(http://www.cancer.

org/Cancer/NasopharyngealCancer/DetailedGuide)

What is nasopharyngeal cancer?

Nasopharyngeal cancer develops in the nasopharynx, an area in the back of the nose toward 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 1 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 entrance into 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 occur in children and young adults. They include
tumors or malformations of the vascular (blood-carrying) system, such as angiofibromas and hemangiomas, and
benign tumors of the minor salivary glands that are found within the nasopharynx. Treatment of these tumors (if
it is needed) is different from that for cancerous nasopharyngeal tumors and is not discussed 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.
Malignant nasopharyngeal tumors
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:
Keratinizing squamous cell carcinoma
Non-keratinizing differentiated carcinoma
 Undifferentiated carcinoma
Each of these types is more common in some areas of the world than in others. Most NPC in the United States
is the keratinizing type. In Southeast Asia, where NPC is much more common, most cases are the
undifferentiated type.
These types look different when seen under a microscope, but studies have shown they start from the same cell
type -- the epithelial cells that cover the surface lining of the nasopharynx. The treatment is also usually the
same for all types of nasopharyngeal cancer. 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 nasopharyngeal carcinomas also contain lots of immune system cells, especially lymphocytes. The term
lymphoepithelioma is sometimes used to describe an 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 from the tissues that make up the
nasopharynx.
Lymphomas can sometimes start in the nasopharynx. They are cancers of immune system cells called
lymphocytes, cells that are normally found 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 found
in the nasopharynx, but they are more commonly found in the nasal or oral cavities. More information on these
cancers can be found in our documents, Oral Cavity and Oropharyngeal Cancer, Nasal Cavity and Paranasal
Sinuses Cancer, and Salivary Gland Cancer.

(http://www.medicinenet.com/nasopharyngeal_cancer/article.htm)

Nasopharyngeal Cancer
Definition
Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the
nasopharynx.
The nasopharynx is the upper part of the pharynx (throat) behind the nose. The pharynx is a hollow tube about 5
inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that
goes from the throat to the stomach). Air and food pass through the pharynx on the way to the trachea or the
esophagus. The nostrils lead into the nasopharynx. An opening on each side of the nasopharynx leads into an
ear. Nasopharyngeal cancer most commonly starts in the squamous cells that line the oropharynx (the part of the
throat behind the mouth).

Epidemiology
Ethnic background and exposure to the Epstein-Barr virus can affect the risk of developing
nasopharyngeal cancer.
Anything that increases your risk of getting a disease is called a risk factor. Risk factors may include the
following:
Chinese or Asian ancestry.
Exposure to the Epstein-Barr virus: The Epstein-Barr virus has been associated with certain cancers,
including nasopharyngeal cancer and some lymphomas.

Signs
Possible signs of nasopharyngeal cancer include trouble breathing, speaking, or hearing.
These and other symptoms may be caused by nasopharyngeal cancer. Other conditions may cause the same
symptoms. A doctor should be consulted if any of the following problems occur:
A lump in the nose or neck. Nosebleeds.
A sore throat. Trouble hearing.
Trouble breathing or speaking. Pain or ringing in the ear.
 Headaches.

Diagnosis
Tests that examine the nose and throat are used to detect (find) and diagnose nasopharyngeal cancer.
The following tests and procedures may be used:
Physical exam of the throat: An exam in which the doctor feels for swollen lymph nodes in the neck and
looks down the throat with a small, long-handled mirror to check for abnormal areas.
Nasoscopy: A procedure to look inside the nose for abnormal areas. A nasoscope is inserted through the
nose. A nasoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a
tool to remove tissue samples, which are checked under a microscope for signs of cancer.
Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function.
The exam checks a person's mental status, coordination, and ability to walk normally, and how well the
muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
Head and chest x-rays: An x-ray of the skull and organs and bones inside the chest. An x-ray is a type of
energy beam that can go through the body and onto film, making a picture of areas inside the body.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to
make a series of detailed pictures of areas inside the body. This procedure is also called nuclear
magnetic resonance imaging (NMRI).
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken
from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be
injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is
also called computed tomography, computerized tomography, or computerized axial tomography.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body.
A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around
the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up
brighter in the picture because they are more active and take up more glucose than normal cells do. PET
scans may be used to find nasopharyngeal cancers that have spread to the bone.
Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the
body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to
check for signs of cancer.

