Nasopharyngeal carcinoma

Definition
Nasopharyngeal (nay-zo-fuh-RIN-gee-uhl) carcinoma is cancer that occurs in the nasopharynx, which is located behind your nose and above the bac of your throat! Nasopharyngeal carcinoma is rare in the "nited #tates! In other parts of the world $ specifically %sia and northern %frica $ nasopharyngeal carcinoma occurs much more fre&uently! Nasopharyngeal carcinoma is difficult to detect early, probably because the nasopharnyx isn't easy to examine and symptoms of nasopharyngeal carcinoma mimic those of many other conditions! (our main treatment options for nasopharyngeal carcinoma are radiation therapy, chemotherapy or a combination of the two! (ou can wor with your doctor to determine the exact approach depending on your particular situation!

Symptoms
In its early stages, nasopharyngeal carcinoma may not cause any symptoms! )ossible noticeable symptoms of nasopharyngeal carcinoma include*

% lump in your nec caused by a swollen lymph node +lood in your saliva +loody discharge from your nose Nasal congestion ,earing loss -re&uent ear infections ,eadaches

When to see a doctor .arly nasopharyngeal carcinoma symptoms may not always prompt you to see your doctor! ,owever, if you notice any unusual and persistent changes in your body, such as unusual nasal congestion, that don't seem right to you, see your doctor!

Causes
/ancer begins when one or more genetic mutations cause normal cells to grow out of control, invade surrounding structures and eventually spread (metastasize) to other parts of the body! In nasopharyngeal carcinomas, this process begins in the s&uamous cells that line the surface of the nasopharynx!

.xactly what causes the gene mutations that lead to nasopharyngeal carcinoma isn't nown, though factors, such as the .pstein-+arr virus, that increase the ris of this cancer have been identified! ,owever, it isn't clear why some people with all the ris factors never develop cancer, while others who have no apparent ris factors do!

Risk factors
Researchers have identified some factors that appear to increase your ris of developing nasopharyngeal carcinoma, including*

Sex. Nasopharyngeal carcinoma is more common in men than it is in women! Race. 0his type of cancer more commonly affects people in %sia and northern %frica! In the "nited #tates, %sian immigrants have a higher ris of this type of cancer than do %merican-born %sians! 0he Inuits of %las a also have an increased ris of nasopharyngeal cancer! Age. Nasopharyngeal cancer can occur at any age, but it's most commonly diagnosed in adults between the ages of 12 and 32! Salt-cured foods. /hemicals released in steam when coo ing salt-cured foods, such as fish and preserved vegetables, may enter the nasal cavity, increasing the ris of nasopharyngeal carcinoma! +eing exposed to these chemicals at an early age may increase the ris even more! Epstein- arr !irus. 0his common virus usually produces mild signs and symptoms, such as those of a cold! #ometimes it can cause infectious mononucleosis! .pstein-+arr virus is also lin ed to several rare cancers, including nasopharyngeal carcinoma! "amily history. ,aving a family member with nasopharyngeal carcinoma increases your ris of the disease, though researchers aren't sure if this association is due to genetic or environmental factors! Smoking cigarettes and drinking alcohol. #mo ing cigarettes and drin ing alcohol is lin ed to nasopharyngeal carcinoma among people in the "nited #tates and .urope who have a low ris of this cancer!

Complications
Nasopharyngeal carcinoma complications can include*

Cancer that spreads to other areas of the #ody. Nasopharyngeal carcinoma fre&uently spreads (metastasizes) beyond the nasopharynx! 4ost people with nasopharyngeal carcinoma have regional metastases, meaning cancer cells from the initial tumor have migrated to nearby areas, such as lymph nodes in the nec ! /ancer cells that spread to other areas of the body (distant metastases) most commonly travel to the bones and bone marrow, lungs and liver!

$mmune system reactions to cancer. Nasopharyngeal carcinoma may also cause paraneoplastic syndromes! In these rare disorders your body's immune system reacts to the presence of cancer by attac ing normal cells! 5nce your cancer is treated, your doctor may prescribe medications to control your immune system!

%ests and diagnosis

%ests to diagnose nasopharyngeal carcinoma 0ests and procedures used to diagnose nasopharyngeal carcinoma include*

&hysical exam. 6iagnosing nasopharyngeal carcinoma usually begins with a general examination! (our doctor will as &uestions about your symptoms! ,e or she may press on your nec to feel for swelling in your lymph nodes! Exam using a camera to see inside your nasopharynx. If nasopharyngeal carcinoma is suspected, your doctor may recommend a nasal endoscopy! 0his test uses a thin, flexible tube with a camera on the end to see inside your nasopharynx and loo for abnormalities! 0he camera may be inserted through your nose or through the opening in the bac of your throat that leads up into your nasopharynx! Nasal endoscopy may re&uire local anesthesia! %est to remo!e a sample of suspicious cells. (our doctor may also use the endoscope or another instrument to ta e a small tissue sample (biopsy) to be tested for cancer!

