Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is a cancer that develops in the nasopharynx, the part of the throat which connects to your nose.

Nasopharyngeal carcinoma is rare in the United States whereas it is common in Southeast Asia. Examining nasopharynx is difficult and the associated symptoms are similar to those of other medical conditions. Both these factors cause delayed detection of nasopharyngeal carcinoma.

Nasopharyngeal carcinoma can be treated by radiation therapy, chemotherapy or both. You can discuss with your doctor about the treatment approach for your condition.

You may not experience any symptoms in early stages of nasopharyngeal carcinoma. Symptoms of nasopharyngeal carcinoma are:

• A swollen lymph node in the neck
• Blood in saliva
• Nosebleeds
• Stuffy nose
• Decreased hearing ability
• Recurrent ear infections
• Headaches

When to see a doctor?

Make an appointment with your doctor if you experience any of the signs and symptoms that are constantly annoying you.

Scientists are not sure what exactly causes nasopharyngeal cancer.

DNA mutations in the squamous cells, lining the surface of the nasopharynx, cause “out-of-control” growth and multiplication of the cells.

Unlike normal cells, these cancer cells do not die timely and continue to divide causing a mass of cells, tumor. The cancer can invade nearby organs or spread to other parts of your body (metastasis).

No one actually knows what causes these mutations but certain factors like infection by Epstein-Barr virus can increase the risk of this cancer. However, it’s not clear why people with no risk factors develop cancer whereas people with all risk factors don’t.

Making a diagnosis of nasopharyngeal carcinoma is done by performing several tests.

Your doctor may refer you to an oncologist (who treats cancer) or otolaryngologist (who treats ear, nose and throat problems).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms. Write down your key medical information.  Write down the names of all your medications, vitamins or supplements.

Ask a friend or a family member to accompany you during the visit. Make a list of the questions to ask your doctor. Some typical questions can be:

• What are the tests needed?
• What could be possible causes for these symptoms?
• What’s type of my nasopharyngeal cancer?
• Has my cancer affected other body parts including the nasopharynx or beyond?
• What’s the stage of my cancer?
• How do you treat a condition like mine?
• Is the combination of radiation and chemotherapy beneficial for me?
• What are the side effects of radiation and chemotherapy?
• Do I need surgery?
• Can my cancer return?
• Do I need any dietary modifications?
• What are my chances of recovery?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did the symptoms start appearing and how severe are they?
• How often do these symptoms appear?
• Does anything improve or aggravate your symptoms?
• What does your typical diet consist of?
• Did you have any infection by Epstein-Barr virus or mononucleosis in the past?

Diagnostic tests for nasopharyngeal carcinoma include:

• Physical exam: Your doctor may press on your neck to check if the lymph nodes are swollen.
• Nasal endoscopy: It involves examining interior of your nasopharynx with the help of a camera-containing slender, flexible tube, which is inserted through your nose or through the opening in the back of your throat. This exam may require using local anesthetic drug.
• Biopsy: A sample of tissue (biopsy) can be removed during nasal endoscopy and tested to see if the sample consists of cancer cells.

Tests to determine the extent of the cancer.

• Staging your cancer is the next step after the diagnosis is confirmed. Staging may use following tests:
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)
• X-ray

Selection of a treatment approach for nasopharyngeal carcinoma depends upon the stage of your cancer, your health status and your preferences. The treatment often starts with radiation therapy or a combination of radiation and chemotherapy.

• Radiation therapy: It uses ionizing radiations like X-rays to destroy tumors. In external radiation therapy, a large machine targets the radiation to the cancer cells. Internal radiation (Brachytherapy) is used when the cancer comes again and again. Radiation-only therapy can treat small nasopharyngeal tumors. Your doctor may also recommend a combination of radiation therapy and chemotherapy. You may experience a greater extent of side effects when using a combination of radiation therapy and chemotherapy.
• Chemotherapy: It uses oral or injectable chemicals to destroy cancer cells. Following approaches may be used to treat nasopharyngeal carcinoma:
  • Chemotherapy combined with radiation therapy: Chemoradiation, combination of chemotherapy and radiation therapy, increases the effectiveness of radiation therapy. However, it can lead to more severe side effects.
  • Chemotherapy after radiation therapy: Your doctor might recommend chemotherapy after radiation therapy or chemoradiation to destroy the cells that have not been destroyed by radiation only.
  • Chemotherapy before radiation therapy: In neoadjuvant chemotherapy, your cancer is treated with chemotherapy followed by radiation therapy or chemoradiation.

• Surgery: Surgery is rare option and involves removal of cancerous lymph nodes or a tumor from nasopharynx, through an incision made in the roof of your mouth.

Nasopharyngeal carcinoma cannot be prevented but the associated risks can be minimized. To reduce the risk, you have to avoid the things that are likely to cause cancer. For example, avoiding foods treated with salt can lower the risk of cancer.

Tests to screen for nasopharyngeal carcinoma inlude:

• Screening for nasopharyngeal carcinoma is done in areas where it is common.
• Blood tests may be carried out to detect Epstein-Barr virus.

Lifestyle modifications are necessary in order to cope with nasopharyngeal carcinoma.

Radiation therapy can cause dry mouth (xerostomia), difficulty eating, swallowing and speaking. Recurrent mouth or teeth problems can occur as a result of dry mouth. Discuss with your doctor about the appointment with your dentist.

You may do these to get relief:

• Brush your teeth with soft-bristled toothbrush several times a day. Tell your doctor if you can't tolerate gentle brushing.
• Rinse your mouth after each meal with a solution of warm water, salt and baking soda.
• Keep your mouth wet by drinking water or chewing sugarless gum which stimulates saliva production.
• Choose moist foods that have greater fluid content such as sauce, gravy, broth, or milk.
• Avoid acidic or spicy foods, caffeinated and alcoholic drinks.
• Tell your doctor if you have dry mouth. Your doctor may suggest you ways to cope with dry mouth.

Being diagnosed with cancer can be devastating and a painful experience. Following tips might be helpful for you:

• Expand and update your knowledge on nasopharyngeal carcinoma.
• Find someone to talk to and listen to.
• Join support group in your community or online.
• Take care of yourself by taking healthy diet, exercising regularly and sleeping enough.
• DON’T Smoke.

There are several risks and complications associated with nasopharyngeal carcinoma.

Risks

• Sex: Men are more likely to develop nasopharyngeal carcinoma.
• Race: People of China, Southeast Asia and northern Africa are more vulnerable to this rare cancer. Similarly, Asian immigrants have a greater risk compared to the Asians born in the US. Inuits in Alaska have higher risk of nasopharyngeal cancer.
• Age: Though this cancer can affect people of any age, those between 30 and 40 seem to have a greater risk.
• Foods preserved in salt: Salt-preserved foods can also boost your chances of developing this cancer as the chemicals released while cooking these foods are found to cause cancer.
• Epstein-Barr virus: Getting infected by Epstein-Barr virus puts you at greater risk of various rare cancers including such as nasopharyngeal carcinoma.
• Family history: You are likely to have nasopharyngeal carcinoma if anyone in your family has nasopharyngeal carcinoma increases.

Complications

• Advanced nasopharyngeal cancer can affect the surrounding tissues and organs like throat, bones and brain, and can cause complications.
• Sometimes, the cancer cells can also migrate to distant body parts like lymph nodes in the neck, bones, lungs and liver.