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This information is about nasopharyngeal cancer (cancer of the nasopharynx). You may find it helpful to read the information alongside our general information about head and neck cancers.|
The nasopharynx is an air cavity lying at the back of the nose and above the soft part of the palate (roof of the mouth) - see diagram below. It connects the nose to the back of the mouth (oropharynx), allowing you to breathe through your nose and to swallow mucus produced by the lining membranes of the nose.
Side view of structures in the head and neck
View a large copy of the side view of structures in the head and neck image|
This type of cancer is rare in the West, but much more common in countries of the Far East. Approximately 230 new cases of nasopharyngeal cancer are diagnosed in the UK each year. It can occur at any age, but is more likely to be seen in people aged between 50–60. It affects more men than women.
There are different types of nasopharyngeal cancer, which are named after the specific type of cell within the nasopharynx that has become cancerous.
Most nasopharyngeal cancers are squamous cell carcinomas. They develop in the cells that line the nasopharynx. The more common types which are all treated in much the same way, are:
There are other types of cancer that can develop in the nasopharynx, such as melanoma,| lymphoma| and sarcoma|. These are much rarer and are treated in different ways.
The exact cause of nasopharyngeal cancer is unknown. In some areas of the world, such as China and North Africa, dietary factors (such as the cooking of salt-cured fish and meat, which releases chemicals known as nitrosamines) are thought to increase a person's risk of developing the disease.
The Epstein-Barr virus (which causes glandular fever) has also been linked to an increased risk of developing nasopharyngeal cancer. As with other cancers, nasopharyngeal cancer is not infectious and can't be passed on to other people.
One of the first symptoms is often a painless swelling or lump in the upper neck. Other symptoms may include any of the following:
These symptoms are common in conditions other than cancer and most people with these symptoms will not have nasopharyngeal cancer. However, like most cancers, nasopharyngeal cancer is best treated when diagnosed at an early stage, and you should therefore report any of the above symptoms to your GP if they do not improve after a few days.
Your GP will examine your mouth, throat and ears. They will refer you to a hospital for any further tests and for specialist advice and treatment.
The specialist will examine your nasopharynx by using a very thin, flexible tube with a light at the end (nasendoscope). The tube will be passed into your nostril in order to get a better view of the back of the nose. This can be uncomfortable and you may be given a local anaesthetic spray to numb your nose and throat. If you do have a local anaesthetic to your throat, you may be told not to eat or drink anything for about an hour afterwards, or until your throat has lost the numb feeling.
In order to make a diagnosis, a piece of affected tissue will be removed and then examined under a microscope (this is called a biopsy). This is performed under a general anaesthetic, and you may need to spend the night in hospital.
You may have blood tests and a chest x-ray to check your general health. There are several other tests that may be used to help diagnose nasopharyngeal cancer, and to check whether or not the cancer has spread. Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body's defence against infection and disease. The system is made up of a network of lymph nodes or glands that are linked by fine ducts containing lymph fluid.
The results of these tests will help the specialist to decide on the best type of treatment for you.
This test uses magnetism to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan.
Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones.
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10–30 minutes. It may be used to identify the exact site of the tumour, or to check if the cancer has spread. CT scans use a small amount of radiation, which is very unlikely to harm you and won't harm anyone you come into contact with.
You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it's important to let your doctor know beforehand.
This is a test that shows up any abnormal areas of bone. A very small amount of a mildly radioactive substance is injected into a vein, usually in the arm.
About 2–3 hours later, a scan is taken of the whole body. As abnormal bone absorbs more of the radioactive substance than normal bone, any abnormal areas show up on the scan as highlighted areas (sometimes known as hot spots).
This scan won't make you radioactive, and it is perfectly safe for you to be with other people afterwards.
The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment for you.
The most commonly used staging system is called the TNM system:
The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue. The exact details of the T, N and M will depend on the type of cancer.
