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What is cancer?
The body is made up of trillions of living cells. Normal body cells grow, divide into new
cells, and die in an orderly way. During the early years of a person's life, normal cells divide
faster to allow the person to grow. After the person becomes an adult, most cells divide only
to replace worn-out or dying cells or to repair injuries.
Cancer begins when cells in a part of the body start to grow out of control. There are many
kinds of cancer, but they all start because of out-of-control growth of abnormal cells.
Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells
continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into)
other tissues, something that normal cells cannot do. Growing out of control and invading
other tissues are what makes a cell a cancer cell.
Cells become cancer cells because of damage to DNA. DNA is in every cell and directs all its
actions. In a normal cell, when DNA gets damaged the cell either repairs the damage or the
cell dies. In cancer cells, the damaged DNA is not repaired, but the cell doesn’t die like it
should. Instead, this cell goes on making new cells that the body does not need. These new
cells will all have the same damaged DNA as the first cell does.
People can inherit damaged DNA, but most DNA damage is caused by mistakes that happen
while the normal cell is reproducing or by something in our environment. Sometimes the
cause of the DNA damage is something obvious, like cigarette smoking. But often no clear
cause is found.
In most cases the cancer cells form a tumor. Some cancers, like leukemia, rarely form
tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate
through other tissues where they grow.
Cancer cells often travel to other parts of the body, where they begin to grow and form new
tumors that replace normal tissue. This process is called metastasis. It happens when the
cancer cells get into the bloodstream or lymph vessels of our body.
No matter where a cancer may spread, it is always named for the place where it started. For
example, breast cancer that has spread to the liver is still called breast cancer, not liver
cancer. Likewise, prostate cancer that has spread to the bone is metastatic prostate cancer, not
bone cancer.
Different types of cancer can behave very differently. For example, lung cancer and breast
cancer are very different diseases. They grow at different rates and respond to different
treatments. That is why people with cancer need treatment that is aimed at their particular
kind of cancer.
Not all tumors are cancerous. Tumors that aren’t cancer are called benign. Benign tumors can
cause problems – they can grow very large and press on healthy organs and tissues. But they
cannot grow into (invade) other tissues. Because they can’t invade, they also can’t spread to
other parts of the body (metastasize). These tumors are almost never life threatening.
Nasopharyngeal tumors
Several types of tumors can develop in the nasopharynx. Some of these tumors are benign
(non-cancerous), but others are malignant (cancerous). It is important to discuss what type of
tumor you might have with your doctor.
Nasopharyngeal cancers
These tumors can invade surrounding tissues and spread to other parts of the body.
Nasopharyngeal carcinoma (NPC): This is by far the most common malignant tumor of the
nasopharynx. A carcinoma is a cancer that starts in epithelial cells – the cells lining the
internal and external surfaces of the body. Most of the rest of this document refers to NPC.
There are 3 types of NPC, based on how the cancer cells look under the microscope:
• Keratinizing squamous cell carcinoma
• Non-keratinizing differentiated carcinoma
• Undifferentiated carcinoma
Each of these types is seen more often in some areas of the world than in others. In southern
China, where NPC is much more common, nearly all cases are the undifferentiated type. In
the United States, where NPC is rare, about 1 out of 5 cases are the keratinizing type.
Even though these types look different when seen under a microscope, studies have shown
they start from the same cell type – the epithelial cells that line the surface of the
nasopharynx. The treatment is also usually the same for all types of NPC. The stage of the
cancer – how far it has grown and spread – is often more important than its type in predicting
a person's outlook (prognosis).
Many NPCs also contain lots of immune system cells, especially lymphocytes. The term
lymphoepithelioma is sometimes used to describe an undifferentiated NPC with many
lymphocytes among the cancer cells. The presence of these cells does not usually affect the
choice of treatment options. But they may be a clue to developing new treatments since they
may represent the body's attempt to “reject” the tumor (for more information, see the section
“What's new in nasopharyngeal cancer research and treatment?”).
