Nasopharyngeal cancer

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

Nasopharyngeal cancer shouldn't be confused with other types of cancer that also affect the throat, such as laryngeal cancer and oesophageal cancer.

Symptoms of nasopharyngeal cancer

It's often difficult to recognise nasopharyngeal cancer because the symptoms are similar to other, less serious conditions. Also, 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 1 ear
• tinnitus – hearing sounds that come from inside the body rather than from an outside source
• a blocked or stuffy nose
• nosebleeds

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

What causes nasopharyngeal cancer?

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

• 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
• having a job where you're regularly exposed to hardwood dust
• having a first-degree relative, such as a parent, who's had the condition

Being exposed to the human papilloma virus (HPV) may also increase your risk of developing certain types of nasopharyngeal cancer.

About 3 times as many men as women are affected by nasopharyngeal cancer. The average age at diagnosis is about 50.

Diagnosing nasopharyngeal cancer

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

If your GP thinks further tests are necessary, they'll 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's carried out while you're 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 whether the cancer has spread
• a panendoscopy – a more detailed examination of your nose and throat carried out under general anaesthetic (where you're unconscious) 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. They'll also be able to 'stage' the cancer, which means giving it a score to describe how large it is and how far it has spread.

The Cancer Research UK website has more information about the stages of nasopharyngeal cancer.

How nasopharyngeal cancer is treated

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

The 2 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 radiotherapy and chemotherapy will be used.

Surgery isn't usually used to treat nasopharyngeal cancer as it's difficult for surgeons to access the affected area.

Radiotherapy

Radiotherapy is the most commonly used treatment for nasopharyngeal cancer. It can be used on its own to treat 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 on to the area that requires treatment.

In nasopharyngeal cancer, an advanced form of external radiotherapy called intensity-modulated radiation therapy (IMRT) is used.

It 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.

Stereotactic radiotherapy is another way of giving radiotherapy externally and may be used to target a specific area where the cancer has returned.

External radiotherapy is often given in short sessions, once a day from Monday to Friday, with a break at weekends. This is usually carried out for up to 7 weeks. You won't need to stay in hospital overnight between these appointments.

In some cases, internal radiotherapy may be required where nasopharyngeal cancer has returned after initial treatment. 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's usually given through a drip into a vein (intravenous chemotherapy), with sessions every 3 to 4 weeks spread over several months. You won't usually need to stay in hospital overnight 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's also a risk of longer-term problems, such as infertility. You should discuss any concerns you have about the potential side effects of treatment 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'll need to have regular follow-up appointments and scans to monitor your recovery and check for any signs of the cancer returning.

To start with, these appointments will be every few weeks or months, but they'll become gradually less frequent over time.