Nasopharyngeal cancer

The nasopharynx is the area that connects your nose to the back of your mouth. Symptoms of nasopharyngeal cancer include:

  • a painless swelling or lump in the upper neck
  • hearing changes
  • earache.

If you have symptoms, it is important to have them checked by your GP. They may refer you to a specialist for tests. These may include a test to examine your nose and throat closely. The doctor may also take a small sample of tissue (biopsy) to make a diagnosis.

The main treatment for nasopharyngeal cancer is radiotherapy. This uses high energy x-rays to treat the cancer. Sometimes chemotherapy is used. This uses drugs to destroy the cancer cells. Some people may have both treatments at the same time. Your doctor will discuss with you the best treatment for you.

Side effects of radiotherapy include:

  • a dry mouth
  • a sore mouth
  • thick saliva
  • difficulty eating
  • tiredness.

Your hospital team will tell you more about what to expect. There are lots of things that can help you manage side effects during and after treatment.

What is nasopharyngeal cancer?

Nasopharyngeal cancer is a type of head and neck cancer that develops in the nasopharynx. It is rare in the UK. It is more common in other parts of the world, such as East Asia.


The nasopharynx

The nasopharynx is the part of the throat at the back of the nose. ’Naso’ means nose and the ’pharynx‘ is the throat. The nasopharynx connects the nose to the back of the mouth (oropharynx). It lets you breathe through your nose and swallow mucus made in your nose.

The nasopharynx
The nasopharynx

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Causes and risk factors of nasopharyngeal cancer

The most common risk factor for nasopharyngeal cancer is an infection called Epstein-Barr virus (EBV), which causes glandular fever. As with other cancers, nasopharyngeal cancer is not infectious and cannot be passed on to other people.

EBV is very common. 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 infections do not cause any problems.

Most people with EBV will not develop nasopharyngeal cancer.


Symptoms of nasopharyngeal cancer

Often the first symptom of nasopharyngeal cancer is a painless swelling or lump in the upper neck.

Other common symptoms include:

  • changes in hearing
  • earache
  • fluid leaking from the ear
  • a blocked nose
  • nosebleeds
  • a headache.

These symptoms can often be caused by other conditions. But it is important to have them checked by your doctor.


How nasopharyngeal cancer is diagnosed

You usually start by seeing your GP.

They will refer you to a specialist doctor if:

  • they think that your symptoms could be caused by cancer
  • they are not sure what the problem is.

The specialist doctor will ask about your symptoms and general health. If your only symptom is a lump in your neck, you may be referred to a hospital that has a neck lump clinic.

You may have some of the following tests.

Nasendoscopy

You may have this test in the outpatient clinic. The doctor passes a thin, flexible tube called a nasendoscope into your nose, over the back of your tongue and down into the upper part of your throat. The tube has a light and camera at the end, to help the doctor get a better view of the inside of your nose and throat (nasopharynx). You might find this a bit uncomfortable, but it only takes about a minute.

Before the test, the doctor may numb your nose and throat with a local anaesthetic spray. Some people prefer to have this done without the anaesthetic spray. If you have this spray, do not eat or drink for about an hour afterwards, or until the numbness wears off. This is because there is a risk that food and drink may go down the wrong way into your lungs when you swallow. You could also burn your mouth or throat with hot food or drinks.

Biopsy

To make a diagnosis, your doctor needs to remove a small piece of tissue or some cells from the area that looks abnormal. This is called a biopsy. You usually have a general anaesthetic for this. You may need to spend the night in hospital. A doctor who specialises in analysing cells (pathologist) looks at the sample under a microscope. They check the sample for any cancer cells.

At the neck lump clinic

This is a one-stop clinic where you can have all the tests needed to check for cancer in a neck lump.

You will usually have an ultrasound scan and a sample of tissue taken from the lump using fine needle aspiration. You may also have a nasendoscopy here to look at your nose and throat.

The clinic may give you the results of your tests on the same day. But sometimes you may need to wait up to 7 to 10 days.

Ultrasound scan of the neck

This test uses sound waves to produce a picture of your neck and lymph nodes on a computer screen. Lymph nodes are part of the lymphatic system, which helps to protect us from infection and disease.

The scan is painless and only takes a few minutes. The doctor puts some gel onto your neck and moves a small device which produces sound waves over the area. They look for any changes in the size or appearance of the lymph nodes in your neck.

Fine needle aspiration (FNA) of the lymph nodes

You may have this test if the lymph nodes in your neck do not feel or look normal on a scan. It is done to see whether there are any cancer cells in the lymph nodes.

