What is nasopharyngeal cancer?

Nasopharyngeal cancer is sometimes called nasopharyngeal carcinoma or cancer of the post-nasal space. It is a type of head and neck cancer that develops in the nasopharynx.

The nasopharynx is the upper part of the throat (pharynx) at the back of the nose (or nasal cavity). 'Naso' means nose and the 'pharynx' is the throat. The nasopharynx allows air to flow from the nose, through the rest of the pharynx, larynx and trachea (windpipe) and into the lungs.

We have separate information about types of cancer that develops in other areas of the throat such as the oropharynx (oropharyngeal cancer) or hypopharynx.


Cross-section of the head and neck
Image: Cross-section of the head and neck


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Symptoms of nasopharyngeal cancer

The symptoms of nasopharyngeal cancer can include:

  • a painless swelling or lump in the upper neck – this is often the first symptom
  • changes in hearing
  • earache
  • fluid leaking from the ear
  • a blocked nose
  • nosebleeds
  • a headache.

With certain symptoms your GP should refer you to see a specialist within 2 weeks. This includes having a lump in the neck that does not go away.

All these symptoms can often be caused by other conditions. But it is important to have them checked by your doctor. Nasopharyngeal cancer can be treated more successfully when it is diagnosed early.

We have more information about the symptoms of head and neck cancer.

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Causes and risk factors of nasopharyngeal cancer

The exact cause of nasopharyngeal is not known. But there are risk factors that can increase the chances of developing it.

The most common risk factor for nasopharyngeal cancer is a virus called the Epstein-Barr virus (EBV). This virus causes glandular fever. Almost everyone is infected with EBV at some time during their life. The body’s immune system is normally able to get rid of the virus, and usually the infections do not cause any problems.

Only a very small number of people who have had EBV develop nasopharyngeal cancer. Most people with EBV will not develop nasopharyngeal cancer.

As with other cancers, nasopharyngeal cancer is not infectious and cannot be passed on to other people.

We have more information about the causes and risk factors of head and neck cancers.

Diagnosis of nasopharyngeal cancer

You usually start by seeing your GP. If they think your symptoms could be linked to cancer, they will refer you to a specialist doctor. You will usually see a specialist within 2 weeks. You may see an ear, nose and throat (ENT) specialist.

If your only symptom is a lump in your neck, you may be referred to a hospital that has a neck lump clinic.

The specialist doctor will ask about your symptoms and general health.

You may have some of the following tests.

A nasendoscope is a thin, flexible tube with a light and camera on the end. It allows your doctor to look inside your nose, the back of your nose and your throat.

To make a diagnosis your doctor needs to remove a small piece of tissue or some cells (biopsy) from the area that looks abnormal. Your doctor may take a biopsy while they are examining you with the nasendoscope. Or they might arrange for you to have a general anaesthetic to take the biopsy.

A doctor who specialises in analysing cells (pathologist) looks at the sample under a microscope to check for cancer cells.

Ultrasound scan of the neck
If you have a lump or a swelling in your neck you usually have an ultrasound scan of the area. This uses soundwaves to produce a picture of your neck and nearby lymph nodes.

Fine needle aspiration (FNA) of the lymph nodes
You may have a fine needle aspiration test to see whether there are any cancer cells in the lymph nodes in the neck. The doctor passes a fine needle into the lump. They withdraw (aspirate) some cells into the syringe. Sometimes they use an ultrasound scan to help the doctor to guide the needle into the correct area.

We have more information about tests for head and neck cancer.

Further tests for nasopharyngeal cancer

Your specialist may arrange further tests. These may help diagnose nasopharyngeal cancer or be used to check the size of the cancer and whether it has spread (staging).

  • CT scan

    A CT scan takes a series of x-rays, which build up a three-dimensional (3D) picture of the head and neck.

  • MRI scan

    An MRI scan ses magnetism to build up a detailed picture of the head and neck.

  • PET-CT scan

    A PET-CT scan gives more detailed information about the part of the body being scanned.

  • Testing for the Epstein-Barrvirus (EBV)

    If you have nasopharyngeal cancer, you may have tests on the cancer cells to see if it is linked to the Epstein-Barr virus (EBV). This virus causes glandular fever. Almost everyone is infected with EBV at some time during their life. The body’s immune system is normally able to get rid of the virus, and usually the infections do not cause any problems.

    Only a very small number of people who have had EBV develop nasopharyngeal cancer. Most people with EBV will not develop nasopharyngeal cancer.

Waiting for test results can be a difficult time. We have more information that can help.

Staging and grading of nasopharyngeal cancer

The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging. The grade of the cancer gives an idea how quickly it may develop.

Knowing the stage and grade of the cancer helps doctors plan the best treatment for you.

The staging systems most often used for nasopharyngeal cancer are the TNM and number staging systems.

TNM staging system

TNM stands for tumour, node and metastases.

Tumour (T)

T describes the size of the tumour and where the tumour is in the nasopharynx, nose and throat. It also describes whether it has grown into nearby tissues, such as bones, nerves or muscles. It is numbered between 0 and 4.

  • T0 means there are no signs of a tumour, but there may be abnormal cells that are pre-cancerous. Or, there are lymph nodes in the neck contain cancer cells that test positive for the Epstein Barr virus.
  • T1 the tumour is only in the nasopharynx and the nose, or back of the throat (oropharynx).
  • T2 the tumour has spread further into the surrounding tissue or muscle.
  • T3 the tumour is larger and has spread to structures around the nasopharynx, including the sinuses and bone at the base of the skull.
  • T4 the tumour has grown further into nearby nerves, bones, muscles or other areas of the skull.