%ests to determine the extent of the cancer 5nce the diagnosis is confirmed, your doctor orders other tests to determine the extent (stage) of the cancer, such as imaging tests! Imaging tests may include computerized tomography (/0), magnetic resonance imaging (4RI), positron emission tomography ().0) and 7-ray! 5nce your doctor has determined the extent of your cancer, a Roman numeral that signifies its stage is assigned! 0he stage is used along with several other factors to determine your treatment plan and your prognosis! % lower numeral means the cancer is small and confined to the nasopharynx! % higher numeral means cancer has spread beyond the nasopharynx to lymph nodes in the nec or to other areas of the body! 0he stages of nasopharyngeal cancer range from I to I8!

%reatments and drugs

(ou and your doctor wor together to devise a treatment plan based on several factors, such as the stage of your cancer, your treatment goals, your overall health and the side effects you're willing to tolerate! 0reatment for nasopharyngeal carcinoma usually begins with radiation therapy, or a combination of radiation and chemotherapy! Radiation therapy Radiation therapy uses high-powered energy beams, such as 7-rays, to ill cancer cells! Radiation therapy for nasopharyngeal carcinoma is usually administered in a procedure called

external beam radiation! 6uring this procedure, you're positioned on a table and a large machine is maneuvered around you, directing radiation to the precise spot where it can target your cancer! -or small nasopharyngeal tumors, radiation therapy may be the only treatment necessary! In other situations, radiation therapy may be combined with chemotherapy! Radiation therapy carries a ris of side effects, including temporary s in redness, hearing loss and dry mouth! %nother type of radiation therapy, an internal form of radiation (brachytherapy), is sometimes used in recurrent nasopharyngeal carcinoma! 9ith this treatment, radioactive seeds or wires are positioned in the tumor or very close to it! Chemotherapy /hemotherapy is a drug treatment that uses chemicals to ill cancer cells! /hemotherapy drugs can be given in pill form or administered through a vein! /hemotherapy may be used to treat nasopharyngeal carcinoma in three ways*

Chemotherapy at the same time as radiation therapy. 9hen the two treatments are combined, chemotherapy enhances the effectiveness of radiation therapy! 0his combined treatment is called concomitant therapy or chemoradiation! ,owever, side effects of chemotherapy are added to the side effects of radiation therapy, ma ing concomitant therapy more difficult to tolerate! Chemotherapy after radiation therapy. 0his is called ad:uvant chemotherapy! (our doctor might recommend ad:uvant chemotherapy after concomitant therapy! %d:uvant chemotherapy is used to attac any remaining cancer cells in your body, including those that may have bro en off from the original tumor and spread elsewhere! #ome controversy exists as to whether ad:uvant chemotherapy actually improves survival in people with nasopharyngeal carcinoma! 4any people who undergo ad:uvant therapy after concomitant therapy are unable to tolerate the side effects and must discontinue treatment! Chemotherapy #efore radiation therapy. Neoad:uvant chemotherapy is chemotherapy treatment administered before radiation therapy alone or before concomitant therapy! 4ore research is needed to determine whether neoad:uvant chemotherapy can improve survival rates in people with nasopharyngeal carcinoma!

9hat chemotherapy drugs you receive and how often will be determined by your doctor! 0he side effects you're li ely to experience will depend on which drugs you receive! Surgery #urgery is not often used as a treatment for nasopharyngeal carcinoma! #urgery may be used to remove cancerous lymph nodes in the nec ! In certain cases, surgery may be used to remove a tumor from the nasopharynx! 0his usually re&uires surgeons to ma e an incision in the roof of your mouth in order to access the area to remove the cancerous tissue!

&re!ention
No sure way exists to prevent nasopharyngeal carcinoma! ,owever, if you're concerned about your ris of nasopharyngeal carcinoma, you may consider avoiding habits that have been associated with the disease! -or instance, you may*

/ut bac on the amount of salt-cured foods you eat or avoid these foods altogether #top smo ing 6rin alcohol in moderation, if at all

%ests to screen for nasopharyngeal carcinoma In the "nited #tates and in other areas where the disease is rare, routine screening for nasopharyngeal carcinoma isn't done! +ut in areas of the world where nasopharyngeal carcinoma is much more common, for instance in some areas of /hina, doctors may offer screenings to people thought to be at high ris of the disease! #creenings may include blood tests to determine whether a person carries the .pstein-+arr virus and what the levels of the virus are, or careful examinations of the nasopharynx using a tiny camera attached to the end of a flexible tube (endoscope)!