Other cancers in the nasopharynx: Other types of cancers can arise in the nasopharynx.
Lymphomas can sometimes start in the nasopharynx. They are cancers of immune system
cells called lymphocytes, which are found throughout the body, including in the nasopharynx.
These cancers are discussed in our document Non-Hodgkin Lymphoma.
Adenocarcinoma and adenoid cystic carcinoma are cancers that can develop in the minor
salivary glands in the nasopharynx, but these cancers are more commonly found in the nose
(nasal cavity) or mouth (oral cavity). More information on these cancers can be found in our
documents Oral Cavity and Oropharyngeal Cancer, Nasal Cavity and Paranasal Sinuses
Cancer, and Salivary Gland Cancer.
Gender
NPC is found about twice as often in males as it is in females.
Diet
People who live in parts of Asia, northern Africa, and the Arctic region where NPC is
common, typically eat diets very high in salt-cured fish and meat. Indeed, the rate of this
cancer is dropping in southeast China as people begin eating a more Westernized diet. In
contrast, some studies have suggested that diets high in fruits and vegetables may lower the
risk of NPC.
Family history
Family members of people with NPC are more likely to get this cancer. It is not known if this
is because of inherited genes, shared environmental factors (such as the same diet or living
quarters), or some combination of these.
Endoscopic biopsy
If a suspicious growth is found in the nasopharynx during an exam, the doctor may remove a
biopsy sample with small instruments and the aid of a fiber-optic scope. Often, biopsies of
the nasopharynx are done in the operating room as an outpatient procedure. The sample is
then sent to a lab, where a pathologist (a doctor who specializes in diagnosing and classifying
diseases in the lab) looks at it under a microscope. If the biopsy sample contains cancer cells,
the pathologist sends back a report describing the type of the cancer.
NPC is not always visible during an exam. If a person has symptoms suggesting NPC but
nothing abnormal is seen on exam, the doctor may biopsy normal-looking tissue, which may
be found to contain cancer cells when looked at under the microscope.
Imaging tests
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive particles to create
pictures of the inside of your body. Imaging tests may be done for a number of reasons,
including to help find a suspicious area that might be cancerous, to learn how far cancer may
have spread, and to help determine if treatment has been effective.
Chest x-ray
If you have been diagnosed with NPC, a plain x-ray of your chest may be done to see if the
cancer has spread to your lungs. This is very unlikely unless your cancer is far advanced.
This x-ray can be done in any outpatient setting. If the results are normal, you probably don’t
have cancer in your lungs.
Blood tests
Blood tests are not used to diagnose NPC, but they may be done for other reasons, such as to
help determine whether the cancer may have spread to other parts of the body.
I 72%
II 64%
III 62%
IV 38%
The treatment information in this document is not official policy of the Society and is not intended as medical
advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your
family make informed decisions, together with your doctor.
Your doctor may have reasons for suggesting a treatment plan different from these general treatment options.
Don’t hesitate to ask him or her questions about your treatment options.
Cetuximab (Erbitux®)
Cetuximab is a monoclonal antibody (a man-made version of an immune system protein) that
targets the epidermal growth factor receptor (EGFR). EGFR is a protein found on the surface
of cells. It normally receives signals telling the cells to grow and divide. Nasopharyngeal
cancer (NPC) cells sometimes have more than normal amounts of EGFR, which can help
them grow faster. By blocking EGFR, cetuximab may slow or stop this growth.
The exact role of cetuximab in treating NPC is still being studied. It is most often used along
with chemo and/or radiation in cases where the cancer has come back or continues to grow
after initial chemo.
Cetuximab is given by IV infusion, usually once a week. Common side effects include:
• Skin problems, such as an acne-like rash on the face and chest during treatment, which in
some cases can lead to infections.
• Headache
• Tirednes,
• Fever
• Diarrhea
A rare but serious side effect of cetuximab is an allergic reaction during the first infusion,
which could cause breathing problems and low blood pressure. You may be given medicine
before treatment to help prevent this.
