What is Nasopharynx Cancer?
Cancer starts when cells begin to grow out of control. Nasopharyngeal cancer is a type of head and neck cancer. It starts in the nasopharynx, the upper part of the throat behind the nose and near the base of skull.
What causes nasopharynx cancer?
DNA is that chemical in our cells that makes up our genes - the instructions on how our cells function. It also can influence our risk for developing certain diseases, including some kinds of cancer. The etiology of nasopharyngeal cancer is linked to ebstein barr virus infection and certain dietary habits like consumtion of salt preserved salted fish.
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Here, you will find information about signs and symptoms, causes and risk factors, types, diagnosis, staging and prevention about nasopharynx cancer.
These are some of the most common symptoms of nasopharynx cancer:
Lump or mass in the neck, a common symptom
Ear infections that keep coming back
Hearing loss, ringing in the ear, pain, or feeling of fullness in the ear, most often only on one side
Headaches
Nasal blockage or stuffiness
Nosebleeds
Facial pain or numbness
Anything that raises an individual's chance of getting a disease such as cancer is known as a risk factor. Different cancers have different risk factors. There are types of risk factors, some that can be changed and some which cannot be changed.
Gender: Nasopharynx cancer is mostly found in males than in females.
Race/ethnicity and where you live: Nasopharynx cancer is Commonly seen in inhabits of northeastern India
Diet: Nasopharynx cancer has been associated to certain areas where people consume more of salt-cured fish and meat.
Epstein-Barr virus infection: Epstein barr virus is strongly associated with nasopharygeal carcinoma, especially with undifferentiated carcinoma
Family history: Most often it is noted that family members of people with nasopharynx cancer are prone to get this cancer.
Certain habits like smoking, alcohol, and certain types of workplace exposures also increase the risk of this cancer.
Different types of nasopharynx cancers are:
Nasopharyngeal carcinoma (NPC): Most of the nasopharyngeal cancers are nasopharyngeal carcinomas. It is one of the most common cancers of the Nasopharynx. There are 3 types in them.
a. Non-keratinizing undifferentiated carcinoma.
b. Non-keratinizing differentiated carcinoma
c. Keratinizing squamous cell carcinoma
Lymphomas: These also can sometimes start in the nasopharynx from lymphoid tissue located in the nasopharynx.
Adenocarcinoma and adenoid cystic carcinoma are cancers that can start in the minor salivary glands in the nasopharynx.
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Medical history and physical exam: When found with signs or symptoms suggestive of NPC, the doctor will want to get a complete medical history. The patient will be asked about any change that has happened, possible risk factors, and the family history.
Physical exam also will be done to look for the signs of NPC or any other health problems. A thorough examination of the nasopharynx would be done. Also a hearing test may be done.
Nasopharyngoscopy is used to examine nasopharyneal cavity and map the extent of disease.
Biopsy: Though the exams can may indicate of NPC, the only way to be certain is through biopsy. The process of taking out cells from the abnormal area and looking at them under a microscope is called a biopsy. There are different types.
a. Endoscopic biopsy where biopsy is taken from nasopharyngeal mass.
b. Fine needle aspiration biopsy is used to examine nodal mass in the neck.
Imaging tests: Imaging tests are done for a lot of reasons like, to help find a suspicious area which could be cancer, to learn how far the cancer might have spread, and to check if the treatment is working. They use x-rays, magnetic fields, sound waves, or radioactive particles to take pictures of the inside of the body. The following imagng modalities are used to stage the disease
a. Computed tomography (CT) scan
b. Magnetic resonance imaging (MRI) scan
c. Positron emission tomography (PET) scan
Epstein-Barr virus (EBV) DNA levels may be done which helps to assess the burden of disease, response to treatment and also identify recurrence of disease after completion of treatement
Once diagnosed with nasopharyngeal cancer, doctors will try to figure out its spread. This process is called staging.
The staging system most often used for nasopharyngeal cancer is the TNM system, which is based on the 3 key piece of information.
The extent of the main tumor (T): How far has the tumor grown into nearby structures?
The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes in the neck? If so, how large are they?
The spread (metastasis) to distant sites (M): Has the cancer spread to distant parts of the body? (The most common sites of spread are the lungs, liver, bones, or lymph nodes in distant parts of the body.)