The doctor passes a fine needle into the lymph node. They withdraw (aspirate) some cells into a syringe. Sometimes the doctor uses an ultrasound scan to help guide the needle into the area.

The test might be uncomfortable, but it is very quick. You do not usually need a local anaesthetic to numb the area. It is common to have some bruising or soreness in the area the sample was taken from. The soreness may last for a week or so. Taking mild painkillers should help. Ask your nurse or doctor what they recommend.

After the test, a doctor who specialises in analysing cells (called a pathologist) will look at the sample under a microscope to check for cancer cells.

It’s hard to imagine how you will cope with the diagnosis of cancer. It has become a familiar word to all of us, but its meaning is highly personal.

Christine


Further tests for nasopharyngeal cancer

These tests may be used to help diagnose nasopharyngeal cancer and to check whether it has spread.

CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10 to 30 minutes and is painless. It uses a small amount of radiation. This is very unlikely to harm you and will not harm anyone you come into contact with. You may be asked not to eat or drink for at least four hours before the scan.

CT scan
CT scan

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You may be given an injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma. You could have a more serious reaction to the injection.

You will probably be able to go home as soon as the scan is over.

MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.

You should also tell your doctor if you have ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will 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. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

PET-CT scan

This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan. A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body.

PET-CT scans give more detailed information about the part of the body being scanned. You may have to travel to a specialist centre to have one. You cannot eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. You will wait for at least an hour before you have the scan. It usually takes 30 to 90 minutes. You should be able to go home after the scan.

Testing for viruses

If you have nasopharyngeal cancer, your doctor may do a test to see if it is linked to the Epstein-Barr virus (EBV). Knowing more about the type of the cancer helps doctors decide on the best treatment for you.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


Staging for nasopharyngeal cancer

The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage helps doctors decide on the best treatment for you.

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

TNM staging system

TNM stands for tumour, node and metastases

  • 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 depending on the size and extent of the tumour. T0 means that there are no signs of a tumour, but there may be abnormal cells that are pre-cancerous. A T1 tumour is only in the nasopharynx and the nose, or back of the throat (oropharynx). A T4 tumour has grown further into nearby nerves, bones or other areas of the skull.
  • N describes whether the cancer has spread to the lymph nodes. N0 means that no lymph nodes are affected. N1, N2 or N3 means that there are cancer cells in the neck lymph nodes. The number depends on how many lymph nodes contain cancer cells, the size and where they are.
  • M describes whether the cancer has spread to another part of the body. This is called met astatic cancer. M0 means the cancer has not spread. M1 means the cancer has spread to distant organs, such as the lungs or liver.

Number staging system

There are usually 3 or 4 number stages for each cancer type. Stage 1 describes a cancer at an early stage when it is usually small in size and has not spread. Stage 4 describes a cancer at a more advanced stage when it has usually spread to other parts of the body.

Your doctor can tell you more about the stage of your cancer.

Other terms used

Your doctor may use other terms to describe the stage of the cancer:

  • Early or local – a small cancer that has not spread.
  • Locally advanced – cancer that has started to spread into surrounding tissues or nearby lymph nodes, or both.
  • Local recurrence – cancer that has come back in the same area after treatment.
  • Secondary, advanced, widespread or metastatic – cancer that has spread to other parts of the body.


Grading

The grade of a cancer gives the doctors an idea of how quickly it may develop. Doctors will look at a sample of the cancer cells under a microscope to find the grade of the cancer.

  • Grade 1 or low grade – the cancer cells look like normal cells and usually grow slowly.
  • Grade 2 and 3 – the cancer cells look different to normal cells and are slightly faster growing.
  • Grade 4 or high grade – the cancer cells look very different to normal cells and may grow more quickly.


How nasopharyngeal cancer is treated

Your treatment depends on the stage and grade of the cancer, as well as your general health. Your specialist doctor or nurse will explain the best treatment for you and any side effects that are likely.

The main treatment for nasopharyngeal cancer is radiotherapy. For early-stage nasopharyngeal cancer, this may be the only treatment needed. If cancer has spread into areas around the nasopharynx, chemotherapy is often given with radiotherapy. This is called chemoradiation. Sometimes chemotherapy is given to shrink a tumour before chemoradiation. Chemotherapy and radiotherapy can also be given if the cancer has spread to other parts of the body.

Cancer that has come back in the nasopharynx or neck lymph nodes can be treated with one treatment, or a combination of treatments. These can include surgery, radiotherapy and chemotherapy.


Radiotherapy and chemoradiation for nasopharyngeal cancer

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells.

