Medicines for Nasopharyngeal cancer

What it is

Nasopharyngeal cancer is a rare cancer that develops in the nasopharynx — the upper part of the throat, behind the nose, that connects the back of the nose to the back of the throat. It is uncommon in the UK, though it is more common in certain parts of the world and in people of certain ethnic backgrounds (such as some East and Southeast Asian and North African populations). It is linked with infection with the Epstein-Barr virus (a common virus that causes glandular fever), as well as other factors such as a family history, certain dietary factors, and smoking. Because of where it develops, its symptoms can affect the neck, nose, and ears, and can include: a lump in the neck (from a swollen lymph node — this is a common first sign); a blocked or stuffy nose, often on one side; nosebleeds; hearing problems, ringing in the ear, or a feeling of fullness in one ear (as the tube connecting the throat and ear can be affected); headaches; and, as it progresses, other symptoms such as facial numbness, double vision, or difficulty swallowing or speaking. Because many of these symptoms — such as a blocked nose or ear problems — are very commonly caused by ordinary conditions, they usually do not mean cancer; but a persistent lump in the neck, persistent one-sided nasal or ear symptoms, or other unexplained persistent symptoms should be checked. Nasopharyngeal cancer is diagnosed and treated by specialist teams, and because of its position, radiotherapy (often combined with chemotherapy) is usually the main treatment rather than surgery; it can be treated effectively, particularly when found earlier. Awareness of a persistent neck lump and persistent nasal or ear symptoms, and prompt assessment, are the key messages.

How it is treated

Nasopharyngeal cancer is diagnosed and treated by specialist ENT and oncology teams, and because of its position deep in the upper throat, its treatment differs from many other head and neck cancers. Assessment usually involves examining the nasopharynx (including with a small camera passed through the nose), and, if an abnormal area is found, a biopsy (taking a sample), along with scans to confirm the diagnosis and determine the extent; the neck is also assessed, as spread to the lymph nodes in the neck is common. Because of where the cancer is (in a position that is difficult to operate on), surgery is not usually the main treatment; instead, the main treatment is usually radiotherapy, often combined with chemotherapy (chemoradiotherapy), which can be very effective, particularly for cancers found at an earlier stage. Chemotherapy may also be used at other points, and the approach is tailored to the stage and the person’s situation. Supportive care and rehabilitation (for example managing the effects of treatment, and support with swallowing, hearing, and other functions) are important parts of care, and follow-up is arranged. Because early diagnosis improves outcomes, and because a persistent neck lump is a common first sign, the key messages are to get a persistent lump in the neck, or persistent one-sided nasal or ear symptoms, or other unexplained persistent symptoms, checked. It is worth keeping perspective — a neck lump and nasal or ear symptoms are far more often due to common, benign causes than to cancer — but persistent or unexplained symptoms should not be ignored. Reducing risk where possible (for example not smoking) is also worthwhile. The reassuring messages are that nasopharyngeal cancer is rare in the UK, that the symptoms are usually due to harmless causes, and that it can be treated effectively (usually with radiotherapy and chemotherapy), particularly when found earlier, so persistent symptoms should be checked.