Prognosis
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
The stage of the cancer (whether it affects part of the nasopharynx, involves the whole nasopharynx, or
has spread to other places in the body).
The type of nasopharyngeal cancer.
The size of the tumor.
The patient's age and general health.
After nasopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread
within the nasopharynx or to other parts of the body.
The process used to find out whether cancer has spread within the nasopharynx or to other parts of the body is
called staging. The information gathered from the staging process determines the stage of the disease. It is
important to know the stage in order to plan treatment. The results of the tests used to diagnose nasopharyngeal
cancer are often also used to stage the disease.
The following stages are used for nasopharyngeal cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the lining of the nasopharynx. These abnormal cells may become cancer
and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed and is found in the nasopharynx only.
Stage II
Stage II nasopharyngeal cancer is divided into stage IIA and stage IIB as follows:
Stage IIA: Cancer has spread from the nasopharynx to the oropharynx (the middle part of the throat that
includes the soft palate, the base of the tongue, and the tonsils), and/or to the nasal cavity.
Stage IIB: Cancer is found in the nasopharynx and has spread to lymph nodes on one side of the neck, or
has spread to the area surrounding the nasopharynx and may have spread to lymph nodes on one side of
the neck. The involved lymph nodes are 6 centimeters or smaller.
Stage III
In stage III nasopharyngeal cancer, the cancer:
is found in the nasopharynx and has spread to lymph nodes on both sides of the neck and the lymph
nodes are 6 centimeters or smaller; or
has spread into the soft tissues (oropharynx and/or nasal cavity) and to lymph nodes on both sides of the
neck and the lymph nodes are 6 centimeters or smaller; or
has spread beyond the soft tissues into areas around the pharynx and to lymph nodes on both sides of the
neck and the lymph nodes are 6 centimeters or smaller; or
has spread to nearby bones or sinuses and may have spread to lymph nodes on one or both sides of the
neck and the involved lymph nodes are 6 centimeters or smaller.
Stage IV
Stage IV nasopharyngeal cancer is divided into stage IVA, stage IVB, and stage IVC as follows:
Stage IVA: Cancer has spread beyond the nasopharynx and may have spread to the cranial nerves, the
hypopharynx (bottom part of the throat), areas in and around the side of the skull or jawbone, and/or the
bone around the eye. Cancer may also have spread to lymph nodes on one or both sides of the neck, and
the involved lymph nodes are 6 centimeters or smaller.
Stage IVB: Cancer has spread to lymph nodes above the collarbone and/or the involved lymph nodes are
larger than 6 centimeters.
Stage IVC: Cancer has spread beyond nearby lymph nodes to other parts of the body.
Recurrent Nasopharyngeal Cancer
Recurrent nasopharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer
may come back in the nasopharynx or in other parts of the body.

Treatment
There are different types of treatment for patients with nasopharyngeal cancer.
Different types of treatment are available for patients with nasopharyngeal cancer. Some treatments are standard
(the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients
may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help
improve current treatments or obtain information on new treatments for patients with cancer. When clinical
trials show that a new treatment is better than the standard treatment, the new treatment may become the
standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is
available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally
involves the patient, family, and health care team.
Three types of standard treatment are used:
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer
cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a
machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive
substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way
the radiation therapy is given depends on the type and stage of the cancer being treated.
External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works.
The doctor may test the thyroid gland before and after therapy to make sure it is working properly. It is also
important that a dentist check the patient's teeth, gums, and mouth, and fix any existing problems before
radiation therapy begins.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells
or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the
drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When
chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the
drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given
depends on the type and stage of the cancer being treated.
Surgery
Surgery is a procedure to find out whether cancer is present, to remove cancer from the body, or to repair a
body part. Also called an operation. Surgery is sometimes used for nasopharyngeal cancer that does not respond
to radiation therapy. If cancer has spread to the lymph nodes, the doctor may remove lymph nodes and other
tissues in the neck.
New types of treatment are being tested in clinical trials. These include the following:
Biologic therapy
Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the
body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This
type of cancer treatment is also called biotherapy or immunotherapy.
Intensity-modulated radiation therapy
Intensity-modulated radiation therapy (IMRT) is a type of 3-dimensional radiation therapy that uses computer-
generated images to show the size and shape of the tumor.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every
new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Treatment Options by Stage

Stage I Nasopharyngeal Cancer
Treatment of stage I nasopharyngeal cancer is usually radiation therapy to the tumor and lymph nodes in the
neck.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
stage I nasopharyngeal cancer.
Stage II Nasopharyngeal Cancer
Treatment of stage II nasopharyngeal cancer may include the following:
Chemotherapy combined with radiation therapy.
Radiation therapy to the tumor and lymph nodes in the neck.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
stage II nasopharyngeal cancer.
Stage III Nasopharyngeal Cancer
Treatment of stage III nasopharyngeal cancer may include the following:
Chemotherapy combined with radiation therapy.
Radiation therapy to the tumor and lymph nodes in the neck.
Radiation therapy followed by surgery to remove cancer-containing lymph nodes in the neck that remain
or come back after radiation therapy.
A clinical trial of chemotherapy before, combined with, or after radiation therapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every
new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
stage III nasopharyngeal cancer.
Stage IV Nasopharyngeal Cancer
Treatment of stage IV nasopharyngeal cancer may include the following:
Chemotherapy combined with radiation therapy.
Radiation therapy to the tumor and lymph nodes in the neck.
 Radiation therapy followed by surgery to remove cancer-containing lymph nodes in the neck that remain
or come back after radiation therapy.
Chemotherapy for cancer that has metastasized (spread) to other parts of the body.
A clinical trial of chemotherapy before, combined with, or after radiation therapy.
A clinical trial of new radiation therapy such as intensity-modulated radiation therapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every
new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
stage IV nasopharyngeal cancer.
Treatment Options for Recurrent Nasopharyngeal Cancer
Treatment of recurrent nasopharyngeal cancer may include the following:
External radiation therapy plus internal radiation therapy.
Surgery.
Chemotherapy.
A clinical trial of biologic therapy and/or chemotherapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every
new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
recurrent nasopharyngeal cancer.