Nasopharyngeal cancer

The symptoms of nasopharyngeal cancer can include:

• a painless swelling or lump in the upper neck, which is often the first symptom
• changes in hearing
• earache
• fluid leaking from the ear
• a blocked nose
• nosebleeds
• a headache

With certain symptoms, your doctor should refer you to see a specialist within 2 weeks. This includes having a lump in the neck that doesn't go away.

Other conditions can often cause all of these symptoms. Even so, it's important to have them checked by your doctor, because nasopharyngeal cancer can be treated more successfully when it's diagnosed early.

Macmillan Cancer Support, a UK charity, has more information about the symptoms of head and neck cancer.

You usually start by seeing your doctor. If they think your symptoms could be linked to cancer, they'll refer you to a specialist doctor, and you'll usually see that specialist within 2 weeks. It may be an ear, nose and throat (ENT) specialist.

If a lump in your neck is your only symptom, you may be referred to a hospital that has a neck lump clinic.

The specialist doctor will ask about your symptoms and your general health. You may then have some of the following tests.

A nasendoscope is a thin, flexible tube with a light and a camera on the end. Your doctor uses it to look inside your nose, and at the back of your nose and your throat.

To make a diagnosis of nasopharyngeal cancer, your doctor needs to take a small piece of tissue or some cells (a biopsy) from the area that looks abnormal. Sometimes the doctor does this while examining you with the nasendoscope. Or they may arrange for you to have a general anaesthetic so the biopsy can be taken.

The sample then goes to a pathologist, a doctor who specialises in analysing cells. The pathologist looks at it under a microscope to check for cancer cells.

If you have a lump or swelling in your neck, the doctor will usually arrange an ultrasound scan of that area. The scan uses soundwaves to make a picture of your neck and the lymph nodes nearby.

The specialist may arrange more tests. Some of these can help confirm nasopharyngeal cancer, and others are used to check the size of the cancer and whether it has spread, which doctors call staging.

A CT scan takes a series of X-rays and puts them together to build a three-dimensional (3D) picture of your head and neck.

An MRI scan uses magnetism to build up a detailed picture of your head and neck.

A PET-CT scan gives your doctors more detailed information about the part of your body that is being scanned.

If you have nasopharyngeal cancer, your doctor may test the cancer cells to see if the cancer is linked to the Epstein-Barr virus (EBV). This is the virus that causes glandular fever.

Almost everyone is infected with EBV at some time in their life. The body's immune system can normally get rid of the virus, and the infection usually causes no problems.

Only a very small number of people who have had EBV go on to develop nasopharyngeal cancer. Most people with EBV will not develop it.

Waiting for test results can be a difficult time, and support can help while you wait.

Your test results help your doctors find out more about the size and position of the nasopharyngeal cancer, and whether it has spread. This is called staging. The grade of the cancer gives an idea of how quickly it may develop.

Knowing the stage and grade supports your doctors in planning the best treatment for you.

For nasopharyngeal cancer, the staging systems most often used are the TNM and number staging systems.

TNM stands for tumour, node and metastases.

T tells you the size of the tumour and where it sits in the nasopharynx, nose and throat. It also tells you whether the tumour has grown into nearby tissues, like the bones, nerves or muscles. In nasopharyngeal cancer, T is numbered between 0 and 4.

T0 means there are no signs of a tumour, but there may be abnormal cells that are pre-cancerous. Or, lymph nodes in the neck contain cancer cells that test positive for the Epstein Barr virus.

T1 means the tumour is only in the nasopharynx and the nose, or back of the throat (oropharynx).

T2 means the tumour has spread further into the surrounding tissue or muscle.

T3 means the tumour is larger and has spread to structures around the nasopharynx, including the sinuses and bone at the base of the skull.

T4 means the tumour has grown further into nearby nerves, bones, muscles or other areas of the skull.

N tells you whether the nasopharyngeal cancer has spread to the lymph nodes.

M tells you whether nasopharyngeal cancer has spread to another part of the body. Doctors call this metastatic cancer.

The number staging system pulls together all the information from TNM staging and gives it a number from 1 to 4.

