Nasopharyngeal Cancer

What is nasopharyngeal cancer?

Nasopharyngeal cancer (NPC), also known as nasopharyngeal carcinoma, is a rare type of head and neck cancer.

It affects the tissue that connects the back of your nose to the back of your mouth. This area is called the nasopharynx, and it’s located just above the roof of your mouth, at the base of your skull. When you breathe in through your nose, air flows through your nose, nasopharynx and into your throat before it reaches your lungs.

Nasopharyngeal cancer begins when abnormal cells in your nasopharynx start to grow out of control and form cancerous tumors that can spread to your lymph nodes, liver, lungs and bones.

Types of nasopharyngeal cancer

There are different kinds of tissue in your nasopharynx, and each kind contains different types of cells. Each cell type looks different when viewed under a microscope. Nasopharyngeal cancer subtypes are classified by the type of cell affected. According to the World Health Organization (WHO), NPC is classified into three subtypes:

• Keratinizing squamous cell carcinoma (WHO type 1): Cancer cells in the tissue lining your nasopharynx that are covered with keratin. Keratin is a protein in your hair and nails.
• Nonkeratinizing squamous cell carcinoma (WHO type 2): Cancer cells in nasopharynx tissues that aren’t covered with keratin.
• Undifferentiated or poorly differentiated carcinoma, including lymphoepithelioma and anaplastic variants (WHO type 3): These are cancer cells that look very different from healthy cells when viewed under a microscope. Poorly differentiated or undifferentiated cancer cells grow and spread very quickly.

Is nasopharyngeal cancer common?

It’s rare in the U.S., affecting 1 out of 100,000 people each year. Nasopharyngeal cancer is more common in Asia, North Africa and the Middle East. Nasopharyngeal cancer in the U.S. typically affects people ages 15 to 24 and ages 65 to 79.

What are symptoms of nasopharyngeal cancer?

In most cases, people with nasopharyngeal cancer notice a lump on the back of their neck. There may be one or multiple lumps, and they’re usually not painful. These masses appear when cancer spreads to the lymph nodes in your neck and causes them to swell.

There are also several other warning signs such as:

• Tinnitus, or ringing in your ears.
• Hearing loss.
• A feeling of fullness in your ears.
• Ear infections that won’t go away.
• Headaches.
• Stuffy nose.
• Nosebleeds.
• Difficulty opening your mouth.
• Facial pain.
• Facial numbness.
• Difficulty breathing or speaking.

Many nasopharyngeal cancer symptoms are like symptoms of other, less serious illnesses. Having one or more of these symptoms doesn’t mean you have nasopharyngeal cancer. But you should talk to a healthcare provider if you have symptoms that last for more than two weeks or they keep coming back.

What causes nasopharyngeal cancer?

Experts aren’t exactly sure what causes nasopharyngeal cancer. However, certain lifestyle behaviors and medical conditions can increase your chance of developing the disease, including:

• Heavy smoking, or using any tobacco product.
• Frequent and heavy consumption of beverages that contain alcohol.
• Having Epstein-Barr virus (EBV). This is the same virus that causes mononucleosis. EBV is common in people diagnosed with nasopharyngeal cancer.
• Regularly eating salt-cured foods. People who eat diets rich in salt-cured meat and fish have a higher chance of developing nasopharyngeal cancer.
• Being exposed to lots of dust and smoke may increase risk.
• Having a family history. If you have a family member with nasopharyngeal cancer, you’re more likely to develop the condition.
• Race. Nasopharyngeal cancer is more common in people living in Southeast Asia, southern China and northern Africa. People who’ve immigrated to the U.S. from Asia also have a higher risk compared to American-born Asians.
• Sex. Men and people assigned male at birth (AMAB) are about three times more likely to develop this cancer than women and people assigned female at birth (AFAB).

How is nasopharyngeal cancer diagnosed?

If your healthcare provider thinks that you may have nasopharyngeal cancer, they’ll ask about your family history and do a full physical exam. They’ll examine your nasopharynx, head, neck, mouth, throat, nose, facial muscles and lymph nodes. They may do a hearing test. Other tests may include:

• Epstein-Barr virus test. (Because nasopharyngeal cancer is often linked to the Epstein-Barr virus, you’ll be tested to measure the amount of EBV virus in your blood.)
• Biopsy.
• Computed tomography (CT) scan.
• Magnetic resonance imaging (MRI) scan.
• Positron emission tomography (PET) scan.