In addition to TNM staging, you’ll probably hear the doctors use a number staging system. There are usually three or four number stages for each cancer type.
Stage 1 describes a cancer at an early stage when it is usually small in size and hasn’t spread, whereas stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in between these stages.
The number stages are made up of different combinations of the TNM stages. So a stage 1 cancer may be described as either T1, N0, M0 or T2, N0, M0.
Number stages may also be further subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer might differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.
In the last few years, staging systems have become increasingly complex and they now describe the size and spread of different types of cancer in much greater detail. This can be very helpful in planning the details of treatment or predicting outcomes.
However, doctors will often use a much simpler approach when talking about staging. They might use words like ‘early’ or ‘local’ if the cancer hasn't spread, ‘locally advanced’ if it has begun to spread into surrounding tissues or nearby lymph nodes, or ‘advanced’ or ‘widespread’ if it has spread to other parts of the body. Your doctors can give you more information about the stage of your particular cancer.
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop.
Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.
The treatment you have for your nasopharyngeal cancer will depend on the type and stage of your cancer.
Radiotherapy| is the main treatment for nasopharyngeal cancer. As well as treating the tumour, radiotherapy will usually be given to the lymph nodes in the neck.
Radiotherapy treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal tissue. The radiotherapy is usually given to the lymph glands in the neck as well as the nasopharyngeal area.
External radiotherapy is the most common type of radiotherapy used to treat cancer of the nasopharynx. Occasionally, internal radiotherapy is used.
External radiotherapy is given from a radiotherapy machine, much like an x-ray machine. Occasionally, specialised techniques are used such as stereotactic radiotherapy. With this technique, radiation is directed at the tumour from many different angles so that the dose going to the tumour is very high. It can sometimes be used to treat a small area of recurrence (when the cancer has come back) in the nasopharynx. This treatment is only available in some specialist hospitals.
Internal radiotherapy is given by placing radioactive metal needles or wires close to the tumour while you are under a general anaesthetic. After a few days the needles or wires are removed.
Radiotherapy to the nasopharynx can cause the salivary glands to produce less saliva, so it is important to keep your mouth clean. Your doctors and nurses will tell you how to do this.
If you have a dry mouth| it is important to see a dentist regularly. It is best not to have teeth taken out after radiotherapy to this area, but if it's necessary to have a tooth removed, it should be done by a hospital specialist.
Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy is often given in combination with radiotherapy for more advanced-stage cancers that haven't spread to other parts of the body. This is also known as chemoradiation. Chemotherapy may also be given if the cancer has spread to other parts of the body.
You may be offered chemotherapy as part of a research trials|. Before any trial is allowed to take place it must have been approved by the ethics committee, which checks that the trial is in the interest of patients. Your doctor must discuss this treatment with you so that you have a full understanding of the trial and what it involves.
You may decide not to take part, or withdraw from a trial at any stage.
Occasionally, the doctor may recommend surgery| after the radiotherapy treatment, to remove any affected lymph nodes in the neck that may still contain cancer cells. There is a network of lymph nodes (or glands) throughout the body that form part of the body's natural defence against infection. The lymph nodes are connected by a network of tiny tubes known as lymph vessels.
Surgery may also be used to remove the tumour if it comes back in the lymph nodes in the neck.
After your treatment is completed, you'll have regular check-ups and possibly scans or x-rays. These will probably continue for several years. If you have any problems or notice any new symptoms between these appointments, let your doctor know as soon as possible.
You are likely to experience a number of different emotions|, from shock and disbelief to fear and anger. These feelings may be overwhelming and difficult to control, particularly if you have experienced changes in your appearance because of surgery, and feel self-conscious. These feelings are natural and it is important for you to be able to express them.
Each individual has their own way of coping with difficult situations; some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope.
You can talk to your doctor or specialist nurse about how you're feeling. They may be able to refer you to a trained counsellor who can listen and help you deal with difficult emotions. Our cancer support specialists can also give you information about where to get counselling.
This section has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.