Alaskan natives, African
Americans, whites, and Hispanics/Latinos.
Diet
People who live in parts of Asia, northern Africa, and the Arctic region where NPC is
common, typically eat diets very high in salt-cured fish and meat. Indeed, the rate of this
cancer is dropping in southeast China as people begin eating a more Westernized diet.
In contrast, some studies have suggested that diets high in fruits and vegetables may
lower the risk of NPC.
Epstein-Barr virus infection

Almost all NPC cells contain parts of the Epstein-Barr virus (EBV), and most people with
NPC have evidence of infection by this virus in their blood. Infection with EBV is very
common throughout the world, often occurring in childhood. In the United States, where
infection with this virus tends to occur in slightly older children, it often causes infectious
mononucleosis (“mono”), usually in teens.
The link between EBV infection and NPC is complex and not yet completely
understood. EBV infection alone is not enough to cause NPC, since infection with this
virus is very common and this cancer is rare. Other factors, such as a person’s genes,
may affect how the body deals with EBV, which in turn may affect how EBV contributes
to the development of NPC.
Genetic factors
A person’s genes may affect their risk for NPC. For example, just as people have
different blood types, they also have different tissue types. Studies have found that
people with certain inherited tissue types have an increased risk of developing NPC.
Tissue types affect immune responses, so this may be related to how a person's body
reacts to EBV infection.
Family history
Family members of people with NPC are more likely to get this cancer. It is not known if
this is because of inherited genes, shared environmental factors (such as the same diet
or living quarters), or some combination of these.
Other possible risk factors

Tobacco and alcohol use: Most (but not all) studies have found that smoking may
contribute to the development of NPC, especially the keratinizing type. Some studies
have linked heavy drinking to this type of cancer. More research is needed to define
these links, but they seem to be much weaker than the link between tobacco and
alcohol use and most other types of cancers that start in the throat.
Workplace exposures: Some studies have suggested that workplace exposure to
formaldehyde or wood dust may increase the risk of NPC. Still, not all studies have
shown this and this link isn’t clear.
●References

Do We Know What Causes

The exact cause of most cases of nasopharyngeal cancer (NPC) is not known. But
scientists have found that the disease is linked with certain diets, infections, and
inherited characteristics, which are described in the section called What Are the Risk
Factors for Nasopharyngeal Cancer? Research is being done to learn more about these
causes.
In recent years, scientists have studied how the Epstein-Barr virus (EBV) may cause
cells in the nasopharynx to become cancerous, but much still remains to be learned. In
developed countries, most people infected with EBV develop only infectious
mononucleosis (mono), and their immune system is able to recognize and destroy the
virus. These people recover without any long-term problems. But in some cases, pieces
of viral DNA mix with the DNA of cells in the nasopharynx.
DNA is the chemical in each of our cells that makes up our genes, the instructions for
how our cells function. We usually look like our parents because they are the source of
our DNA. But DNA affects more than how we look. Some genes contain instructions for
controlling when cells grow and divide into new cells. Viruses such as EBV also contain
DNA. When a cell is infected with the virus, the viral DNA may mix with the normal
human DNA. EBV DNA may instruct the cells of the nasopharynx to divide and grow in
an abnormal way.
But EBV infection only rarely results in NPC, so other factors probably play a role in
whether or not it causes cancer. Eating a diet high in salt-cured fish and meat seems to
increase the ability of EBV to cause NPC. Studies show that foods preserved in this way
may produce chemicals that can damage DNA. The damaged DNA alters a cell’s ability
to control its growth and replication.
Some studies suggest that inheriting certain tissue types may contribute to a person’s
risk of developing NPC. Because the tissue type plays a role in the function of the
immune system, some scientists suspect that an abnormal immune reaction to EBV
infection may be involved. The details of how certain tissue types might increase NPC
risk are still being worked out.
●References

Can Nasopharyngeal Cancer Be

Prevented?
Most people in the United States who develop nasopharyngeal cancer (NPC) have no
avoidable risk factors, so their cancers could not have been prevented. The possible
links with tobacco and heavy alcohol use are not clear, so it’s not known if avoiding
these can lower a person’s risk of NPC. However, both tobacco and alcohol use have
clearly been linked to a number of other cancers, as well as other health problems, so
avoiding them can have many health benefits.
Because certain dietary factors have been linked with NPC risk, reducing or eliminating
some types of food may lower the number of cases in parts of the world where NPC is
common, such as southern China, northern Africa, and the Arctic region. Descendants
of Southeast Asians who immigrated to the United States and eat a typical American
diet, for example, have a lower risk of developing NPC. But these dietary factors are not
thought to account for all cases of NPC in most other parts of the world. Other factors,
such as genetics, are likely to play a part as well.
●References


Nasopharyngeal Cancer Early Detection,
Diagnosis, and Staging
Detection and Diagnosis
Catching cancer early often allows for more treatment options. Some early cancers
may have signs and symptoms that can be noticed, but that is not always the case.
● Can Nasopharyngeal Cancer Be Found Early?

● Signs and Symptoms of Nasopharyngeal Cancer
● How Is Nasopharyngeal Cancer Diagnosed?
Stages and Outlook (Prognosis)
After a cancer diagnosis, staging provides important information about the extent of
cancer in the body and anticipated response to treatment.
● Nasopharyngeal Cancer Stages

● Survival Rates for Nasopharyngeal Cancer by Stage
Questions to Ask About Nasopharyngeal Cancer
Here are some questions you can ask your cancer care team to help you better
understand your cancer diagnosis and treatment options.
● What Should You Ask Your Doctor About Nasopharyngeal Cancer?
Can Nasopharyngeal Cancer Be Found

Early?
In the United States and other countries where nasopharyngeal cancer (NPC) is fairly
rare, most doctors do not recommend routine screening for this cancer (screening is
testing for cancer in people without any symptoms). There are no simple, non-invasive
exams or blood tests that can reliably find this cancer early.
But in some parts of the world such as China, where NPC is common, some people are
being screened routinely for this cancer. They are first selected because their blood
shows evidence of infection with the Epstein-Barr virus, although EBV infection is much
more common than NPC. They are given regular exams of the nasopharynx and neck.
This approach can also be used in families when one member has developed NPC. It
isn’t known if this strategy lowers the death rate from this cancer.
Sometimes NPC can be found early if it causes symptoms that make patients seek
medical attention. The symptoms may even seem unrelated to the nasopharynx (for
example, a constant feeling of fullness in one ear). But in most people, NPCs may not
cause symptoms until they have reached an advanced stage.
●References

Signs and Symptoms of Nasopharyngeal

Cancer
About 3 out of 4 people with NPC complain of a lump ormass in the neckwhen they
first see their doctor. There may be lumps on both sides of the neck towards the back.
The lumps are usually not tender or painful. This is caused by the cancer spreading to
lymph nodes in the neck, making them larger than normal. Lymph nodes are glands or
organs that contain collections of immune system cells that are found throughout the
body. Normally, they are smaller than the size of a pea.
Other possible symptoms of NPC include:

● Hearing loss, ringing in the ear, or feeling of fullness in the ear (especially on one
side only)
● Ear infections that keep coming back
● Nasal blockage or stuffiness
● Nosebleeds
● Headache
● Facial pain or numbness
● Trouble opening the mouth
● Blurred or double vision
Ear infections are common in children, but are less common in adults. If you develop an
infection in one ear and you have not had ear infections in the past, it is important to
have a specialist examine your nasopharynx. This is especially true if you don't have an
upper respiratory tract infection (like a “cold”) along with the ear infection.
Many of the symptoms and signs of NPC are more often caused by other, less serious
diseases. Still, if you have any of these problems, it's important to see your doctor right
away so the cause can be found and treated, if needed.
●References

How Is Nasopharyngeal Cancer

Diagnosed?
Nasopharyngeal cancer (NPC) is most often diagnosed when a person goes to a doctor
because of symptoms such as a lump in the neck. The doctor will take a history, do an
exam, and then may refer the patient to a specialist and/or order some tests.
Medical history and physical exam

