This information is about cancer of the nasopharynx (nasopharyngeal cancer). You may find it helpful to read the information alongside our general information about head and neck cancers, which discusses the treatments and their effects in more detail.

The nasopharynx is an air cavity lying at the back of the nose and above the soft part of the palate (roof of the mouth) – see diagram below. It connects the nose to the back of the mouth (oropharynx), allowing you to breathe through your nose and to swallow mucus produced by the lining membranes of the nose.

This type of cancer is rare in the West, but much more common in countries of the Far East. Approximately 230 new cases of nasopharyngeal cancer are diagnosed in the UK each year. It can occur at any age, but is more likely to be seen in people aged between 50 and 60. It affects more men than women.

There are different types of nasopharyngeal cancer that are named after the specific type of cell within the nasopharynx that has become cancerous.

Most nasopharyngeal cancers are squamous cell carcinomas. They develop in the cells that line the nasopharynx. There are three different types that are all treated in much the same way:

• keratinising squamous cell carcinoma (type 1)
• non-keratinising squamous cell carcinoma (type 2)
• undifferentiated carcinoma (type 3).

There are other types of cancer that can develop in the nasopharynx, such as melanoma, lymphoma and sarcoma. These are much rarer and treated in different ways.

The exact cause of cancer of the nasopharynx is unknown. In some areas of the world, such as China and North Africa, dietary factors (such as the cooking of salt-cured fish and meat, which releases chemicals known as nitrosamines) are thought to increase a person's risk of developing the disease.

The Epstein-Barr virus (which causes glandular fever) has also been linked to an increased risk of developing nasopharyngeal cancer. As with other cancers, nasopharyngeal cancer is not infectious and cannot be passed on to other people.

One of the first symptoms is often a painless swelling or lump in the upper neck. Other symptoms may include any of the following:

• a blocked nose
• nosebleeds
• changes in hearing
• ringing in the ears (tinnitus).

These symptoms are common in conditions other than cancer, and most people with these symptoms will not have cancer of the nasopharynx. However, like most cancers, nasopharyngeal cancer is best treated when diagnosed at an early stage, and you should therefore report any of the above symptoms to your GP if they do not improve after a few days.

Your GP will examine your mouth, throat and ears. They will refer you to a hospital for any further tests and for specialist advice and treatment.

The specialist will examine your nasopharynx by using a very thin, flexible tube with a light at the end (nasendoscope). The tube will be passed into your nostril in order to get a better view of the back of the nose. This can be uncomfortable, and you may be given a local anaesthetic spray to numb your nose and throat. If you do have a local anaesthetic to your throat, you may be told not to eat or drink anything for about an hour afterwards, or until your throat has lost the numb feeling.

In order to make a diagnosis, a piece of affected tissue will be removed and then examined under a microscope (this is called a biopsy). This is performed under a general anaesthetic, and you may need to spend the night in hospital.

You may have blood tests and a chest x-ray to check your general health. There are several other tests which may be used to help diagnose cancer of the nasopharynx, and to check whether or not the cancer has spread. Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body's defence against infection and disease. The system is made up of a network of lymph glands, or nodes, that are linked by fine ducts containing lymph fluid. The results of these tests will help the specialist to decide on the best type of treatment for you.

MRI (magnetic resonance imaging) scan This scan uses magnetism to form a series of cross-sectional pictures of the inside of the body. During the scan you will be asked to lie very still on a couch inside a metal cylinder. You may be given an injection of liquid that allows the pictures to be seen more clearly. The test can take up to an hour and is completely painless. If you do not like enclosed spaces you may find the machine claustrophobic. The machine is also quite noisy but you will be given earplugs or headphones to wear.

CT (computerised tomography) scan This is a sophisticated type of x-ray which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes longer than an x-ray (approximately 10–15 minutes). It may be used to identify the exact site of the tumour, or to check for any spread of the cancer. Most people who have a CT scan are given a drink, or injection, that allows particular areas to be seen more clearly. Before having the injection it is important to tell the person doing this test if you are allergic to iodine or have asthma.

Isotope bone scan This is a test which shows up any abnormal areas of bone. A very small amount of a mildly radioactive substance is injected into a vein, usually in the arm. Two to three hours later, a scan is taken of the whole body. As abnormal bone absorbs more of the radioactive substance than normal bone, any abnormal areas show up on the scan as highlighted areas (sometimes known as hot spots).

This scan will not make you radioactive, and it is perfectly safe for you to be with other people afterwards.