Radiotherapy is given on its own for stage 1 nasopharyngeal cancer, or with chemotherapy for more advanced cancers. Having chemoradiation is more effective than having chemotherapy or radiotherapy alone, but it can cause more severe side effects. It is important that you are well enough to cope with the side effects of having both treatments together.

Radiotherapy is also usually given to the lymph nodes in the neck, even if there are no signs of cancer there. This is to reduce the risk of the cancer coming back in this area.

Planning your radiotherapy treatment

To make sure that your radiotherapy is as effective as possible, it has to be carefully planned. Planning your treatment makes sure the radiotherapy is aimed precisely at the cancer, so it causes the least possible damage to the surrounding healthy tissue. The treatment is planned by a specialist doctor called a clinical oncologist.

You usually need to have a clear plastic mould or mask made before your treatment is planned. This helps keep your head in the same position for each session of radiotherapy. The mask should not be uncomfortable and does not affect your breathing. We have a video that shows how radiotherapy masks are made. If you are worried about the mask, let your radiotherapy team know so they can help.

Having radiotherapy

Radiotherapy is normally given as a series of short, daily outpatient treatments, over 5 to 7 weeks, with a rest at the weekend. Each treatment only takes a few minutes. If you are having radiotherapy to control symptoms such as pain, you might only need a few days of treatment or even just a single dose.

It is given in the radiotherapy department using equipment similar to a large x-ray machine. Radiotherapy only treats the area of the body the rays are aimed at. It does not make you radioactive.

There are different types of radiotherapy. The type of radiotherapy usually used is called intensity-modulated radiotherapy (IMRT). IMRT uses high-energy rays that are shaped very precisely to target the area of cancer. This means a higher dose of radiation is given to the tumour, and healthy areas nearby get a lower dose. This can reduce side effects.

Another way giving radiotherapy is called stereotactic radiotherapy. It uses many small beams of radiation to target the tumour. This delivers high doses of radiotherapy to very specific areas of the body, which can reduce side effects. You may only need 1 session of treatment.

The number of treatments you have depends on the aim of your treatment. Your doctor or nurse will tell you how many treatments you are likely to have.

Side effects of radiotherapy

You may have side effects during radiotherapy. These usually get better slowly over a few weeks or months after treatment finishes, but many people continue to have a dry mouth.

Some side effects develop later on after treatment finishes and can last longer. These are less common, but can happen months or even years after your treatment. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.

Sore or sensitive skin

The skin over your face and neck will gradually redden or darken, depending on your skin tone. It may also feel sore and itchy (a bit like sunburn). This starts after about 2 weeks of treatment and lasts for up to about 4 weeks after radiotherapy has finished.

When you wash your face and neck, it is very important to use only the soaps, creams and lotions that your radiotherapy team recommend. This is because chemicals in some products can make the skin more sensitive to radiation. Moisturisers need to be sodium lauryl sulphate (SLS) free. Your radiotherapy team can give you more information about how to care for your skin when you have radiotherapy and after you have finished treatment. They can also tell you when and how to use sun-protection cream after your treatment.

We have more information about skin care when you have radiotherapy to the head and neck area.

Sore mouth

It is important to look after your mouth during radiotherapy. Following a mouth care routine to keep your mouth clean helps prevent problems. Your mouth and throat may become sore after a couple of weeks of treatment. You may develop mouth ulcers. You might also find it difficult to speak, or notice changes to your sense of taste and smell. Eating food can become difficult and you may find it painful to swallow. Your doctor can prescribe medicines to help.

We have more information about coping with a sore mouth.

Dry mouth

Radiotherapy to the head and neck may reduce the amount of spit (saliva) you make. It can make the mouth and throat dry. This can affect eating, speaking and sleeping. It also makes you much more likely to have tooth decay. So it is really important to care for your teeth during and after treatment.

It helps to carry a bottle of water with you so you can take frequent sips of water. Or you could use a water spray instead. Artificial saliva can also help moisten your mouth and throat. It comes in different forms, such as gels, sprays, mouthwashes, pastilles or tablets. Your doctor or dentist can prescribe artificial saliva or you can buy it from a chemist.

We have more information about coping with a dry mouth.

Thick, sticky saliva (mucus)

Radiotherapy to the head and neck affects the salivary glands. Your saliva may become thicker, stringy and sticky. Your nose, mouth and throat may also feel dry. This can make eating and talking difficult.