If you have any signs or symptoms that suggest you might have nasopharyngeal
cancer, your doctor will want to get your complete medical history to learn about your
symptoms and any possible risk factors, including your family history.
A physical exam will be done to look for signs of NPC or other health problems. During
the exam, the doctor will pay special attention to the head and neck area, including the
nose, mouth, and throat; the facial muscles, and the lymph nodes in the neck.
If your doctor suspects you may have a tumor or other problem in the nose or throat, he
or she may order imaging tests (such as CT or MRI) to look at the head and neck area
more closely. Your doctor may also refer you to an otolaryngologist (a doctor
specializing in ear, nose, and throat problems, also sometimes called an ENT doctor),
who will do a more thorough exam of the nasopharynx. The nasopharynx is a difficult
area to examine. Most other kinds of doctors do not have the specialized training or
equipment to do a thorough exam of this part of the body.
Exams of the nasopharynx
The nasopharynx is located deep inside the head and is not easily seen, so special
techniques are needed to examine this area. There are 2 main types of exams used to
look inside the nasopharynx for abnormal growths, bleeding, or other signs of disease.
Both types of exams are usually done in the doctor's office.
● For indirect nasopharyngoscopy, the doctor uses special small mirrors and lights
placed at the back of your throat to look at the nasopharynx and nearby areas.
● For direct nasopharyngoscopy, the doctor uses a fiber-optic scope known as a
nasopharyngoscope (a flexible, lighted, narrow tube inserted through the nose) to
look directly at the lining of the nasopharynx. You will have numbing medicine
sprayed into your nose before the exam to make it easier. This is the method most
often used to carefully examine the nasopharynx.
If a tumor starts under the lining of the nasopharynx (in the tissue called the
submucosa), it may not be possible to see it directly on physical exam, which is why
imaging tests such as CT scans (see below) may be needed as well.
Biopsy
Symptoms and the results of exams can suggest that a person might have NPC, but the
actual diagnosis is made by removing cells from an abnormal area and looking at them
under a microscope. This is known as a biopsy. Different types of biopsies may be
done, depending on where the abnormal area is.
Endoscopic biopsy
If a suspicious growth is found in the nasopharynx during an exam, the doctor may
remove a biopsy sample with small instruments and the aid of a fiber-optic scope.
Often, biopsies of the nasopharynx are done in the operating room as an outpatient
procedure. The sample is then sent to a lab, where a pathologist (a doctor who
specializes in diagnosing and classifying diseases in the lab) looks at it under a
microscope. If the biopsy sample contains cancer cells, the pathologist sends back a
report describing the type of the cancer.
NPC is not always visible during an exam. If a person has symptoms suggesting NPC
but nothing abnormal is seen on exam, the doctor may biopsy normal-looking tissue,
which may be found to contain cancer cells when looked at under the microscope.
Fine needle aspiration (FNA) biopsy
An FNA biopsy may be used if you have a suspicious lump in or near your neck. For
this procedure, the doctor uses a thin, hollow needle attached to a syringe to aspirate
(withdraw) a few drops of fluid containing cells and tiny fragments of tissue. A local
anesthetic (numbing medicine) may be used on the skin where the needle will be
inserted might be numbed with a local anesthetic but sometimes this is not needed.
The doctor places the needle directly into the mass for about 10 seconds and withdraws
cells and a few drops of fluid. The cells are then looked at under a microscope to see if
they are cancerous.
An FNA biopsy can help determine if an enlarged lymph node in the neck area is
caused by a response to an infection, the spread of cancer from somewhere else (such
as the nasopharynx), or a cancer that begins in lymph nodes – called a lymphoma. If
the cancer started somewhere else, the FNA biopsy alone might not be able to tell
where it started. But if a patient already known to have NPC has enlarged neck lymph
nodes, FNA can help determine if the spread of NPC caused the lymph node swelling.
Imaging tests
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive particles to
create pictures of the inside of your body. Imaging tests may be done for a number of
reasons, including to help find a suspicious area that might be cancerous, to learn how
far cancer may have spread, and to help determine if treatment has been effective.
Chest x-ray
If you have been diagnosed with NPC, a plain x-ray of your chest may be done to see if
the cancer has spread to your lungs. This is very unlikely unless your cancer is far
advanced. This x-ray can be done in any outpatient setting. If the results are normal,
you probably don’t have cancer in your lungs.
Computed tomography (CT) scan
The CT scan is an x-ray test that produces detailed cross-sectional images of your
body. Instead of taking one x-ray, a CT scanner takes many pictures as it rotates
around you. A computer then combines them into images of slices of the part of your
body that is being studied.
Before the pictures are taken, you may get an IV (intravenous) line through which a kind
of contrast dye (IV contrast) is injected. This helps better outline structures in your body.
You may also be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps
outline the intestine so that certain areas are not mistaken for tumors. It may not be
needed for CT scans of the nasopharynx.
The injection can cause some flushing (redness and warm feeling). Some people are
allergic and get hives or, rarely, more serious reactions like trouble breathing and low
blood pressure. Be sure to tell the doctor if you have any allergies or have ever had a
reaction to a contrast material used for x-rays.
You need to lie still on a table while the scan is being done. During the test, the table
slides in and out of the scanner, a ring-shaped machine that completely surrounds the
table. You might feel a bit confined by the ring you have to lie in while the pictures are
being taken.
A CT scan of the head and neck can provide information about the size, shape, and
position of a tumor and can help find enlarged lymph nodes that might contain cancer.
CT scans or MRIs are important in looking for cancer that may have grown into the
bones at the base of the skull. This is a common place for nasopharyngeal cancer to
grow. CT scans can also be used to look for tumors in other parts of the body.
Magnetic resonance imaging (MRI) scan
Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI
scans use radio waves and strong magnets instead of x-rays. The energy from the radio
waves is absorbed and then released in a pattern formed by the type of body tissue and
by certain diseases. A computer translates the pattern into very detailed images of parts
of the body. A contrast material called gadolinium is often injected into a vein before the
scan to better see details.
MRI scans may be a little more uncomfortable than CT scans. They take longer – often
up to an hour. You may be asked to lie on a table that slides inside a large tube, which
is confining and can upset people with a fear of enclosed spaces. Special, “open” MRI
machines can sometimes help with this if needed, but the drawback is that the images
may not be as clear. The MRI machine makes buzzing and clicking noises that you may
find disturbing. Some places will provide earplugs to help block this noise out.
Like CT scans, MRIs can be used to try to determine if the cancer has grown into
structures near the nasopharynx. MRIs are a little better than CT scans at showing the
soft tissues in the nose and throat, but they’re not quite as good for looking at the bones
at the base of the skull, a common place for nasopharyngeal cancer to grow.
Positron emission tomography (PET) scan
For a PET scan, you receive an injection of a form of radioactive sugar (known as
fluorodeoxyglucose or FDG). The amount of radioactivity used is low. Because cancer
cells in the body are growing rapidly, they absorb large amounts of the sugar. After
about an hour, you are moved onto a table in the PET scanner. You lie on the table for
about 30 minutes while a special camera creates a picture of areas of radioactivity in
the body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful
information about your whole body.
Your doctor may use this test to see if the cancer has spread to your lymph nodes. It
can also help give the doctor a better idea of whether an abnormal area on a chest x-
ray may be cancer. A PET scan can also be useful if your doctor thinks the cancer may
have spread but doesn’t know where.
Some machines are able to do both a PET and CT scan at the same time (PET/CT
scan). This lets the doctor compare areas of higher radioactivity on the PET with the
more detailed appearance of that area on the CT.
Blood tests
Blood tests are not used to diagnose NPC, but they may be done for other reasons,
such as to help determine whether the cancer may have spread to other parts of the
body.
Routine blood counts and blood chemistry tests
Routine blood tests can help determine a patient’s overall health. These tests can help
diagnose malnutrition, anemia (low red blood counts), liver disease, and kidney disease.
And they may suggest the possibility of spread of the cancer to the liver or bone, which
may prompt further testing.
In people getting chemotherapy, blood tests are important to see if the treatment is
damaging the bone marrow (where new blood cells are made), liver, and kidneys.
Epstein-Barr virus (EBV) DNA levels
In some patients, the blood level of EBV DNA may be measured before and after
treatment to help show how effective treatment is.
●References

Nasopharyngeal Cancer Stages

After someone is diagnosed with nasopharyngeal cancer (NPC), doctors will try to figure
out if it has spread, and if so, how far. This process is called staging. The stage of a
cancer describes how much cancer is in the body. It helps determine how serious the
cancer is and how best to treat it. Doctors also use a cancer's stage when talking about
survival statistics.
The earliest stage of NPC is stage 0, also known as carcinoma in situ (CIS). The other
main stages range from I (1) through IV (4). Some stages are split further, using capital
letters (A, B, etc.). As a rule, the lower the number, the less the cancer has spread. A
higher number, such as stage IV, means cancer has spread more. And within a stage,
an earlier letter means a lower stage. Although each person’s cancer experience is
unique, cancers with similar stages tend to have a similar outlook and are often treated
in much the same way.
How is the stage determined?