Staging

The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment for you.

The most commonly used staging system is called the TNM system.

• T refers to the tumour size.
• N refers to whether or not lymph nodes are affected.
• M refers to whether or not the cancer has spread to other parts of the body (metastases).

Tumour size (T)

• T1 The cancer is found in the nasopharynx only.
• T2a The cancer has spread to the oropharynx or nasal cavity.
• T2b The cancer has spread to the oropharynx or nasal cavity, and also to nearby soft tissues.
• T3 The cancer has spread into the bones or the paranasal sinuses.
• T4 The cancer has spread to other parts of the head, including the nerves, eye, or inside the skull.

Lymph nodes (N)

• N0 None of the lymph nodes are affected.
• N1 The cancer has spread to lymph nodes on one side of the neck. The affected nodes are 6cm or smaller.
• N2 Lymph nodes are affected on both sides of the neck. The nodes are 6cm or smaller.
• N3a The affected lymph nodes are larger than 6cm.
• N3b The cancer has spread to lymph nodes above the collarbone.

Metastases (M)

• M0 The cancer has not spread to other parts of the body.
• M1 The cancer has spread to other parts of the body.

Grading

Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop.

Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.

The treatment you will have depends on the type and stage of your nasopharyngeal cancer.

Radiotherapy

Radiotherapy is the main treatment for nasopharyngeal cancer. As well as treating the tumour, radiotherapy will usually be given to the lymph nodes in the neck.

Radiotherapy treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal tissue. The radiotherapy is usually given to the lymph glands in the neck as well as the nasopharyngeal area.

The types of radiotherapy used to treat cancer of the nasopharynx are external radiotherapy and occasionally internal radiotherapy. External radiotherapy is given from a radiotherapy machine, much like an x-ray machine. Internal radiotherapy is given by placing radioactive metal needles or wires close to the tumour while you are under a general anaesthetic. After a few days the needles or wires are removed. External radiotherapy is the main type used; some people, however, may go on to have internal radiotherapy.

Radiotherapy to the nasopharynx can cause the salivary glands to produce less saliva, so it is important to keep your mouth clean. Your doctors and nurses will advise you how to do this.

If you have a dry mouth it is important to see a dentist regularly. It is best not to have teeth taken out after radiotherapy to this area, but if it is necessary to have a tooth removed, it should be done by a hospital specialist.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy is often given in combination with radiotherapy. Chemotherapy may also be given if the cancer has spread to other parts of the body.

Research trials You may be offered chemotherapy as part of a research trial. Before any trial is allowed to take place it must have been approved by the ethics committee, which checks that the trial is in the interest of patients. Your doctor must discuss this treatment with you so that you have a full understanding of the trial and what it involves.

You may decide not to take part, or withdraw from a trial at any stage.

Surgery

Occasionally, the doctor may recommend surgery after the radiotherapy treatment, to remove any affected lymph nodes in the neck that may still contain cancer cells. There is a network of lymph nodes (or glands) throughout the body which form part of the body's natural defence against infection. The lymph nodes are connected by a network of tiny tubes known as lymph vessels.

Surgery may also be used to remove the tumour if it comes back in the lymph nodes in the neck.

After your treatment is completed, you will have regular check-ups and possibly scans or x-rays. These will probably continue for several years. If you have any problems, or notice any new symptoms between these times, let your doctor know as soon as possible.

You are likely to experience a number of different emotions, from shock and disbelief to fear and anger. These feelings may be overwhelming and difficult to control, particularly if you have experienced changes in your appearance because of surgery; and feel self-conscious. These feelings are quite natural and it is important for you to be able to express them.

Each individual has their own way of coping with difficult situations; some people find it helpful to talk to friends or family, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. You may wish to contact our cancer support service for information about counselling in your area.

This section has been compiled using information from a number of reliable sources, including:

• Improving Outcomes in Head and Neck Cancers. National Institute for Health and Clinical Excellence (NICE). November 2004.
• Oxford Textbook of Oncology (2nd edition). Eds Souhami et al. Oxford University Press, 2002.
• Cancer and its Management (5th edition). Eds Souhami and Tobias. Oxford Blackwell Scientific Publications, 2005.
• The Textbook of Uncommon Cancers (3rd edition). Eds Raghavan et al. Wiley, 2006.
• Cancer: Principles and Practice of Oncology (7th edition). Eds DeVita et al. Lippincott, Williams and Wilkins, 2005.

For further references, please see the general bibliography.