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Nasopharyngeal carcinoma

Definition


Disease: Nasopharyngeal carcinoma Nasopharyngeal carcinoma
Category: Tumors

Disease Definition:

Nasopharyngeal carcinoma is cancer that occurs in the nasopharynx, which is positioned behind the nose and above the back of the throat.

 

Although rare in some countries, but nasopharyngeal carcinoma occurs commonly in other countries, such as northern Africa and Asia.

 

Symptoms of nasopharyngeal carcinoma resemble those of many other conditions and the nasopharynx is not easy to examine; these factors make this cancer difficult to detect early. Chemotherapy, radiation therapy or a combination of the two are the primary treatments for nasopharyngeal carcinoma, and patients could work with the doctor depending on their particular situation to choose the best treatment option.
 

Work Group:


Symptoms, Causes

Symptoms:

Possible detectable symptoms of nasopharyngeal carcinoma include face and neck pain, headaches, hearing loss in one ear, frequent ear infections, double vision, bloody discharge from the nose, nasal congestion on one side of the nose and a lump in the neck caused by a swollen lymph node.

 

The early symptoms of nasopharyngeal carcinoma might not always make people see their doctors, but when seeing any chronic and unusual changes in the body like unusual nasal congestion, the doctor should be seen. However, nasopharyngeal carcinoma may not cause any symptoms in its early stages.

 

Causes:

Cancer starts when one or more genetic mutations cause normal cells to grow out of control then invade surrounding structures and ultimately metastasize (spread to other body parts). This process starts in the squamous cells that line the surface of the nasopharynx in the case of nasopharyngeal carcinomas.

 

What exactly causes the gene mutations that result in nasopharyngeal carcinoma is still not known; however, certain factors like the Epstein-Barr virus may increase the risk of this cancer. It is also not known why some people who have no obvious risk factors develop cancer, while others with all the risk factors never do.
 

Complications

Complications:

Nasopharyngeal carcinoma often metastasizes beyond the nasopharynx, and most people with this cancer have regional metastases in which cancer cells from the primary tumor migrate to nearby areas like lymph nodes in the neck. Cancer cells that do distant metastases (spreading beyond head and neck) most usually reach the liver, lungs, bones and bone marrow.

 

Nasopharyngeal carcinoma may also cause rare disorders like paraneoplastic syndromes in which the cancer produces substances that cause changes in other parts of the body; however, these changes are not a direct effect of cancer cells. This disorder might cause joint and neurological problems as well as high levels of certain white blood cells in the blood. The doctor may prescribe medications to control the immune system as soon as the cancer is treated.
 

Treatments:

Patients and doctors work together to come up with a plan of treatment based on several factors such as the stage of the cancer, the type of cells involved, treatment aims, the patient’s general health and the side effects that he/she is willing to endure.

 

Because the nasopharynx is not easy to examine and symptoms of nasopharyngeal carcinoma resemble those of many other conditions, many people are not diagnosed with this cancer until it has spread; as a result, when it becomes more advanced, it becomes more difficult to be successfully treated.

 

Treatment for nasopharyngeal carcinoma usually starts with radiation therapy or a combination of radiation and chemotherapy. Although surgery is the primary treatment for many cancers, but going through the nasopharynx with surgical instruments is delicate.

 

RADIATION THERAPY:

Radiation therapy destroys quickly growing cells in the area where the beams are focused including cancer cells. During this treatment, the patient is positioned on a table and a large machine is maneuvered around him/her to the precise spot where it can target the cancer. Radiation therapy is normally received five days a week for six or seven weeks. Some doctors are using a newer form of radiation called IMRT (Intensity-Modulated Radiation Therapy) which may affect fewer healthy cells because it is more effective at contouring to the shape of the tumor.

 

Radiation therapy has a risk of side effects including:

 

  • Temporary skin changes
  • Dry mouth
  • Difficulty swallowing
  • Hearing loss

 

The nasopharynx is positioned among some delicate organs that the radiation therapy team works to protect, but this cannot always be done. Some of these organs are:

 

  • Brain
  • Spinal cord
  • Eyes
  • Ears
  • Thyroid gland

 

Brachytherapy or internal radiation therapy is sometimes used in recurrent nasopharyngeal carcinoma. In this treatment, radioactive seeds or wires are positioned in the tumor or very close to it.

 

CHEMOTHERAPY:

Chemotherapy medications travel throughout the body, unlike radiation therapy which is focused on one part of the body. Chemotherapy works by attacking quickly growing cells such as cancer cells; however, some healthy cells are also killed, which can cause side effects including hair loss, fatigue, and nausea and vomiting.
Chemotherapy may be used in three ways to treat nasopharyngeal carcinoma: concomitant therapy, adjuvant chemotherapy and neoadjuvant chemotherapy.

 

CONCOMITANT THERAPY (CHEMORADIOTHERAPY):

In this therapy, the patient will be given chemotherapy at the same time as radiation therapy. Chemotherapy enhances the effectiveness of radiation therapy and using the two treatments together might reduce the need for high doses of radiation, which in turn can reduce the side effects associated with radiation therapy. However, side effects of chemotherapy are added to those of radiation therapy making concomitant therapy more difficult to tolerate.

 

ADJUVANT CHEMOTHERAPY:

Adjuvant chemotherapy, in which chemotherapy is given after radiation therapy, is used to attack any remaining cancer cells in the body including those that might have broken off from the original tumor and spread elsewhere. The doctor may recommend adjuvant therapy after radiation therapy or after concomitant therapy. However, it is still controversial whether adjuvant chemotherapy actually improves survival in people with nasopharyngeal carcinoma or not. Furthermore, many people who go through adjuvant therapy after concomitant therapy are unable to tolerate the side effects and must stop treatment.

 

NEOADJUVANT THERAPY:

In this treatment, chemotherapy is given before radiation therapy, and it works in the same way as adjuvant chemotherapy, but it is administered before radiation therapy or before concomitant therapy. However, this therapy is not considered a standard treatment because little research has been done on it.

 

The doctor will decide what chemotherapy drugs should be given as well as how they should be taken, and the side effects patients are possible to have will depend on the drugs they are given.

 

SURGERY:

The most common surgery for nasopharyngeal carcinoma is surgery to remove cancerous lymph nodes in the neck. Surgery to remove a tumor from the nasopharynx requires surgeons to make a cut in the palate of the mouth in order to reach the cancerous area and remove the cancerous tissue. However, surgery is not used often as a treatment for nasopharyngeal carcinoma.
 

Prognosis:

Not available

Expert's opinion

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Consultants Corner

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology
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