The staging system most often used for nasopharyngeal cancer is the American Joint
Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of
information:
● The extent of the main tumor (T): How far has the tumor grown into nearby
structures?
● The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph
nodes in the neck? If so, how large are they?
● The spread (metastasis) to distant sites (M): Has the cancer spread to distant
parts of the body? (The most common sites of spread are the lungs, liver, bones, or
lymph nodes in distant parts of the body.)
These categories are determined mainly based on the results of any exams, biopsies,
and imaging tests that have been done (as described in How Is Nasopharyngeal Cancer
Diagnosed?). Numbers or letters after T, N, and M provide more details about each of
these factors. Higher numbers mean the cancer is more advanced.
Once the T, N, and M categories of the cancer have been determined, this information
is combined in a process called stage grouping to assign an overall stage. For more
information, see Cancer Staging.
The system described below is the most recent AJCC system for NPC, effective
January 2018.
NPC staging can be complex. If you have questions about your cancer's stage and what
it might mean for you, ask your doctor to explain it to you in a way you understand.
Stages of nasopharyngeal cancer

Stage
AJCC stage Stage description*
grouping
The tumor is only in the top layer of cells lining the inside of the
nasopharynx, and has not grown any deeper (Tis).
0 Tis N0 M0
The cancer has not spread to nearby lymph nodes (N0) or to
distant parts of the body (M0).
I T1 N0 M0 The tumor is in the nasopharynx. It might also have grown into
the oropharynx (the part of the throat in the back of the mouth)
and/or nasal cavity but no farther (T1)
The cancer has not spread to nearby lymph nodes (N0) or to
distant parts of the body (M0).
The tumor is in the nasopharynx. It might also have grown into
the oropharynx (the part of the throat behind the mouth) and/or
nasal cavity but no farther (T1). OR no tumor is seen in the
nasopharynx, but cancer is found in lymph nodes in the neck
T1 (or T0) and is Epstein-Barr virus (EBV) positive, which makes it very
N1 M0 likely to be NPC (T0).
The cancer has spread to 1 or more lymph nodes on one side
of the neck, or it has spread to lymph nodes behind the throat.
In either case, no lymph node is larger than 6 cm across (N1).
The cancer has not spread to distant parts of the body (M0).
II
OR
The tumor has grown into the tissues of the left or right sides of
the upper part of the throat (but not into bone) (T2).
The cancer has not spread to nearby lymph nodes (N0). OR it
T2 N0 or
has spread to 1 or more lymph nodes on one side of the neck,
N1 M0
or it has spread to lymph nodes behind the throat. In either
case, no lymph node is larger than 6 cm across (N1).
The tumor is in the nasopharynx. It might also have grown into
the oropharynx (the part of the throat behind the mouth) and/or
nasal cavity but no farther (T1). OR no tumor is seen in the
nasopharynx, but cancer is found in lymph nodes in the neck
T1 (or T0)
and is Epstein-Barr virus (EBV) positive, which makes it very
N2 M0
likely to be NPC (T0).
The cancer has spread to lymph nodes on both sides of the
neck, none of which is larger than 6 cm across (N2). The
cancer has not spread to distant parts of the body (M0).
OR
The tumor has grown into the tissues of the left or right sides of
III the upper part of the throat (but not into bone) (T2). The cancer
T2 N2 M0 has spread to lymph nodes on both sides of the neck, none of
which is larger than 6 cm across (N2).
OR
The tumor has grown into the sinuses and/or the bones nearby
T3 N0 to (T3). The cancer might or might not have spread to nearby
N2 M0 lymph nodes in the neck or behind the throat, but none are
larger than 6 cm across (N0 to N2).
The tumor has grown into the skull and/or cranial nerves, the
hypopharynx (lower part of the throat), the main salivary gland,
or the eye or its nearby tissues (T4).
T4 N0 to
The cancer might or might not have spread to nearby lymph
N2 M0
nodes in the neck or behind the throat, but none are larger than
6 cm across (N0 to N2). The cancer has not spread to distant
parts of the body (M0).
IVA OR
The tumor might or might not have grown into structures
outside the nasopharynx (any T). The cancer has spread to
Any T N3
lymph nodes that are either larger than 6 cm across, or located
M0
in the shoulder area just above the collarbone (N3).
The tumor might or might not have grown into structures
Any T outside the nasopharynx (any T). The cancer might or might not
IVB
Any N M1 have spread to nearby lymph nodes (any N).
The cancer has spread to distant parts of the body (M1).
*The following additional categories are not listed in the table above:
● TX: Main tumor cannot be assessed due to lack of information.
● NX: Nearby lymph nodes cannot be assessed due to lack of information.
● References
American Joint Committee on Cancer. Nasopharynx. In: AJCC Cancer Staging Manual.
8th ed. New York, NY: Springer; 2017: 103-111.
Last Medical Review: December 20, 2017 Last Revised: December 20, 2017

Survival Rates for Nasopharyngeal

Cancer by Stage
Survival rates tell you what portion of people with the same type and stage of cancer
are still alive a certain amount of time (such as 5 years) after they were diagnosed.
They can’t tell you how long you will live, but they may help give you a better
understanding about how likely it is that your treatment will be successful. Some people
will want to know the survival rates for their cancer, and some people won’t. If you don’t
want to know, you don’t have to.
What is a survival rate?

Statistics on the outlook for a certain type and stage of cancer are often given as 5-year
survival rates, but many people live longer – often much longer – than 5 years. The 5-
year survival rate is the percentage of people who live at least 5 years after being
diagnosed with cancer. For example, a 5-year survival rate of 70% means that an
estimated 70 out of 100 people who have that cancer are still alive 5 years after being
diagnosed. Keep in mind, however, that many of these people live much longer than 5
years after diagnosis.
Relative survival rates are a more accurate way to estimate the effect of cancer on
survival. These rates compare people with a certain type (and stage) of cancer to
people in the overall population. For example, if the 5-year relative survival rate for a
specific type and stage of cancer is 80%, it means that people who have that cancer
are, on average, about 80% as likely as people who don’t have that cancer to live for at
least 5 years after being diagnosed.
But keep in mind that survival rates are estimates – your outlook can vary based on a
number of factors specific to you.
Cancer survival rates don’t tell the whole story

Survival rates are often based on previous outcomes of large numbers of people who
had the disease, but they can’t predict what will happen in any particular person’s case.
There are some limitations to remember:
● The numbers below are among the most current available. But to get 5-year
survival rates, doctors have to look at people who were treated at least several
years ago. As treatments are improving over time, people who are now being
diagnosed with nasopharyngeal cancer may have a better outlook than these
statistics show.
● These statistics are based on the stage of the cancer when it was first diagnosed.
They do not apply to cancers that later come back or spread, for example.
● The outlook for people with nasopharyngeal cancer varies by the stage (extent) of
the cancer – in general, the survival rates are higher for people with earlier stage
cancers. But many other factors can also affect a person’s outlook, such as a
person’s age and overall health, where the cancer is in the body, and how well the
cancer responds to treatment. The outlook for each person is specific to their
circumstances.
Your doctor can tell you how these numbers may apply to you, as he or she is familiar
with your particular situation.
Survival rates for nasopharyngeal cancer

The numbers below were published in 2010 in the 7th edition of the AJCC Cancer
Staging Manual and are based on people diagnosed between 1998 and 1999.
Stage Relative 5-year survival rate

I 72%
II 64%
III 62%
IV 38%
Remember, these survival rates are only estimates – they can’t predict what will happen
to any individual. We understand that these statistics can be confusing and may lead
you to have more questions. Talk with your doctor to better understand your situation.
● References
American Joint Committee on Cancer. Pharynx. In: AJCC Cancer Staging Manual. 7th
ed. New York, NY: Springer; 2010: 41-56.
Last Medical Review: December 20, 2017 Last Revised: December 20, 2017

What Should You Ask Your Doctor

About Nasopharyngeal Cancer?
As you deal with your cancer and the process of treatment, you need to have honest,
open discussions with your cancer care team. You should feel free to ask any question,
no matter how minor it might seem. Among the questions you might want to ask are:
● What kind of nasopharyngeal cancer do I have? Does this affect my options?