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Infection with Epstein-Barr virus has been linked to nasopharynx cancer, but there is yet no way to prevent the EBV itself, as no vaccine has yet been created for the same.
Certain types of foods have been linked with nasopharynx cancer risk, reducing or not eating those types of food may lower the number of cases.
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How Nasopharynx Cancer is treated?
Once the nasopharyngeal cancer is found and staged, then it is the treatment options, which is very important. It is important to weigh the benefits as well as the possible risks and side effects of each treatment option. There are ways to treat nasopharynx cancer. The treatment depends on the type and stage of the cancer. It also depends on many more factors such as the patient's age, general health, and other things that are unique to the patient. Most cases of nasopharynx cancer can be cured with treatment.
Surgery is not usually the main treatment for people with nasopharyngeal cancer, as nasopharynx is a hard place to operate on and other types of treatment often work very well.
1. Surgery to remove the tumor: Surgery is an option in adenocarcinoma or adenoid cystic carcinoma of nasopharynx.With newer endoscopic / robotic surgery techniques, doctors can use flexible fiberoptic scopes and long, thin surgical instruments to completely remove some nasopharyngeal tumors. But this is only an option for a small number of patients.
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Radiation therapy uses high-energy x-rays or particles to kill cancer cells or slow their rate of growth. Radiation therapy is in most cases of nasopharyngeal cancer used as a part of the main treatment.
Chemotherapy is given along with radiation to try to increase its effects, which is also known as chemoradiation and works better.
Radiation therapy is usually given both to the main nasopharyngeal tumor and to the nearby lymph nodes in the neck. The types of radiation therapy are:
1. External beam radiation therapy (EBRT): This type of radiation therapy uses x-rays that are aimed at the tumor from a large machine. It's the most common form of radiation therapy for NPC. It is given usually by the use of a technique called IMRT, which helps to reduce the side effects.
2. Stereotactic radiosurgery: This is a type of radiation treatment that sends a large, precise radiation dose to the tumor area in a single session. Commonly used in recurrent or residual disease.
3. Brachytherapy: Brachytherapy is also known as internal radiation therapy. It is very rarely used. Commonly used in recurrent or residual disease.
The use of anti-cancer drugs to treat cancer is chemotherapy. These drugs are administered through the vein (IV). As they enter the bloodstream, they reach throughout the body making it a useful treatment to treat the cancer that has spread up to head and neck.
Chemo may be used in different situations to treat nasopharyngeal cancer (NPC)
Chemoradiation: Chemo is used together with radiation as the first treatment for advanced stages of the nasopharynx cancer.
Induction chemo: Chemo given before chemoradiation,commonly adviced in advanced stages of nasopharygeal cancer
Adjuvant treatment: Chemo given after chemoradiation. Nasopharynx is the only subsite where adjuvant chemotherapy is advocated in head and neck cancer.
Chemo is also used for those patients whose nasopharynx cancer has spread to distant organs such as the lungs, bones, or liver. It may be used alone or along with radiation.
Common chemo drugs for nasopharynx cancer are Cisplatin, 5-fluorouracil (5-FU), Carboplatin, Doxorubicin, Epirubicin, Paclitaxel, Docetaxel, Gemcitabine, Bleomycin, Methotrexate.
The targeted drugs work differently from the standard chemotherapy. They often also have less severe side effects.
Cetuximab is a monoclonal antibody, which targets the epidermal growth factor receptor, which is a protein found on the surface of cancer cells. Nasopharyngeal cancer cells sometimes have more than normal amounts of EGFR, which helps them grow faster. By blocking EGFR, cetuximab may slow or stop this growth. Though the exact role of it in treating NPC is not certain.
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The use of medicines to help a person's own immune system find and destroy cancer cells is known as immunotherapy. It is used in treatment for some people with nasopharyngeal cancer.
Immune checkpoint inhibitors: The main role of the immune system is the ability to keep itself from attacking the normal cells in the body. To do this, it uses "checkpoints" - proteins on immune cells that need to be turned on/off to start an immune response. Pembrolizumab and nivolumab are the drugs that target PD-1 (a protein on immune system cells called T cells). These drugs boost the immune response against the cancer cells, which can shrink some tumors or slow the growth.
These drugs can be used in chemotherapy resistant people with recurrent nasopharyngeal cancer or has spread to other parts of the body.