Nasopharyngeal Cancer: NCCN Guidelines for Patients
September 5, 2022 - read ≈ 6 min
The NCCN Guidelines for Patients were developed by the National Comprehensive Cancer Network (NCCN). NCCN is an organization that unites leading cancer care centers in the United States of America. Its activities are focused on scientific research, treatment and education of patients.
Nasopharyngeal cancer basics
Nasopharyngeal cancer is a type of throat cancer. Read this chapter to learn where this cancer grows and what puts people at risk for this cancer.
Before learning about nasopharyngeal cancer, it is helpful to know about the throat. The throat is also called the pharynx.
The pharynx is a tube-like structure within the head. It starts behind the nose and ends at the voice box (larynx). Food passes from the mouth through the pharynx on its way to the stomach.
Air also passes from either the mouth or nose through the pharynx on its way to the lungs.
The pharynx has 3 parts, which are the:
The nasopharynx is behind the nose. The oropharynx is below the nasopharynx. The hypopharynx is below the oropharynx and just behind the voice box. See Figure 1.
Throughout your body — including your throat — is a clear fluid called lymph. Lymph contains food and water for your cells. It also contains germ-fighting blood cells. Lymph drains from body tissues into channels that transport it to the bloodstream.
As lymph travels, it passes through lymph tissue. Lymph tissue removes germs from lymph. Lymph nodes are small structures that contain lymph tissue. They are found throughout the body. There are many lymph nodes in the left and right sides of the neck. See Figure 2.
The tonsils are larger clusters of lymph tissue. There is a tonsil on the left and right side of the throat. There are similar clusters of lymph tissue in the nasopharynx and at the back of the tongue.
Head and neck cancer
Head and neck cancer is a group of cancers. It includes cancers of the inner lip, mouth, throat, voice box, nose, and sinuses. These cancers are referred to as upper aerodigestive tract cancers.
This book is about treatment for nasopharyngeal carcinoma. Almost all nasopharyngeal cancers are carcinomas. Carcinomas are cancers of cells that line the inner or outer surfaces of the body. Nasopharyngeal carcinoma forms from cells that line the nasopharynx. The cancer cells can grow into nearby tissue, such as the skull. They often spread to lymph nodes behind the ears and in the neck.
There are three classes of nasopharyngeal carcinoma:
- Nonkeratinizing carcinoma
- Keratinizing squamous cell carcinoma
- Basaloid squamous cell carcinoma
Nasopharyngeal cancers are further grouped by how they look under a microscope.
- Well differentiated cancers look like normal tissue.
- Poorly differentiated cancers look less like normal tissue.
- Undifferentiated cancers don’t look like normal tissue.
Nonkeratinizing carcinomas can be undifferentiated. Among nasopharyngeal cancers, the undifferentiated type is the most common. It is also called a lymphoepithelioma.
A risk factor is anything that increases your chance of cancer. Worldwide, several risk factors are linked to nasopharyngeal cancer.
- In some parts of the world, nasopharyngeal cancer is commonly linked to alcohol and tobacco use.
- In other areas, it is linked to often eating salt-cured foods.
- There is a very strong link between nasopharyngeal cancer and the Epstein-Barr virus.
Most people who have the Epstein-Barr virus do not get nasopharyngeal cancer. In Asia and Africa, the cause of nasopharyngeal cancer for most people appears to be an interaction of the virus with other factors. In the United States, the virus is a less common cause.
This section briefly describes treatments for nasopharyngeal cancer. Not everyone receives the same treatment. Your doctor will tailor treatment to you based on tests described in in Part 2. Treatment options based on cancer features are listed in Part 3.
One treatment choice may be a clinical trial. Clinical trials are strongly supported by NCCN. NCCN believes that you will receive the best management if treated in a clinical trial.
A clinical trial is a type of research that studies a promising test or treatment in people. It gives people access to health care that otherwise couldn’t usually be received. Clinical trials of treatment often include new treatments added to standard treatments. Ask your treatment team if there is an open clinical trial that you can join.
Radiation therapy uses high-energy x-rays or particles to treat nasopharyngeal cancer. It damages cancer cells. The cancer cells either die or stop making new cancer cells.
External beam radiation therapy (EBRT) is used for treatment. A large machine makes radiation beams that are shaped to the form of the tumor. The highest radiation dose is aimed at the cancer. A much lower dose is given to nearby tissue. NCCN experts recommend the following techniques:
- Intensity-modulated radiation therapy (IMRT) is the preferred technique. It delivers x-ray beams that very closely match the shape of the target and spares more normal tissue.
- Three-dimensional conformal radiation therapy (3D-CRT) delivers an x-ray beam that matches the shape of the target but may not be as focused as IMRT.
- Proton therapy treats cancer with proton beams. Proton beams deliver radiation mostly within the tumor. NCCN experts advise to get proton therapy only when x-ray beams would damage too much normal tissue.
Chemotherapy is a treatment with drugs that stop the cell life cycle. As a result, cancer cells cannot make new cells. Chemotherapy can also cause cells to destroy themselves.
Cisplatin, carboplatin, 5-fluorouracil (5-FU), and gemcitabine are commonly used to treat nasopharyngeal cancer. There are other drugs that are less often used but can work.
Chemotherapy may be received with radiation therapy. It improves the results of radiation. When received at the same time, it is called chemoradiation. Chemotherapy may also be received alone. Chemotherapy by itself may be received first or last in a series of treatment.
Targeted therapy is a treatment with drugs that stop some of the ways by which cancer cells grow. Cetuximab is a targeted therapy that stops growth signals from a structure called EGFR that is on cancer cells. It also allows immune cells to destroy the cancer cells. It is given with carboplatin to treat some nasopharyngeal cancers.
T cells are a type of white blood cell. They help fight disease, including cancer. But, they are unable to attack cancer cells that have a protein called PD-L1.
Immune checkpoint inhibitors are a type of immunotherapy. These drugs include pembrolizumab and nivolumab. They allow T cells to attack cancer cells with PD-L1. They are routinely used to treat some advanced throat cancers but are also being tested for other uses.
Surgery is a treatment that removes tumors or entire organs with cancer. It is not a common treatment for tumors in the nasopharynx. More often, surgery that removes lymph nodes in the neck is done. This type of surgery is called a neck dissection.
- The nasopharynx is the part of the throat that is behind the nose.
- Most nasopharyngeal cancers form from cells that line the surface of the upper throat.
- There is a strong link between nasopharyngeal cancer and the Epstein-Barr virus.
- Not everyone receives the same treatment for nasopharyngeal cancer. Your treatment will be partly based on test results.
You can read more about Nasopharyngeal Cancer, its treatment methods and follow-up after treatment in the full text of the recommendations for patients by downloading it below.