Providers use test results to stage nasopharyngeal cancer. Cancer staging systems help providers plan treatment and estimate prognosis.

What are the stages of nasopharyngeal cancer?

Nasopharyngeal cancer staging is determined by several factors, including the size and location of the tumor and how far the cancer cells have spread.

• Stage 0: Cancer only affects the top layer of cells inside your nasopharynx.
• Stage 1: The tumor has grown into nearby structures, such as the back of your throat or your nasal cavity.
• Stage 2: Cancer has spread to one or more lymph nodes on one side of your neck.
• Stage 3: Cancer has spread to lymph nodes on both sides of your neck.
• Stage 4: The tumor has spread to your skull, eye, cranial nerves, salivary glands or lower part of your throat. It may have spread to more distant areas of your body like your lungs or liver.

What are treatments for nasopharyngeal cancer?

Specific treatment depends on the stage of cancer. Nasopharyngeal cancer treatment may include:

• Radiation therapy.
• Chemotherapy.
• Chemoradiation (combination of chemotherapy and radiation).
• Targeted therapy.
• Surgery. In some instances, the tumor can be surgically removed. But because the nasopharynx is a difficult area to operate on, surgery usually isn’t the main treatment option. However, surgery is sometimes used to remove lymph nodes in your neck that haven’t responded to other treatments.

What are treatment side effects?

Healthcare providers typically treat nasopharyngeal with radiation therapy or chemotherapy. Radiation and chemotherapy side effects may vary. If you’re being treated for nasopharyngeal cancer, you may want to consider palliative care to help you manage treatment side effects.

Is nasopharyngeal cancer curable?

NPC can be cured if healthcare providers diagnose the condition before it spreads.

What is the survival rate for nasopharyngeal cancer?

Data kept by the American Cancer Society show 63% of people with nasopharyngeal cancer in the U.S. were alive five years after diagnosis. Like many cancer types, NPC survival rates improve if cancer is diagnosed before it can spread:

• Local: An estimated 82% of people with local nasopharyngeal cancer were alive five years after diagnosis. Local NPC is cancer that hasn’t spread to other areas of your body.
• Regional disease: An estimated 72% of people with regional nasopharyngeal cancer were alive five years after diagnosis. This is cancer in nearby lymph nodes, tissues and organs.
• Metastatic disease: An estimated 49% of people with cancer that’s spread (metastasized) to more distant organs were alive five years after diagnosis.

Survival rates are estimates based on the experiences of other people who have the same kind of cancer. Many factors affect survival rates, including a person’s age, overall health and how well they respond to treatment.

If you have nasopharyngeal cancer, it’s important to remember that your experience may be different from other people’s experiences. Ask your healthcare provider what you can expect given your situation.

How do I take care of myself?

Your healthcare provider can help you find ways to manage your symptoms, relieve pain and improve your overall quality of life. Recommendations often include:

• Eating a healthy, well-balanced diet.
• Practicing mindfulness or meditation.
• Joining a local support group.

What questions should I ask my healthcare provider?

If you’ve been diagnosed with nasopharyngeal cancer, gaining a full understanding of your situation can empower you and help you make informed decisions about your health. Here are some questions to ask your healthcare provider:

• Has the cancer spread to other areas of my body?
• What stage of nasopharyngeal cancer do I have?
• What are my treatment options?
• What side effects are possible from treatment?
• Can treatment cure my cancer?
• How long will my treatment last?
• What are the chances that my cancer will come back?
• What will my follow-up care involve?

A note from Cleveland Clinic

Nasopharyngeal cancer is a rare type of head and neck cancer. Experts aren’t sure why it happens, but they believe heavy use of tobacco and beverages containing alcohol increases a person’s risk. They also believe having a biological family history of the condition may play a role. Talk to a healthcare provider if you’re concerned you may be at risk. They’ll evaluate your overall health, assess your risk and suggest ways you can reduce it.