● Has my cancer spread beyond the nasopharynx?
● What is the stage of my cancer? What does the stage mean in my case?
● Are there other tests that need to be done before we can decide on treatment?
● Are there other doctors I need to see?
● How much experience do you have treating this type of cancer?
● What treatment choices do I have?
● What do you recommend and why?
● What is the goal of the treatment?
● What are the chances my cancer can be cured with treatment?
● How quickly do we need to decide on treatment?
● What should I do to be ready for treatment?
● How long will treatment last? What will it involve? Where will it be done?
● How will treatment affect my daily activities?
● What risks and side effects can I expect? How long are they likely to last?
● What are the chances that my cancer will recur?
● What would we do if the treatment doesn’t work or if the cancer recurs?
● What type of follow-up might I need after treatment?
Along with these sample questions, you might want to write down some of your own.
For instance, you might want more information about recovery times so you can plan
your work or activity schedule. Or you may want to ask about second opinions or about
clinical trials for which you may qualify. Keep in mind, too, that doctors are not the only
ones who can give you information. Other health care professionals, such as nurses
and social workers, may have the answers you seek.
●References

Treating Nasopharyngeal Cancer
General treatment information
After the cancer is found and staged, your cancer care team will discuss treatment
options (choices) with you. Depending on the stage of the cancer, your overall health,
and other factors, your treatment options may include:
● Surgery
● Radiation therapy
● Chemotherapy
● Targeted therapy
Depending on the stage of the cancer, some of these treatments may be combined. For
most nasopharyngeal cancers (NPCs), a combination of radiation therapy and
chemotherapy is used. See Treatiment Options by Stage for Nasopharyngeal Cancer to
learn about common treatment plans.
Based on the stage of the cancer, you may have different types of doctors on your
treatment team. These doctors may include:
● An otolaryngologist (also known as an ear, nose, and throat, or ENT doctor): a

surgeon who treats certain diseases of the head and neck.
● A radiation oncologist: a doctor who treats cancer with radiation therapy.
● A medical oncologist: a doctor who treats cancer with medicines such as
chemotherapy or targeted therapy.
Many other specialists may be involved in your care as well, including nurse
practitioners, nurses, nutrition specialists, social workers, and other health
professionals.
Making treatment decisions

It’s important to discuss all treatment options, including their goals and possible side
effects, so you can make the decision that best fits your needs. You may feel that you
need to make a decision quickly, but it’s important to give yourself time to absorb the
information you have learned. Ask your cancer care team questions. You can find some
good questions to ask in Questions to Ask Your Doctor About Nasopharyngeal Cancer.
Getting a second opinion
You may want to get a second opinion. This can give you more information and help
you feel more certain about the treatment plan you choose. If you aren’t sure where to
go for a second opinion, ask your doctor for help.
Thinking about taking part in a clinical trial
Clinical trials are carefully controlled research studies that are done to get a closer look
at promising new treatments or procedures. Clinical trials are one way to get state-of-
the art cancer treatment. In some cases they may be the only way to get access to
newer treatments. They are also the best way for doctors to learn better methods to
treat cancer. Still, they're not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by
asking your doctor if your clinic or hospital conducts clinical trials. See Clinical Trials to
learn more.
Considering complementary and alternative methods
You may hear about alternative or complementary methods that your doctor hasn’t
mentioned to treat your cancer or relieve symptoms. These methods can include
vitamins, herbs, and special diets, or other methods such as acupuncture or massage,
to name a few.
Complementary methods refer to treatments that are used along with your regular
medical care. Alternative treatments are used instead of a doctor’s medical treatment.
Although some of these methods might be helpful in relieving symptoms or helping you
feel better, many have not been proven to work. Some might even be dangerous.
Be sure to talk to your cancer care team about any method you are thinking about
using. They can help you learn what is known (or not known) about the method, which
can help you make an informed decision. SeeComplementary and Alternative Medicine
to learn more.
Choosing to stop treatment or choosing no treatment at all
For some people, when treatments have been tried and are no longer controlling the
cancer, it could be time to weigh the benefits and risks of continuing to try new
treatments. Whether or not you continue treatment, there are still things you can do to
help maintain or improve your quality of life. Learn more in If Cancer Treatments Stop
Working.
Some people, especially if the cancer is advanced, might not want to be treated at all.
There are many reasons you might decide not to get cancer treatment, but it’s important
to talk to your doctors and you make that decision. Remember that even if you choose
not to treat the cancer, you can still get supportive care. to help with pain or other
symptoms?.
Help getting through cancer treatment

Your cancer care team will be your first source of information and support, but there are
other resources for help when you need it. Hospital- or clinic-based support services are
an important part of your care. These might include nursing or social work services,
financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services – including rides to
treatment, lodging, and more – to help you get through treatment. Call our National
Cancer Information Center at 1-800-227-2345 and speak with one of our trained
specialists.
The treatment information given here is not official policy of the American Cancer
Society and is not intended as medical advice to replace the expertise and judgment of
your cancer care team. It is intended to help you and your family make informed
decisions, together with your doctor. Your doctor may have reasons for suggesting a
treatment plan different from these general treatment options. Don't hesitate to ask him
or her questions about your treatment options.
Surgery for Nasopharyngeal Cancer

Because the nasopharynx is a hard place to operate on and because other types of
treatment are often effective, surgery is seldom the main treatment for patients with
nasopharyngeal cancer (NPC). When surgery is used, it is most often to remove lymph
nodes in the neck that haven’t responded to other treatments.
Removing the tumor
With newer endoscopic surgery techniques, doctors can use flexible fiberoptic scopes
and long, thin surgical instruments to completely remove some nasopharyngeal tumors.
But this is only an option for a small number of patients. These complex procedures are
done only in specialized centers.
Surgery does have some advantages over other treatments such as radiation therapy –
for example, it lets doctors look at the cancer (and nearby tissues) closely in the lab to
make sure that none has been left behind.
Removing lymph nodes
Cancers of the nasopharynx often spread to the lymph nodes in the neck. These
cancers often respond well to treatment with radiation therapy (and sometimes
chemotherapy). But if some cancer remains after these treatments, an operation called
a neck dissection may be needed to remove these lymph nodes.
There are several types of neck dissection surgery. They differ in the amount of tissue
removed from the neck.
● A partial or selective neck dissection removes only lymph nodes that are closest to
the primary tumor site and most likely to have cancer spread.
● A modified radical neck dissection removes lymph nodes on one side of the neck
between the jaw bone and collarbone, as well as some muscle and nerve tissue.
The main nerve to the shoulder muscle is usually preserved.
● A radical neck dissection removes nearly all lymph nodes on one side as well as
even more muscles, nerves, and veins.
Possible risks and side effects of surgery
The risks and side effects of any surgery depend on the extent of the operation and a
person's general health before the surgery. If you are considering surgery, your doctor
will discuss the likely side effects with you beforehand.
All surgeries carry some risk, including the possibility of bleeding, infections,
complications from anesthesia, and pneumonia. Most people will have some pain for a
while after the operation, although this can usually be controlled with medicines. Other
possible side effects of surgery in the head and neck area can include problems with
speech or swallowing.
The most common side effects of any neck dissection are numbness of the ear,
weakness when raising the arm above the head, and weakness of the lower lip. These
side effects are caused by the effects of the operation on certain nerves that supply
these areas. After a selective neck dissection, the weakness of the shoulder and lower
lip usually go away after a few months. But if either of the nerves that supply these
areas is removed as part of a radical neck dissection or because of involvement with
tumor, the weakness will be permanent.
After more extensive neck dissections, physical therapists can teach you exercises to
improve neck and shoulder strength and mobility.
●References

