The Farber Center: For Radiation Oncology

The nasopharynx is the small area at the very back of your nasal passageway, in between the ears. Nasopharyngeal cancer most commonly starts in the squamous cells that line the oropharynx (the part of the throat behind the mouth). Very common in areas such as South East China/ Guangzhou region and common in areas such as South East Asia.

• Enlarged neck lymph nodes is most common
• Loss of hearing on one side
• Ear infection
• Nasal obstruction
• Bloody nose
• Nerve paralysis in the head/neck region
• Double vision
• Difficulty opening your jaw/pain in opening your jaw
• Pain

Risk Factors

• Epstein-Barr Virus: The Epstein-Barr virus has been associated with certain cancers, including nasopharyngeal cancer and some lymphomas.
• Ancestry: It can be genetic (in countries such as China)
• Tobacco

Physical exam: Diagnosing nasopharyngeal carcinoma usually begins with a general examination. Your doctor will ask questions about your symptoms. He or she may press on your neck to feel for swelling in your lymph nodes.

Exam using a camera to see inside your nasopharynx. If nasopharyngeal carcinoma is suspected, your doctor may recommend a nasal endoscopy. This test uses a thin, flexible tube with a camera on the end to see inside your nasopharynx and look for abnormalities. The camera may be inserted through your nose or through the opening in the back of your throat that leads up into your nasopharynx. Nasal endoscopy may require local anesthesia.

CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the neck area. You may receive an injection of a special dye so your larynx shows up clearly in the pictures. From the CT scan, the doctor may see tumors in your larynx or elsewhere in your neck.

Biopsy: If an exam shows an abnormal area, the doctor may remove a small sample of tissue. Removing tissue to look for cancer cells is called a biopsy. For a biopsy, you receive local or general anesthesia, and the doctor removes tissue samples through a laryngoscope. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if a tumor is cancerous.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

T stands for tumor (its size and how far it has spread within nasopharynx and to nearby organs).

Tis: Carcinoma in situ (cancer cells are present only in the surface layer of the nasopharynx but have not invaded into deeper layers).

T1: Tumor is in the nasopharynx. The cancer may also have grown into the oropharynx (the back of the mouth, where the throat begins) and/or nasal cavity but no farther.

T2: The cancer has grown into the tissues of left or right sides of the upper part of the throat (but not bone)

T3: The tumor has grown from the nasopharynx into the sinuses and/or the bones nearby.

T4: The tumor has grown from the nasopharynx into the skull and/or cranial nerves (nerves in the head that lie near the nasopharynx and have special functions such as vision, smell, and eye movement), the hypopharynx (lower part of the throat), or the eye or its nearby tissues.

N stands for spread to nearby lymph nodes in the neck

N0: No spread to nearby lymph nodes.

N1: Spread to 1 or more lymph nodes on one side of the neck; OR spread to lymph nodes behind the throat (called retropharyngeal lymph nodes) on either side of the neck. In either case, no lymph node is larger than 6 cm (about 2½ inches) across.

N2: Spread to lymph nodes not larger than 6 cm across, on both sides of the neck.

N3: Spread to 1 or more lymph nodes that are either:

N3a: larger than 6 cm across
N3b: are located in the shoulder area just above the collarbone (this area is called the supraclavicular fossa)

M is for metastasis (spread to distant organs).

M0: The cancer has not spread to distant sites.

M1: The cancer has spread to distant sites.

Stage Grouping

Stage 0
Tis, N0, M0

Stage II
T2, N0, M0
T1 or T2, N1, M0
Stage III
T3, N0 to N2, M0
T1 or T2, N2, M0

Stage IVA
T4, N0 to N2, M0

Stage IVB
Any T, N3, M0

Stage IVC
Any T, any N, M1

RADIATION THERAPY
is the use of high-dose X-rays to destroy cancer cells and shrink tumors and is the primary modality to treat nasopharynx cancer. It may be used alone for early disease

Radiation therapy with chemotherapy is used for more advanced disease

SURGERY
may be used for involved lymph nodes that don’t respond to radiation and chemotherapy

CHEMOTHERAPY
alone may be used if the disease has spread

Possible Treatment Side Effects
Dr. Farber, Dr. Spierer, and their staff at The Farber Center for Radiation Oncology will discuss potential side effects with you before, during, and after treatment, and ensure that your experience is personalized.