Rinsing your mouth regularly can help with this. Your specialist head and neck team can give you advice on the type of mouth rinse that might be best for you to use. Sometimes a build-up of mucus can cause coughing, especially at night. Your nurse or doctor may prescribe a nebuliser to help to loosen the mucus. A nebuliser is a machine that changes a liquid medicine into a mist or fine spray. Your nurse or doctor can also prescribe mouthwashes, lozenges, artificial saliva sprays or gels to help.

Changes in the saliva usually get better within about 8 weeks of radiotherapy ending, but sometimes it continues for several months or longer.

Difficulty eating

If you find it hard to eat and drink because of any side effects, let your doctor or nurse know. They can give you advice and medications to help. They may refer you to a dietitian for more advice. You may need food supplements to add extra energy or protein to your diet. Some supplements can be used to replace meals, and others are used in addition to your normal diet. You can get some of these from your chemist or the supermarket. Your doctor, nurse or dietitian can also prescribe them for you.

Some people need to be fed through a tube if they cannot eat and are losing lots of weight. This is known as nutritional support or tube feeding. It is usually only done for a short time until treatment is finished and their swallowing is back to normal.

Tiredness

This is a common side effect that may last for a couple of months after treatment. Try to get plenty of rest and pace yourself. Balance this with some physical activity, such as short walks. This will give you more energy.

Late effects of radiotherapy

Your doctor, specialist nurse or radiographer can tell you whether your treatment may cause any late effects. They will also tell you what you can do to help reduce your risk of problems. And they can tell you what support is available.

Our general information about head and neck cancers has more information about:

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Chemotherapy for nasopharyngeal cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. For nasopharyngeal cancer, it is usually given with radiotherapy. Chemotherapy may also be given if the cancer has come back or spread to other parts of the body.

Cisplatin is the most common chemotherapy drug used with radiotherapy to treat nasopharyngeal cancer. Other drugs are sometimes given with cisplatin, such as fluorouracil (5FU) or gemcitabine (Gemzar®). These drugs are given into a vein by infusion (drip).

Chemotherapy is usually given as several sessions of treatment, called treatment cycles. Each treatment cycle is followed by a rest period, to give the body time to recover.

Side effects of chemotherapy

The side effects depend on the drug or combination of drugs you are given. Your doctor or nurse will explain the treatment you are offered and what to expect.

Chemotherapy can reduce the number of white blood cells in the blood during treatment. This makes you more likely to get an infection. Your doctor or nurse will give you advice about what to do if this happens.

Chemotherapy can also cause other side effects, such as:

  • feeling tired
  • a sore mouth
  • feeling sick (nausea) or being sick (vomiting)
  • diarrhoea
  • hair loss.

Let your doctor or nurse know about any side effects during treatment. They can often give you advice and help to reduce these.

We have more information about coping with the side effects of chemotherapy and about different chemotherapy drugs.

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Surgery for nasopharyngeal cancer

Sometimes surgery is used to remove cancer that comes back or that is left behind after the radiotherapy or chemoradiation.

The surgeon aims to remove as much of the cancer as possible from the nasopharynx or the neck lymph nodes, or both. They will explain what to expect and what support is available.

You can read more in our general information about head and neck cancers.


Clinical trials for nasopharyngeal cancer

Cancer research trials are done to try to find new and better treatments for cancer. Trials that are done on patients are known as clinical trials.

Research into treatments for nasopharyngeal cancer is ongoing. But because nasopharyngeal cancer is rare, there may not always be a relevant trial in progress. If there is, you may be asked to take part. Your doctor must discuss the treatment with you, so you fully understand the trial and what it means to take part. You can decide not to take part, or to withdraw from a trial at any stage. You will still receive the best standard treatment available.


Follow-up after treatment

After your treatment finishes, you will have regular check-ups and tests. 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.


Your feelings

For some people, it takes several months to recover from treatment. It can be hard to cope if treatment has changed your appearance, voice or how you eat and drink.

It is common to feel overwhelmed by different feelings. For example, you may feel shocked, scared, upset or angry. Everyone has their own way of coping. But it is important to be able to express how you feel.

Some people find that it helps to share their feelings with family or friends. Others get help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope. But remember that help is available if you need it.

You might want to join a local cancer support group. Meeting other people in a similar situation and sharing your experience may help you feel less alone. You can ask your specialist nurse if there are any local support groups in your area.

If you are finding it difficult to talk, our Online Community (community.macmillan.org.uk) is also a good place to meet people who may be in a similar situation.

There are national support groups that you may find helpful:

  • Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
  • Changing Faces offers advice and information to anyone who is affected by a change in their appearance.

You may also want to talk to our cancer support specialists. Call us free on 0808 808 00 00 (Monday to Friday, 9am to 8pm).

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