For information about managing skin problems from targeted therapy, see our document
Targeted Therapy.
Clinical trials for nasopharyngeal cancer
You may have had to make a lot of decisions since you’ve been told you have cancer. One of
the most important decisions you will make is choosing which treatment is best for you. You
may have heard about clinical trials being done for your type of cancer. Or maybe someone
on your health care team has mentioned a clinical trial to you.
Clinical trials are carefully controlled research studies that are done with patients who
volunteer for them. They are done to get a closer look at promising new treatments or
procedures.
If you would like to take part in a clinical trial, you should start by asking your doctor if your
clinic or hospital conducts clinical trials. You can also call our clinical trials matching service
for a list of clinical trials that meet your medical needs. You can reach this service at 1-800-
303-5691 or on our website at www.cancer.org/clinicaltrials. You can also get a list of
current clinical trials by calling the National Cancer Institute’s Cancer Information Service
toll-free at 1-800-4-CANCER (1-800-422-6237) or by visiting the NCI clinical trials website
at www.cancer.gov/clinicaltrials.
You must meet the requirements to take part in any clinical trial, but if you do meet them you
still get to choose whether or not to enter (enroll in) it.
Clinical trials are one way to get state-of-the art cancer treatment. Sometimes they may be
the only way to get access to some newer treatments. They are also the only way for doctors
to learn better methods to treat cancer. Still, they are not right for everyone.
You can get a lot more information on clinical trials in our document called Clinical Trials:
What You Need to Know.
Stages 0 and I
The usual treatment for these early stage cancers is radiation therapy aimed at the
nasopharyngeal tumor.
Although the cancer has not yet spread to lymph nodes in these stages, the nearby lymph
nodes in the neck are usually treated with radiation therapy as well. This is considered
preventive (prophylactic) radiation. Some patients may have cancer cells in these lymph
nodes that can’t be detected. Although there are too few cancer cells in the lymph nodes to
cause them to be enlarged, these cells could continue to grow and spread if not destroyed by
radiation therapy.
Stage IVC
These nasopharynx cancers have spread to distant parts of the body and can be hard to treat.
The usual treatment is chemo, often with cisplatin and one other drug. If there is no sign of
the cancer after chemotherapy, radiation therapy to the nasopharynx and the lymph nodes in
the neck or chemoradiation is given to try to kill any remaining cancer cells. Another option
in some cases is to give chemoradiation as the first treatment.
If there are still signs of cancer after the initial chemotherapy, another chemotherapy regimen
using different drugs may be tried. Chemotherapy plus the targeted drug cetuximab (Erbitux)
may be another option.
Because these cancers can be hard to treat effectively, taking part in a clinical trial of newer
treatments may be a good option.
Follow-up care
After you have completed treatment, your doctors will still want to watch you closely. It is
very important to go to all of your follow-up appointments. During these visits, your doctors
will ask questions about any problems you may have and may do exams and lab tests or
imaging tests (such as MRI or CT scans) to look for signs of cancer or treatment side effects.
Your health care team will discuss which tests should be done and how often based on the
stage of your cancer and the type of treatment you received.
Most doctors recommend follow-up exams at least every few months for the first 2 years
after treatment, then less often after this. If you had radiation therapy to the neck, your doctor
will check your thyroid function with blood tests once or twice a year.
You may be advised to see your dentist after treatment to check on the health of your teeth.
Your doctor will also want to keep a close eye on your hearing, speech, and swallowing,
which can be affected by treatment. If you are having problems with any of these, your
doctor may refer you to a therapist for help with rehabilitation.
Imaging tests such as CT or PET/CT scans may be done after treatment to get an idea of what
the nasopharynx and neck area now look like. Further imaging tests may be done if you later
develop any signs or symptoms that might be caused by a return of the cancer.
Almost any cancer treatment can have side effects. Some may last for a few weeks to
months, but others can last the rest of your life. This is the time for you to talk to your cancer
care team about any changes or problems you notice and any questions or concerns you have.