Radiation Therapy for Nasopharyngeal

Cancer
Radiation therapy uses high-energy x-rays or particles to destroy cancer cells or slow
their rate of growth. It is usually at least part of the main treatment for nasopharyngeal
cancer (NPC) because most of these cancers are very sensitive to radiation.
For many cases of NPC, chemotherapy is given with radiation to try to increase its
effects. This treatment, known as chemoradiation, can be better than radiation alone at
fighting the cancer, but it also tends to have more side effects. (This is discussed more
in the section, Chemotherapy for Nasopharyngeal Cancer.)
Radiation therapy is usually given both to the main nasopharyngeal tumor and to nearby
lymph nodes in the neck. Even if the lymph nodes are not abnormally firm or large,
radiation is still used in case a few cancer cells have spread there. If the lymph nodes
are known to have cancer cells, higher radiation doses are used.
Different types of radiation therapy can be used to treat NPC:

External beam radiation therapy (EBRT)
This type of radiation therapy uses x-rays from a machine outside the patient’s body to
kill cancer cells. It is the most common form of radiation therapy for NPC.
Before your treatments start, the radiation team will take careful measurements to
determine the correct angles for aiming the radiation beams and the proper dose of
radiation. Radiation therapy is much like getting an x-ray, but the radiation is stronger.
The procedure itself is painless. Each treatment lasts only a few minutes, although the
setup time – getting you in place for treatment – takes longer. Most often, radiation
treatments are given 5 days a week for about 7 weeks.
EBRT is often given using a technique such as intensity-modulated radiation therapy

(IMRT) that focuses the radiation better and lowers the radiation exposure to nearby
healthy tissues.
Stereotactic radiosurgery is a type of radiation treatment that delivers a large, precise

radiation dose to the tumor area in a single session. (There is no actual surgery
involved in this treatment.) The machines used to deliver this type of radiation are
known as a Gamma Knife, X-Knife, CyberKnife, and Clinac.
Brachytherapy (internal radiation)
Another way to deliver radiation is to insert (implant) very thin metal rods or wires into or
very near the cancer. Small pellets of radioactive materials are placed into the rods or
wires. The radiation travels a very short distance, so it affects the cancer without
causing much harm to nearby healthy body tissues.
The implant is usually left in place for several days while the patient stays in a private
hospital room. The length of time that visitors, nurses, and other caregivers can spend
with the patient may be limited because of potential radiation exposure, but this
depends on the type of radiation. The implant is removed before the patient goes home.
Brachytherapy may be used if the cancer comes back after external beam radiation
therapy (although stereotactic radiosurgery may be used instead, as it is less invasive).
Sometimes, internal and external beam radiation therapy are used together.
Possible side effects of radiation therapy
Common side effects of external beam radiation to the head and neck include:
● Skin changes in the area where the radiation passes through, with redness or
blistering
● Nausea and vomiting
● Fatigue (tiredness)
● Sores in the mouth and throat which can lead to trouble swallowing and weight loss
from not eating
● Hoarseness
● Loss of taste
These side effects get better once radiation has stopped. Other side effects may not get
better over time, such as:
● Problems with hearing or vision because of damage to certain nerves

● Damage to bones in the skull
● Tooth problems
● Damage to the salivary glands
Radiation to these areas can make any tooth problems that you already have worse and
hard to fix. Most doctors advise that you have your teeth checked by a dentist before
you have radiation therapy to the head or neck area. In some cases, the dentist may
even advise removing some teeth before treatment to lessen the chance you will have
problems later.
A major concern with radiation therapy for NPC is that it can damage the salivary
glands. This damage can result in dry mouth that does not go away, making it hard to
swallow food. Dry mouth can also lead to severe tooth decay. To help prevent dental
problems, people treated with radiation to the head or neck area need to practice
careful oral hygiene.
Dry mouth is less of a problem if radiotherapy techniques such as IMRT are used.
Some of the damage to the salivary glands may also be lessened if a drug called
amifostine (Ethyol®) is given before each radiation treatment. This drug can have
bothersome side effects, though.
The thyroid gland is often damaged if the neck area is treated with external beam
radiation. The damage doesn’t cause problems seen right way, so your doctor will
watch your thyroid function with blood tests in the years after treatment. If your thyroid
function goes down, pills to replace thyroid hormone may be needed.
The pituitary gland, which is responsible for controlling many hormones in the body, can
also be damaged by treatment of a tumor in the nasopharynx. This can also be found
with blood tests. If the damage is serious enough, this might require taking certain
hormones to replace the ones that are missing.
The carotid arteries, which are major blood vessels in the neck that deliver blood to the
brain, can sometimes become narrowed after radiation, which could raise a person’s
risk of stroke or other problems. This usually takes several years to occur.
It is important to discuss the possible side effects of radiation therapy with your doctor
before starting treatment, and to make sure everything is being done to try to limit these
side effects as much as possible.
For more general information about radiation therapy, see the Radiation
Therapy section of our website, or our document A Guide to Radiation Therapy.
●References

Chemotherapy for Nasopharyngeal

Cancer
Chemotherapy (chemo) is the use of anti-cancer drugs to treat cancer. These drugs are
most often given into a vein (IV) or by mouth. They enter the bloodstream and reach
throughout the body, making this treatment useful for cancers that have spread beyond
the head and neck.
Chemo may be used in different situations to treat nasopharyngeal cancer (NPC):
● Chemo is often used together with radiation therapy as the first treatment for more
advanced stages of NPC because some chemo drugs make cancer cells more
sensitive to radiation. This treatment is called chemoradiation.
● Chemo may also be given after radiation (or chemoradiation). This is known as
adjuvant treatment.
● Chemo is used for patients whose NPC has spread to distant organs such as the
lungs, bones, or liver. It may be used either alone or along with radiation.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to
allow the body time to recover. Cycles generally last about 3 to 4 weeks. Chemo is often
not recommended for patients in poor health, but advanced age by itself is not a barrier
to getting chemo.
Cisplatin is the chemo drug used most often to treat NPC. It is used alone as part of
chemoradiation, but may be combined with another drug, 5-fluorouracil (5-FU) if given
after radiation.
Some other drugs may also be helpful in treating cancer that has spread. These
include:
● Carboplatin (Paraplatin®)
● Doxorubicin (Adriamycin®)
● Epirubicin (Ellence®)
● Paclitaxel (Taxol®)
● Docetaxel (Taxotere®)
● Gemcitabine (Gemzar®)
● Bleomycin
● Methotrexate
Often, combinations of 2 or more of these drugs are used.
Possible side effects of chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against
cancer cells. But other cells in the body such as those in the bone marrow, the lining of
the mouth and intestines, and the hair follicles, also divide quickly. These cells are also
likely to be affected by chemo, which can lead to certain side effects.
The side effects of chemo depend on the type and dose of drugs you are given and how
long they are taken. Common side effects include:
● Hair loss
● Mouth sores
● Loss of appetite
● Nausea and vomiting
● Diarrhea
● Increased chance of infections (due to low white blood cell counts)
● Easy bruising or bleeding (due to low blood platelet counts)
● Fatigue (due to low red blood cell counts)
These side effects are usually short-term and go away after treatment is finished. Once
chemo is started, let your health care team know if you have side effects, so they can
be treated. There are ways to prevent or treat many of the side effects of chemo. For
example, many good drugs are available to help prevent or treat nausea and vomiting.
Some drugs can have other side effects. For example, cisplatin can damage nerves
(called neuropathy). This can sometimes lead to hearing loss or symptoms in the hands
and feet such as pain, burning or tingling sensations, sensitivity to cold or heat, or
weakness. In most cases this improves once treatment is stopped, but it may last a long
time in some people. For more information on nerve damage, see our document
Peripheral Neuropathy Caused by Chemotherapy.
In some cases, the doses of the chemo drugs may need to be reduced or treatment
may need to be delayed or stopped to prevent side effects from getting worse.
For more general information about chemotherapy, see the Chemotherapy section on
our website.
●References

