Nasopharyngeal cancer (NPC) is cancer of the nasopharynx, which is the air passageway at the upper part of the pharynx, or throat, behind the nose.

Nasopharyngeal Cancer Treatment In Malaysia



 

According to the World Health Organization (WHO), NPC is classified into 3 subtypes:

  • Keratinizing squamous cell carcinoma (WHO type 1)
  • Nonkeratinizing squamous cell carcinoma (WHO type 2)
  • Undifferentiated or poorly differentiated carcinoma (WHO type 3)

Risk Factors

Tobacco
Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Smokers with NPC are most likely to have the squamous cell type.
Epstein-Barr virus (EBV)
Exposure plays a role in causing NPC.
Gender
Men are 2 times more likely than women to develop NPC.
Eating habits
Eating large amounts of salt-cured fish and meats on a regular basis increases a person's risk of developing NPC.

 

Symptoms and Signs

  • Lump in the neck
  • Nasal obstruction or stuffiness
  • Hearing loss
  • Pain and ringing in the ear
  • Frequent nosebleeds
  • Pain, numbness, or paralysis in the face
  • Frequent headaches
  • Blurred or double vision
  • Fatigue
  • Unexplained weight loss

 

Diagnosis

Nasopharyngoscopy allows the doctor insert a tube into the nasopharynx to examine the head and neck areas.

Biopsy allows a definite diagnosis to be made. During a fine needle aspiration, cells are removed using a thin needle inserted directly into the tumor and examined during cytological examination for signs of cancer.

Computed tomography creates a 3-dimensional picture to allow a detailed, cross-sectional view that shows any abnormalities or tumors.

Magnetic resonance imaging uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue such as the tonsils and base of the tongue. An MRI is more sensitive than a CT scan in detecting a tumor of the nasopharynx and any possible spread to nearby tissues or lymph nodes.

Bone scan uses a radioactive tracer to look cancer spread to bones.

Positron emission tomography or PET-CT scan is usually combined with a CT scan. A small amount of a radioactive sugar substance is injected into the patient’s body. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

 

Nasopharyngeal Cancer Staging

 
Stage I

A small tumor with no spread to lymph nodes and no distant metastasis.

 
Stage II

Tumor is found in the nasopharynx and has spread to lymph nodes on one side of the neck, but no distant metastasis.

 
Stage III

Tumor that has spread to lymph nodes on both sides of the neck but has not metastasized.

Stage IVA

This describes any locally advanced tumor with or without extensive lymph node involvement.

Stage IVB

This describes tumor with distant metastases.

 

Treatment Options

Talk to our Oncologists at Onco Life Centre about your treatment options. The main treatment for NPC is radiation therapy. It is often given in combination with chemotherapy. This approach may be called concomitant chemoradiotherapy. Surgery for NPC is occasionally used, mainly to remove lymph nodes after chemoradiotherapy or to treat NPC that has come back after initial treatment.

 

Radiation therapy

A method of external-beam radiation therapy, known as intensity-modulated radiation therapy (IMRT), allows more effective doses of radiation therapy to be delivered, while reducing damage to healthy cells and causing fewer side effects.

Proton therapy

Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Proton therapy may be used as part of the treatment for some skull-base tumors to further limit the radiation dose to nearby structures, such as the optic nerves in the eye and the brainstem.

Brachytherapy

Brachytherapy is when radiation treatment is given using surgically implanted rods that contain radioactive materials in or near the cancer location. The implant is left in place for several days, and this approach is most often used to treat NPC that has come back after the first treatment.

Before starting radiation treatment for any head and neck cancer, damaged teeth need to be removed and tooth decay can be prevented before cancer treatment begins.

Chemotherapy

A combination of chemotherapy and radiation therapy is commonly used to treat NPC. The use of chemotherapy before radiation therapy is also being studied. In general, chemotherapy in combination with radiation therapy may increase side effects. Nutritional support may be necessary during treatment due to these side effects.

Surgery

Surgery is occasionally used for NPC, but it is not a common treatment choice because the area is hard to reach and lies close to cranial nerves and blood vessels.

If the cancer has spread to the lymph nodes, surgical removal of lymph nodes in the neck or neck dissection may be recommended. A neck dissection may cause numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. These side effects are caused by damage to nerves in the area.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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