It is very important to report any new symptoms to the doctor right away, because they may
prompt your doctor to do tests that could help find recurrent cancer as early as possible, when
the chance of successful treatment is greatest.
If cancer does recur, further treatment will depend on the location of the cancer, what
treatments you’ve had before, and your health. For more information on how recurrent
cancer is treated, see the section "Treatment options, by stage of nasopharyngeal cancer." For
more general information on dealing with a recurrence, you may also want to see our
document When Your Cancer Comes Back: Cancer Recurrence.
It is important to have health insurance. Tests and doctor visits cost a lot, and even though no
one wants to think of their cancer coming back, this could happen.
Eating better
Eating right can be hard for anyone, but it can get even tougher during and after cancer
treatment. This is especially true for cancers of the head and neck, such as nasopharyngeal
cancer. The cancer or its treatment may affect how you swallow or cause dry mouth, changes
in taste, or other problems. Nausea can be a problem from some treatments. You may not feel
like eating and lose weight when you don't want to.
If treatment caused weight changes or eating or taste problems, do the best you can and keep
in mind that these problems usually get better over time. You may find it helps to eat small
portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team
about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with
these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into
place. You may be surprised at the long-term benefits of some simple changes, like
increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight,
eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of
types of cancer, as well as having many other health benefits.
For more information, see our document Nutrition and Physical Activity During and After
Cancer Treatment: Answers to Common Questions.
Treatment
New surgical techniques
Advances in the field of skull base surgery such as the use of endoscopes in the nose now
allow doctors to remove some tumors from hard to reach areas like the nasopharynx. This
type of surgery requires a specialized team that has expertise in this field. It may offer hope
for some patients with recurrent NPC and patients with the keratinizing type of NPC, which
often doesn’t respond to radiation therapy.
Chemotherapy
Researchers continue to develop new chemotherapy drugs, new drug combinations, and new
ways to give drugs that might be more effective against advanced NPC. Several drugs that
are already used to treat other cancers, such as capecitabine, oxaliplatin, and gemcitabine,
have been studied for use against NPC as well.
Clinical trials are also testing ways to best combine chemotherapy with radiation therapy. For
example, studies are comparing the effectiveness of chemotherapy given before, during, or
after radiation therapy.
Targeted therapy
Drugs that target specific parts of cancer cells may prove to be useful against NPC and have
fewer side effects than standard chemotherapy drugs.
The drug cetuximab (Erbitux), which targets the epidermal growth factor receptor (EGFR).
protein found on the surface of cells, is already being used in some cases of NPC that recur
or keep growing after treatment with chemotherapy. Other drugs that target EGFR are also
being studied for use against NPC, including nimotuzumab and icotinib.
Other newer drugs target a tumor’s ability to develop new blood vessels, which they need in
order to grow larger. These drugs are called angiogenesis inhibitors. Several of these drugs
are now being tested for use against NPC, including bevacizumab (Avastin®), sorafenib
(Nexavar®), and pazopanib (Votrient®).
Immunotherapy
NPC seems to be caused at least in part by infection with the Epstein-Barr virus (EBV).
Although patients’ immune systems can be shown to have reacted against EBV, this doesn’t
seem to be enough to kill the cancer. Researchers are trying to use different ways to boost the
immune system or help it better target EBV-infected cells.
One way to do this is to remove T lymphocytes (immune system cells) from the blood of
patients with NPC and alter them in the lab to increase their numbers and their power to kill
EBV. The cells are then injected back into the patients. Early results with small numbers of
patients have been promising, and larger studies of this technique are now under way.
Gene therapy
Scientists have recently discovered how certain gene mutations (changes) in nasopharyngeal
cells may cause them to become cancerous. A clinical trial using a virus to replace the
damaged tumor suppressor gene p53 in the cancer cells had some promising results. This
approach is still being studied.
No matter who you are, we can help. Contact us anytime, day or night, for information and
support. Call us at 1-800-227-2345 or visit www.cancer.org.
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Last Medical Review: 1/15/2015
Last Revised: 8/8/2016