A team of specialists will meet to talk about the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your cancer doctor or specialist nurse will explain the different treatments, any possible side effects and the support you have. They'll also talk with you about the things to think about when making treatment decisions, before you agree (consent) to have treatment.

You'll usually be given advice on getting ready for your treatment too (sometimes called prehabilitation). This helps improve your fitness and diet, and prepares you mentally before treatment starts. If you smoke, it can also help you stop.

These treatments may be used for nasopharyngeal cancer.

Radiotherapy uses high-energy rays to destroy cancer cells while doing as little harm as possible to normal cells. For nasopharyngeal cancer, it is usually the main treatment.

If you have stage 1 (early stage) nasopharyngeal cancer, you may have radiotherapy on its own. If the cancer is locally advanced, you usually have radiotherapy together with chemotherapy (chemoradiation).

The lymph nodes in the neck are also usually treated with radiotherapy, even when there are no signs of cancer there. There may still be some cancer cells in these nodes, so the treatment is given to reduce the risk of the cancer coming back in this area.

The type of radiotherapy most often used is called intensity-modulated radiotherapy (IMRT). Less commonly, another type called stereotactic radiotherapy may be used, and you may need only one session of this.

Radiotherapy may also be used to control symptoms if the cancer has spread to other parts of the body.

You may have side effects for a few weeks after radiotherapy. These usually get better slowly once treatment has finished.

Chemoradiation means having chemotherapy and radiotherapy together. The chemotherapy can make the cancer cells more sensitive to the radiotherapy, so the two work better side by side.

If you have locally advanced nasopharyngeal cancer, chemoradiation is usually the main treatment.

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. For nasopharyngeal cancer, it's usually given together with radiotherapy.

Sometimes you may have chemotherapy on its own first, to shrink a tumour before you start chemoradiation treatment.

Chemotherapy may also be given if the cancer has come back or has spread to other parts of the body.

The drug most commonly used with radiotherapy for nasopharyngeal cancer is cisplatin. Sometimes cisplatin is combined with other chemotherapy drugs, like fluorouracil (5FU) or gemcitabine (Gemzar).

Doctors sometimes use surgery to remove nasopharyngeal cancer that has come back, or that hasn't gone away completely after chemoradiation or radiotherapy.

Surgery may also be used to remove the lymph nodes in the neck.

You may have some of your treatments as part of a clinical trial.

After nasopharyngeal cancer treatment, you'll have regular follow-up appointments. These may go on for several years.

You may also see some other specialists regularly, such as a:

• speech and language therapist (SLT)
• dietitian
• restorative dentist
• dental hygienist

If you have any problems or notice new symptoms between appointments, let your doctor know as soon as possible.

Nasopharyngeal cancer, like other head and neck cancers, and its treatment can sometimes affect your sex life. If this worries you, talk to your doctor or nurse.

Some treatments for nasopharyngeal cancer can also affect whether you can get pregnant or make someone pregnant. If you're worried about this, it's important to talk with your doctor before you start treatment.

Macmillan Cancer Support has more information about:

• fertility in women after treatment
• fertility in men after treatment
• LGBTQ+ people and cancer treatment

Even if you already live healthily, you may want to make a few positive changes during and after treatment for nasopharyngeal cancer. If you smoke, it's best to stop. If you drink alcohol, it's best to cut down the amount.

Eating well and staying active can improve your health and wellbeing, and they can help your body recover too. If you have any trouble eating after treatment, your dietitian can help.

It may take several months to recover from nasopharyngeal cancer treatment. It can be hard if treatment has changed your appearance, how you eat or drink, or your voice. This may also affect your body image, but there are ways to help you manage any changes.

You may still be coping with difficult feelings. Talking to your family and friends or health professionals about how you feel can help them know how to support your wellbeing.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan head and neck cancer forum, where you can talk to others affected by head and neck cancer, ask questions and share your experience

Other organisations that offer information and support include:

• The Mouth Cancer Foundation, which gives information and support to people affected by head and neck cancers
• Changing Faces, which offers advice and information to anyone who is affected by a change in their appearance
• The Swallows, which offers a 24-hour support line to anyone affected by head and neck cancer
• Salivary Gland Cancer UK, which supports people with rare salivary gland cancers

When you post on any of these forums, don't include personal information such as your name, your location or any personal health conditions.