Nasopharyngeal cancer

Nasopharyngeal cancer is a rare type of cancer that affects the part of the throat (pharynx) connecting the back of the nose to the back of the mouth.

Only about 240 people are diagnosed with nasopharyngeal cancer each year in the UK.

Nasopharyngeal cancer should not be confused with other types of cancer that also affect the throat, such as laryngeal (larynx) cancer and oesophageal cancer.

Signs and symptoms of nasopharyngeal cancer

It is often hard to recognise nasopharyngeal cancer because the symptoms are similar to other less serious conditions. Many people with nasopharyngeal cancer don't have any symptoms until the cancer reaches an advanced stage.

Symptoms of nasopharyngeal cancer can include:

• a lump in the neck
• hearing loss (usually only in one ear)
• tinnitus (hearing sound from inside the body rather than from an outside source)
• a blocked or stuffy nose
• nosebleeds

You should see your GP if you develop any worrying symptoms, particularly if they don't improve after a few weeks. While they are very unlikely to be caused by nasopharyngeal cancer, it is best to get them checked out.

What causes nasopharyngeal cancer?

The exact cause of nasopharyngeal cancer is unknown, although a number of factors can increase your risk of developing the condition:

• being of South Chinese or North African descent
• having a diet very high in salt-cured meats and fish
• being exposed to the Epstein-Barr virus (EBV), a common virus that causes glandular fever
• being regularly exposed to hardwood dust through your job
• having a first-degree relative (such as a parent) who has had the condition

About three times as many men as women are affected by nasopharyngeal cancer and the average age at diagnosis is about 50.

Diagnosing nasopharyngeal cancer

If you see your GP with symptoms that could indicate nasopharyngeal cancer, they will usually ask about your symptoms and carry out some examinations. This may involve examining your throat using a small mirror and a light.

If they think further tests are necessary, your GP will refer you to hospital. At hospital, a number of different tests may be carried out to check for nasopharyngeal cancer and rule out other conditions.

Some of the tests you may have include:

• a nasendoscopy – where a thin, flexible telescope (endoscope) is inserted up your nose and passed down your throat to look for any abnormalities; it is carried out while you are awake but local anaesthetic can be used to numb your nose and throat
• imaging scans – magnetic resonance imaging (MRI) scans or computerised tomography (CT) scans can be used to check for tumours and determine if the cancer has spread
• a panendoscopy – a more detailed examination of your nose and throat carried out under general anaesthetic (where you are asleep), using a series of small, rigid telescopes connected together
• a biopsy – where a small tissue sample is removed during a panendoscopy so it can be examined in a laboratory

Once these tests are complete, your doctors will be able to confirm whether you have nasopharyngeal cancer and they will be able to 'stage' the cancer. This means giving it a score to describe how large it is and how far it has spread.

How nasopharyngeal cancer is treated

If you are diagnosed with nasopharyngeal cancer, you will be cared for by a team of different specialists who work together, called a multidisciplinary team (MDT). Your MDT will discuss with you what they think the best treatment option is in your case.

The main treatments for nasopharyngeal cancer are:

• radiotherapy – where radiation is used to kill cancer cells
• chemotherapy – where medication is used to kill cancer cells

In most cases, a combination of these will be used.

Surgery is not generally used to treat nasopharyngeal cancer because it is hard for surgeons to access the affected area.

Radiotherapy

Radiotherapy is the most commonly used treatment for nasopharyngeal cancer. It may be used on its own for very early-stage cancers, or in combination with chemotherapy for more advanced cancers.

In most cases, external radiotherapy is used. This involves using a machine to focus high-energy radiation beams onto the area requiring treatment.

In nasopharyngeal cancer, an advanced form of external radiotherapy called intensity-modulated radiation therapy (IMRT) is used. IMRT involves aiming radiation beams of different strengths at a tumour from several different angles. This helps maximise the dose delivered to the tumour, while minimising the effect on the surrounding healthy tissue.

External radiotherapy is usually given in short sessions, once a day from Monday to Friday, with a break at weekends. This is usually done for up to seven weeks. You won't need to stay in hospital overnight between these appointments.

In some cases where nasopharyngeal cancer has returned after initial treatment, you may have internal radiotherapy. This is where a radioactive source is placed into or near the cancerous area and left in place for anywhere from a few minutes to a few days. Depending on the type of treatment you have, you may need to stay in hospital for a short period of time.

Radiotherapy itself is painless, but it can have some significant side effects, such as:

• red and sore skin in the treatment area
• feeling sick
• changes to your sense of taste
• dry mouth
• hair loss

These side effects are usually temporary, but some can be permanent. Let your care team know if you experience these problems as treatment is often available to help.

Read more about how radiotherapy is performed and the side effects of radiotherapy.

Chemotherapy

Chemotherapy may be used before or alongside radiotherapy for more advanced nasopharyngeal cancers.

It is usually given through a drip into a vein (intravenous chemotherapy), with sessions every three to four weeks spread over several months. You won't usually need to stay overnight in hospital during treatment.

Like radiotherapy, chemotherapy can cause a number of significant side effects, such as:

• feeling sick
• diarrhoea
• sore mouth
• tiredness

These side effects are usually temporary, but there is also a risk of longer-term impacts, such as infertility. If you are concerned about the potential side effects of treatment, you should discuss these with your care team before treatment begins.

Read more about how chemotherapy is performed and the side effects of chemotherapy.

Follow-up

After your course of treatment ends, you will need to have regular follow-up appointments and scans to monitor your recovery and check for any signs of the cancer returning.

These appointments will start off being every few weeks or months, but will become gradually less frequent over time.

Outlook

The outlook for nasopharyngeal cancer depends on how advanced it is when you are diagnosed, your age, and your general health.

Radiotherapy alone can cure many cases of very early-stage nasopharyngeal cancer, but many cases are diagnosed when they are more advanced because the condition doesn't always cause obvious symptoms until later on.

These more advanced cancers are treated with a combination or chemotherapy and radiotherapy and they are often curable if the cancer has not spread beyond the head and neck region.

Overall, about half of those diagnosed with nasopharyngeal cancer will live at least five years.

Want to know more?

• Cancer Research UK: nasopharyngeal cancer
• Macmillan: nasopharyngeal cancer