Targeted Therapy for Nasopharyngeal

Cancer
As researchers have learned more about the changes in cells that cause cancer, they
have been able to develop newer drugs that specifically target these changes. These
targeted drugs work differently from standard chemotherapy (chemo) drugs. They may
work in some instances when chemo drugs do not, or they may help chemo drugs work
better. Targeted drugs also often have different (and less severe) side effects.
Cetuximab (Erbitux®)
Cetuximab is a monoclonal antibody (a man-made version of an immune system

protein) that targets the epidermal growth factor receptor (EGFR). EGFR is a protein
found on the surface of cells. It normally receives signals telling the cells to grow and
divide. Nasopharyngeal cancer (NPC) cells sometimes have more than normal amounts
of EGFR, which can help them grow faster. By blocking EGFR, cetuximab may slow or
stop this growth.
The exact role of cetuximab in treating NPC is still being studied. It is most often used
along with chemo and/or radiation in cases where the cancer has come back or
continues to grow after initial chemo.
Cetuximab is given by IV infusion, usually once a week. Common side effects include:
●Skin problems, such as an acne-like rash on the face and chest during treatment,
which in some cases can lead to infections.
●Headache
●Tiredness
●Fever
●Diarrhea
A rare but serious side effect of cetuximab is an allergic reaction during the first infusion,
which could cause breathing problems and low blood pressure. You may be given
medicine before treatment to help prevent this.
For information about managing skin problems from targeted therapy, see our
document Targeted Therapy.
References
●

Treatment Options, by Stage of

Nasopharyngeal Cancer
Your cancer care team will recommend treatment options depending on the extent of
the cancer at its site of origin and how far the cancer has spread, if at all.
Nasopharyngeal cancer (NPC) in children is treated largely the same way as NPC in
adults.
Stages 0 and I
The usual treatment for these early stage cancers is radiation therapy aimed at the
nasopharyngeal tumor.
Although the cancer has not yet spread to lymph nodes in these stages, the nearby
lymph nodes in the neck are usually treated with radiation therapy as well. This is
considered preventive (prophylactic) radiation. Some patients may have cancer cells in
these lymph nodes that can’t be detected. Although there are too few cancer cells in the
lymph nodes to cause them to be enlarged, these cells could continue to grow and
spread if not destroyed by radiation therapy.
Stages II, III, IVA and IVB
These cancers have spread outside of the nasopharynx, which may mean spread to
lymph nodes in the neck or above the collarbone. Patients with these stages of NPC
usually receive chemoradiation (chemotherapy given along with radiation therapy to the
nasopharynx and neck lymph nodes). The chemotherapy (chemo) drug most often used
is cisplatin, but sometimes another drug is used as well. This is usually followed by
more chemo, most often with cisplatin plus 5-FU. Most studies have found that
chemoradiation helps patients live longer than just radiation therapy alone. But adding
chemo leads to more side effects, which can affect quality of life. It’s important to
understand what the side effects are likely to be before starting this treatment.
If cancer is still in the lymph nodes after this treatment, surgery (neck dissection) may
be done to remove the lymph nodes.
Stage IVC
These nasopharynx cancers have spread to distant parts of the body and can be hard
to treat. The usual treatment is chemo, often with cisplatin and one other drug. If there is
no sign of the cancer after chemotherapy, radiation therapy to the nasopharynx and the
lymph nodes in the neck or chemoradiation is given to try to kill any remaining cancer
cells. Another option in some cases is to give chemoradiation as the first treatment.
If there are still signs of cancer after the initial chemotherapy, another chemotherapy
regimen using different drugs may be tried. Chemotherapy plus the targeted drug
cetuximab (Erbitux) may be another option.
Because these cancers can be hard to treat effectively, taking part in a clinical trial of
newer treatments may be a good option.
Recurrent nasopharyngeal cancer
Cancer is called recurrent when it come backs after treatment. Recurrence can be local
(in or near the same place it started) or distant (spread to organs such as the lungs or
bone). If your cancer returns after treatment, the choices available to you depend on the
location and extent of the cancer, which treatments were used the first time around, and
your overall health. It is important to understand the goal of any further treatment –
whether it is to try to cure the cancer, to slow its growth, or to help relieve symptoms –
as well as the likelihood of benefits and risks.
Some tumors that recur in the nasopharynx can be removed by surgery using an
approach through the nose (called endoscopic skull base surgery). This is a specialized
surgery that should only be done by a surgeon with a great deal of experience in this
procedure, so it’s not available at all medical centers.
Recurrent NPC in regional (neck area) lymph nodes can sometimes be treated by
additional radiation therapy. But if doctors believe that more radiation would cause
serious side effects or if the initial response to radiation was incomplete, surgery (neck
dissection) may be used instead.
Cancer that recurs in distant sites is usually treated with chemotherapy. If

chemotherapy has been given already, different chemo drugs may be tried. The
targeted drug cetuximab may be given along with chemo, generally on a clinical trial.
If chemo is no longer working, a newer option might be treatment with

an immunotherapy drug such as pembrolizumab (Keytruda) or nivolumab (Opdivo).
These drugs can help the body’s own immune system attack the cancer.
New drug treatments being tested in clinical trials and new surgical procedures may
help some patients with recurrent NPC, as well as improve knowledge that can help
others with NPC in the future.
If the cancer can’t be cured, further treatments may be aimed at slowing its growth or
relieving symptoms caused by the distant spread of the cancer. For example, if the
cancer has spread to the spine, radiation therapy may be given to the area to relieve
pain and reduce the chances of further complications. Even if a cure is not possible, it is
important to remember that there are many options to relieve symptoms of advanced
cancer.
●References
Last Medical Review: January 15, 2015 Last Revised: March 2, 2017


After Nasopharyngeal Cancer Treatment
Living as a Cancer Survivor
For many people, cancer treatment often raises questions about next steps as a
survivor.
● What Happens After Treatment for Nasopharyngeal Cancer?

● Lifestyle Changes After Having Nasopharyngeal Cancer
● How Does Having Nasopharyngeal Cancer Affect Your Emotional Health?
Cancer Concerns After Treatment
Treatment may remove or destroy the cancer, but it is very common to have questions
about cancer coming back or treatment no longer working.
● Can I Get Another Cancer After Having Nasopharyngeal Cancer?

● If Treatment for Nasopharyngeal Cancer Stops Working
What Happens After Treatment for