Nodes (N)

N describes whether the cancer has spread to the lymph nodes.

Metastases (M)

M describes whether the cancer has spread to another part of the body (called metastatic cancer).

The number staging system combines all the information from TNM staging and gives it a number from 1 to 4. You can read more about this in our information about staging and grading of head and neck cancer.

Grading of nasopharyngeal cancer

A doctor looks at a sample of the cancer cells under a microscope to find out the grade of the cancer. Nasopharyngeal cancer is graded 1 to 4. You can read more about this in our information about staging and grading of head and neck cancer.

Treatment for nasopharyngeal cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your cancer doctor or specialist nurse will explain the different treatments, any possible side effects and the support you have. They will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment.

You will also usually be given advice about preparing for your treatment (sometimes called prehabilitation). This helps to improve your fitness and diet and help to get you ready mentally before treatment. If you smoke, it can also help you with stopping smoking.

Treatment for nasopharyngeal cancer may include:

  • Radiotherapy

    Radiotherapy uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. This is usually the main treatment for nasopharyngeal cancer.

    If you have stage 1 (early stage) nasopharyngeal cancer, you may have radiotherapy on its own. If you have locally advanced nasopharyngeal cancer, you usually have radiotherapy with chemotherapy (chemoradiation).

    Radiotherapy is also usually given to the lymph nodes in the neck, even if there are no signs of cancer there. This is because it’s possible there still may be some cancer cells in these neck lymph nodes. Radiotherapy is used to reduce the risk of the cancer coming back in this area.

    The type of radiotherapy usually used is called intensity-modulated radiotherapy (IMRT). Less commonly, another type of radiotherapy is called stereotactic radiotherapy may be used. You may only need 1 session of treatment of this type of radiotherapy.

    Radiotherapy may also be used to control symptoms if the cancer has spread to other parts of the body.

    You may have side effects during and for a few weeks after radiotherapy. These usually get better slowly after treatment finishes.

  • Chemoradiation

    Chemoradiation is when you have chemotherapy and radiotherapy together. Chemotherapy can make the cancer cells more sensitive to radiotherapy treatment. If you have locally advanced nasopharyngeal cancer, chemoradiation is usually the main treatment.

  • Chemotherapy

    Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is usually given with radiotherapy for nasopharyngeal cancer.

    Sometimes you may have chemotherapy on its own to shrink a tumour before having chemoradiation treatment.

    Chemotherapy may also be given if the cancer has come back or spread to other parts of the body.

    The chemotherapy drug cisplatin is most commonly used with radiotherapy to treat nasopharyngeal cancer. Cisplatin is sometimes used with other chemotherapy drugs, such as fluorouracil (5FU) or gemcitabine (Gemzar).

  • Surgery

    Surgery is sometimes used to remove cancer that comes back, or that or has not completely gone with chemoradiation or radiotherapy treatment. Surgery may also be used to remove the neck lymph nodes.

You may have some treatments as part of a clinical trial.

After nasopharyngeal cancer treatment

You will have regular follow-up appointments after treatment. These may continue for several years. You may also have regular follow-up appointments with a speech and language therapist (SLT), dietitian, restorative dentist and dental hygienist.

If you have any problems or notice new symptoms between appointments, let your doctor know as soon as possible.

Long-term or late effects

Some treatment side effects may take a long time to improve after treatment finishes, or they may become permanent. These are called long-term effects. Other side effects can develop months or even years after treatment has finished. These are known as late effects. We have more information about long-term and long-term and late effects of head and neck cancer treatment.

Sex life

Head and neck cancer and its treatment can sometimes have an effect on your sex life.

If you are worried about this, talk to your doctor or nurse. You can read about things that may help in our information on cancer and sex.


Some cancer treatments can also affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

We have more information about:

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes during and after treatment. For example, if you smoke or drink alcohol, it is best to avoid smoking or reduce the amount of alcohol.

Eating well and keeping active can improve your health and well-being. It can also help your body recover. Your dietitian can help with any difficulties you might have with eating after treatment.

Getting support

It may take several months to recover from treatment. It can be hard if treatment has changed your appearance, how you eat or drink, or your voice. This may also affect your body image but there are ways to help you to manage any changes.

You may still be coping with difficult feelings. Talking to your family and friends or health professionals about how you feel can help them know how to support your well-being.

There are also national support groups that you may find helpful:

  • The Mouth Cancer Foundation
    The Mouth Cancer Foundation
    gives information and support to people affected by head and neck cancers.
  • Changing Faces
    Changing Faces
    offers advice and information to anyone who is affected by a change in their appearance.
  • The Swallows Head and Neck Cancer Support Group
    The Swallows
    offers a 24-hour support line to anyone affected by head and neck cancer.
  • Salivary Gland Cancer UK
    Salivary Gland Cancer UK supports people with rare salivary gland cancers, such as adenoid cystic carcinoma, ACC, and unknown carcinoma.

Macmillan is also here to support you. If you would like to talk, you can:

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About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Reviewed: 01 March 2022
Reviewed: 01/03/2022
Next review: 01 March 2025
Next review: 01/03/2025