For many people with nasopharyngeal cancer (NPC), treatment may remove or destroy
the cancer. Completing treatment can be both stressful and exciting. You may be
relieved to finish treatment, but find it hard not to worry about cancer coming back.
(When cancer comes back after treatment, it is called recurrence.) This is a very
common concern in people who have had cancer.
It may take a while before your fears lessen. But it may help to know that many cancer
survivors have learned to live with this uncertainty and are leading full lives. Our
document Living With Uncertainty: The Fear of Cancer Recurrence, gives more detailed
information on this.
For other people, the cancer may never go away completely. These people may get
regular treatments with chemotherapy, radiation therapy, or other therapies to try to help
keep the cancer in check. Learning to live with cancer that does not go away can be
difficult and very stressful. It has its own type of uncertainty. Our document When
Cancer Doesn’t Go Away talks more about this.
Follow-up care
After you have completed treatment, your doctors will still want to watch you closely. It
is very important to go to all of your follow-up appointments. During these visits, your
doctors will ask questions about any problems you may have and may do exams and
lab tests or imaging tests (such as MRI or CT scans) to look for signs of cancer or
treatment side effects. Your health care team will discuss which tests should be done
and how often based on the stage of your cancer and the type of treatment you
received.
Most doctors recommend follow-up exams at least every few months for the first 2 years
after treatment, then less often after this. If you had radiation therapy to the neck, your
doctor will check your thyroid function with blood tests once or twice a year.
You may be advised to see your dentist after treatment to check on the health of your
teeth. Your doctor will also want to keep a close eye on your hearing, speech, and
swallowing, which can be affected by treatment. If you are having problems with any of
these, your doctor may refer you to a therapist for help with rehabilitation.
Imaging tests such as CT or PET/CT scans may be done after treatment to get an idea
of what the nasopharynx and neck area now look like. Further imaging tests may be
done if you later develop any signs or symptoms that might be caused by a return of the
cancer.
Almost any cancer treatment can have side effects. Some may last for a few weeks to
months, but others can last the rest of your life. This is the time for you to talk to your
cancer care team about any changes or problems you notice and any questions or
concerns you have.
It is very important to report any new symptoms to the doctor right away, because they
may prompt your doctor to do tests that could help find recurrent cancer as early as
possible, when the chance of successful treatment is greatest.
If cancer does recur, further treatment will depend on the location of the cancer, what
treatments you’ve had before, and your health. For more information on how recurrent
cancer is treated, see the section Treatment Options, by Stage of Nasopharyngeal
Cancer. For more general information on dealing with a recurrence, you may also want
to see our document When Your Cancer Comes Back: Cancer Recurrence.
It is important to have health insurance. Tests and doctor visits cost a lot, and even
though no one wants to think of their cancer coming back, this could happen.
Seeing a new doctor

At some point after your cancer diagnosis and treatment, you may find yourself seeing a
new doctor who does not know anything about your medical history. It is important that
you be able to give your new doctor the details of your diagnosis and treatment. Make
sure you have the following information handy:
● A copy of your pathology report(s) from any biopsies or surgeries

● If you had surgery, a copy of your operative report(s)
● If you stayed in the hospital, a copy of the discharge summary that doctors prepare
when patients are sent home
● If you had radiation therapy, a copy of your treatment summary
● If you had chemotherapy or targeted therapy, a list of your drugs, drug doses, and
when you took them
● Copies of any imaging tests, such as CT scans and MRIs, which can often be
placed on a DVD
The doctor may want copies of this information for his records, but always keep copies
for yourself.
●References

Can I Get Another Cancer After Having
Cancer survivors can be affected by a number of health problems, but often their
greatest concern is facing cancer again. If a cancer comes back after treatment it is
called a “recurrence.” But some cancer survivors may develop a new, unrelated cancer
later. This is called a “second cancer.” No matter what type of cancer you have had, it is
still possible to get another (new) cancer, even after surviving the first.
Unfortunately, being treated for cancer doesn’t mean you can’t get another cancer.
People who have had cancer can still get the same types of cancers that other people
get. In fact, certain types of cancer and cancer treatments can be linked to a higher risk
of certain second cancers.
Survivors of cancer of the nasopharynx can get any second cancer, but they have an
increased risk of:
● Cancer of the tongue

● Cancer of the nose and nasal cavity
● Cancer of the esophagus
● Colon cancer
● Cancer of the cervix
● Kidney cancer
● Cancer of the bone and joints
● Non-Hodgkin lymphoma
Follow-up after treatment
After completing treatment for cancer of the nasopharynx, you should still see your
doctor regularly. Your doctor may order tests to look for signs that the cancer has come
back or spread. These tests are also useful in finding some second cancers, particularly
a new lung cancer or cancer of the mouth or throat. Experts don’t recommend any other
tests to look for second cancers in patients who don’t have symptoms. Let your doctor
know about any new symptoms or problems, because they could be caused by the
cancer coming back or by a new disease or second cancer.
Survivors of nasopharyngeal cancers should follow the American Cancer Society

guidelines for the early detection of cancer and stay away from tobacco products.
Smoking increases the risk of getting certain second cancers as well as other health
problems.
To help maintain good health, survivors should also:
●Achieve and maintain a healthy weight

●Adopt a physically active lifestyle
●Consume a healthy diet, with an emphasis on plant foods
●Limit consumption of alcohol to no more than 1 drink per day for women or 2 per
day for men
These steps may also lower the risk of some cancers.
See Second Cancers in Adults for more information about causes of second cancers.
●References

Lifestyle Changes After Having

Nasopharyngeal Cancer
You can’t change the fact that you have had cancer. What you can change is how you
live the rest of your life – making choices to help you stay healthy and feel as well as
you can. This can be a time to look at your life in new ways. Maybe you are thinking
about how to improve your health over the long term. Some people even start during
cancer treatment.
Making healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they
may not have thought much about in the past. Are there things you could do that might
make you healthier? Maybe you could try to eat better or get more exercise. Maybe you
could cut down on the alcohol, or give up tobacco. Even things like keeping your stress
level under control may help. Now is a good time to think about making changes that
can have positive effects for the rest of your life. You will feel better and you will also be
healthier.
You can start by working on those things that worry you most. Get help with those that
are harder for you. For instance, if you are thinking about quitting smoking and need
help, call the American Cancer Society for information and support. A tobacco cessation
and coaching service can help increase your chances of quitting for good.
Eating better
Eating right can be hard for anyone, but it can get even tougher during and after cancer
treatment. This is especially true for cancers of the head and neck, such as
nasopharyngeal cancer. The cancer or its treatment may affect how you swallow or
cause dry mouth, changes in taste, or other problems. Nausea can be a problem from
some treatments. You may not feel like eating and lose weight when you don't want to.
If treatment caused weight changes or eating or taste problems, do the best you can
and keep in mind that these problems usually get better over time. You may find it helps
to eat small portions every 2 to 3 hours until you feel better. You may also want to ask
your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas
on how to deal with these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits
into place. You may be surprised at the long-term benefits of some simple changes, like
increasing the variety of healthy foods you eat. Getting to and staying at a healthy
weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a
number of types of cancer, as well as having many other health benefits.
For more information, see our document Nutrition and Physical Activity During and After
Cancer Treatment: Answers to Common Questions.
Rest, fatigue, and exercise
Extreme tiredness, called fatigue, is very common in people treated for cancer. This is
not a normal tiredness, but a “bone-weary” exhaustion that doesn’t get better with rest.
For some people, fatigue lasts a long time after treatment, and can make it hard for
them to exercise and do other things they want to do. But exercise can help reduce
fatigue. Studies have shown that patients who follow an exercise program tailored to
their personal needs feel better physically and emotionally and can cope better, too.
If you were sick and not very active during treatment, it is normal for your fitness,
endurance, and muscle strength to decline. Any plan for physical activity should fit your
own situation. A person who has not been physically active will not be able to take on
the same amount of activity as someone who plays tennis twice a week. If you haven’t
been active in a few years, you will have to start slowly – maybe just by taking short
walks.
Talk with your health care team before starting anything. Get their opinion about your
exercise plans. Then, try to find an exercise buddy so you’re not doing it alone. Having
family or friends involved when starting a new exercise program can give you that extra
boost of support to keep you going when the push just isn't there.
If you are very tired, you will need to balance activity with rest. It is OK to rest when you
need to. Sometimes it’s really hard for people to allow themselves to rest when they are
used to working all day or taking care of a household, but this is not the time to push
yourself too hard. Listen to your body and rest when you need to. (For more information
on fatigue and other treatment side effects, see the Physical Side Effects section of our
website.)
Keep in mind exercise can improve your physical and emotional health.
●It improves your cardiovascular (heart and circulation) fitness.

●Along with a good diet, it will help you get to and stay at a healthy weight.
●It makes your muscles stronger.
●It reduces fatigue and helps you have more energy.
●It can help lower anxiety and depression.
●It can make you feel happier.
●It can help you feel better about yourself.
And long term, we know that getting regular physical activity plays a role in helping to
lower the risk of some cancers, as well as having other health benefits.
Can I lower my risk of the cancer progressing or coming back?
Most people want to know if there are specific lifestyle changes they can make to
reduce their risk of their cancer progressing or coming back. For many cancers there is
little solid evidence to guide people. This doesn’t mean that nothing will help — it's just
that for the most part this is an area that hasn’t been well studied. Most studies have
looked at lifestyle changes as ways of preventing cancer in the first place, not slowing it
down or preventing it from coming back.
At this time, not enough is known about nasopharyngeal cancer to say for sure if there
are things you can do that will be helpful. Tobacco and alcohol use have clearly been
linked to most types of cancers of the head and neck, but the link with nasopharyngeal
cancers is not as clear. We don't know for certain if not smoking or drinking can reduce
your risk, but we do know that it can help improve your appetite and overall health. It
can also reduce the chance of developing other types of cancer. If you want to quit
smoking and need help, call the American Cancer Society at 1-800-227-2345.
Adopting other healthy behaviors such as eating well, getting regular physical activity,
and staying at a healthy weight may help as well, but no one knows for sure. However,
we do know that these types of changes can have positive effects on your health that
can extend beyond your risk of cancer.
●References

How Does Having Nasopharyngeal

Cancer Affect Your Emotional Health?
During and after treatment, you may find yourself overcome with many different
emotions. This happens to a lot of people.
You may find yourself thinking about death and dying. Or maybe you’re more aware of
the effect the cancer has on your family, friends, and career. You may take a new look
at your relationships with those around you. Unexpected issues may also cause
concern. For instance, as you feel better and have fewer doctor visits, you will see your
health care team less often and have more time on your hands. These changes can
make some people anxious.
Almost everyone who is going through or has been through cancer can benefit from
getting some type of support. You need people you can turn to for strength and comfort.
Support can come in many forms: family, friends, cancer support groups, church or
spiritual groups, online support communities, or one-on-one counselors. What’s best for
you depends on your situation and personality. Some people feel safe in peer-support
groups or education groups. Others would rather talk in an informal setting, such as
church. Others may feel more at ease talking one-on-one with a trusted friend or
counselor. Whatever your source of strength or comfort, make sure you have a place to
go with your concerns.
The cancer journey can feel very lonely. It is not necessary or good for you to try to deal
with everything on your own. And your friends and family may feel shut out if you do not
include them. Let them in, and let in anyone else who you feel may help. If you aren’t
sure who can help, call your American Cancer Society at 1-800-227-2345 and we can
put you in touch with a group or resource that may work for you. You can also read our
document Distress in People with Cancer or see the Emotional Side Effects section of
our website for more information.
●References

If Treatment for Nasopharyngeal Cancer

Stops Working
If cancer keeps growing or comes back after one kind of treatment, it is possible that
another treatment plan might still cure the cancer, or at least shrink it enough to help
you live longer and feel better. But when a person has tried many different treatments
and has not gotten any better, the cancer tends to become resistant to all treatment. If
this happens, it’s important to weigh the possible limited benefits of a new treatment
against the possible downsides. Everyone has their own way of looking at this.
This is likely to be the hardest part of your battle with cancer – when you have been
through many medical treatments and nothing's working anymore. Your doctor may
offer you new options, but at some point you may need to consider that more treatment
is not likely to improve your health or change your outcome or survival.
If you want to continue to get treatment for as long as you can, you need to think about
the odds of it having any benefit and how this compares to the possible risks and side
effects. In many cases, your doctor can estimate how likely it is the cancer will respond
to the treatment you are considering. For instance, the doctor may say that more
treatment might have about a 1 in 100 chance of working. Some people are still tempted
to try this. But it is important to think about and understand your reasons for choosing
this plan.
No matter what you decide to do, you need to feel as good as you can. Make sure you
are asking for and getting treatment for any symptoms you might have, such as nausea
or pain. This type of treatment is called palliative care.
Palliative care helps relieve symptoms, but is not expected to cure the disease. It can
be given along with cancer treatment, or can even be cancer treatment. The difference
is its purpose – the main purpose of palliative care is to improve the quality of your life,
or help you feel as good as you can for as long as you can. Sometimes this means
using drugs to help with symptoms like pain or nausea. Sometimes, though, the
treatments used to control your symptoms are the same as those used to treat cancer.
For instance, radiation might be used to help relieve bone pain caused by cancer that
has spread to the bones. Or chemo might be used to help shrink a tumor and keep it
from blocking the bowels. But this is not the same as treatment to try to cure the cancer.
You can learn more about the changes that occur when curative treatment stops
working, and about planning ahead for yourself and your family, in our documents
Nearing the End of Lifeand Advance Directives.
At some point, you may benefit from hospice care. This is special care that treats the
person rather than the disease; it focuses on quality rather than length of life. Most of
the time, it is given at home. Your cancer may be causing problems that need to be
managed, and hospice focuses on your comfort. You should know that while getting
hospice care often means the end of treatments such as chemo and radiation, it doesn’t
mean you can’t have treatment for the problems caused by your cancer or other health
conditions. In hospice the focus of your care is on living life as fully as possible and
feeling as well as you can at this difficult time. You can learn more about hospice in our
document called Hospice Care.
Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is
still hope for good times with family and friends – times that are filled with happiness
and meaning. Pausing at this time in your cancer treatment gives you a chance to
refocus on the most important things in your life. Now is the time to do some things
you’ve always wanted to do and to stop doing the things you no longer want to do.
Though the cancer may be beyond your control, there are still choices you can make.
●References


Nasopharyngeal Cancer Complete

Uploaded by

Copyright:

Available Formats

Nasopharyngeal Cancer Complete

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Nasopharyngeal Cancer Complete

Uploaded by

Copyright:

Available Formats

About Nasopharyngeal Cancer

Overview and Types

● What Is Nasopharyngeal Cancer?

● What Are the Key Statistics About Nasopharyngeal Cancer?

What Is Nasopharyngeal Cancer?

About the nasopharynx

● Keratinizing squamous cell carcinoma

American Cancer Society medical information is copyrighted material. For reprint

What Are the Key Statistics About

American Cancer Society medical information is copyrighted material. For reprint

What's New in Nasopharyngeal Cancer

Causes, prevention, and early detection

New radiation therapy techniques

Researchers continue to develop new chemotherapy drugs, new drug combinations,

Scientists have recently discovered how certain gene mutations (changes) in

American Cancer Society medical information is copyrighted material. For reprint

● What Are the Risk Factors for Nasopharyngeal Cancer?

● Can Nasopharyngeal Cancer Be Prevented?

What Are the Risk Factors for

These risk factors are discussed in more detail below

Race/ethnicity and where you live

Epstein-Barr virus infection

Other possible risk factors

American Cancer Society medical information is copyrighted material. For reprint

Do We Know What Causes

American Cancer Society medical information is copyrighted material. For reprint

Can Nasopharyngeal Cancer Be

American Cancer Society medical information is copyrighted material. For reprint

2016 Copyright American Cancer Society

● Can Nasopharyngeal Cancer Be Found Early?

● Nasopharyngeal Cancer Stages

● What Should You Ask Your Doctor About Nasopharyngeal Cancer?

Can Nasopharyngeal Cancer Be Found

American Cancer Society medical information is copyrighted material. For reprint

Signs and Symptoms of Nasopharyngeal

Other possible symptoms of NPC include:

American Cancer Society medical information is copyrighted material. For reprint

How Is Nasopharyngeal Cancer

Medical history and physical exam

Exams of the nasopharynx

Fine needle aspiration (FNA) biopsy

Computed tomography (CT) scan

Magnetic resonance imaging (MRI) scan

Positron emission tomography (PET) scan

Epstein-Barr virus (EBV) DNA levels

American Cancer Society medical information is copyrighted material. For reprint

Nasopharyngeal Cancer Stages

How is the stage determined?

Stages of nasopharyngeal cancer

American Cancer Society medical information is copyrighted material. For reprint

Survival Rates for Nasopharyngeal

What is a survival rate?

Cancer survival rates don’t tell the whole story

Survival rates for nasopharyngeal cancer

Stage Relative 5-year survival rate

American Cancer Society medical information is copyrighted material. For reprint

What Should You Ask Your Doctor

● What kind of nasopharyngeal cancer do I have? Does this affect my options?

American Cancer Society medical information is copyrighted material. For reprint

● An otolaryngologist (also known as an ear, nose, and throat, or ENT doctor): a