Nasopharyngeal cancer is a cancer that starts in the nasopharynx, the upper part of the throat behind the nose and near the base of skull. To understand nasopharyngeal cancer, it helps to know about the structure and function of the nasopharynx.

About the nasopharynx

The nasopharynx is the upper part of the throat (pharynx) that lies behind the nose. It is a box-like chamber about 1½ inches on each edge. It lies just above the soft part of the roof of the mouth (soft palate) and just in back of the nasal passages.

Survival rates tell you what portion of people with the same type and stage of cancer are still alive a certain amount of time (such as 5 years) after they were diagnosed. They can’t tell you how long you will live, but they may help give you a better understanding about how likely it is that your treatment will be successful. Some people will want to know the survival rates for their cancer, and some people won’t. If you don’t want to know, you don’t have to.

What is a survival rate?

Statistics on the outlook for a certain type and stage of cancer are often given as 5-year survival rates, but many people live longer – often much longer – than 5 years. The 5-year survival rate is the percentage of people who live at least 5 years after being diagnosed with cancer. For example, a 5-year survival rate of 70% means that an estimated 70 out of 100 people who have that cancer are still alive 5 years after being diagnosed. Keep in mind, however, that many of these people live much longer than 5 years after diagnosis.

Relative survival rates are a more accurate way to estimate the effect of cancer on survival. These rates compare people with a certain type (and stage) of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific type and stage of cancer is 80%, it means that people who have that cancer are, on average, about 80% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed.

But keep in mind that survival rates are estimates – your outlook can vary based on a number of factors specific to you.

Cancer survival rates don’t tell the whole story

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they can’t predict what will happen in any particular person’s case. There are some limitations to remember:

• The numbers below are among the most current available. But to get 5-year survival rates, doctors have to look at people who were treated at least several years ago. As treatments are improving over time, people who are now being diagnosed with nasopharyngeal cancer may have a better outlook than these statistics show.
• These statistics are based on the stage of the cancer when it was first diagnosed. They do not apply to cancers that later come back or spread, for example.
• The outlook for people with nasopharyngeal cancer varies by the stage (extent) of the cancer – in general, the survival rates are higher for people with earlier stage cancers. But many other factors can also affect a person’s outlook, such as a person’s age and overall health, where the cancer is in the body, and how well the cancer responds to treatment. The outlook for each person is specific to their circumstances.

Your doctor can tell you how these numbers may apply to you, as he or she is familiar with your particular situation.

Survival rates for nasopharyngeal cancer

The numbers below were published in 2010 in the 7^th edition of the AJCC Cancer Staging Manual and are based on people diagnosed between 1998 and 1999.

Remember, these survival rates are only estimates – they can’t predict what will happen to any individual. We understand that these statistics can be confusing and may lead you to have more questions. Talk with your doctor to better understand your situation.

Research into the causes, prevention, and treatment of nasopharyngeal cancer (NPC) is being done in many university hospitals, medical centers, and other institutions around the world.

Causes, prevention, and early detection

Many studies are looking at how Epstein-Barr virus (EBV) infection and other risk factors cause cells of the nasopharynx to become cancerous. Researchers hope these studies may eventually lead to vaccines to help prevent some cases of NPC by avoiding EBV infection.

Recent discoveries about EBV, its interaction with nasopharyngeal cells, and the immune system’s reaction to EBV have led to new blood tests that may help detect NPC early and better predict the response to treatment. These tests are now being studied in areas of the world where this cancer is common.

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.

New radiation therapy techniques

Most types of radiation therapy use radiation in the form of x-rays. Another type of radiation uses protons to kill cancer cells, instead. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and then release their energy after traveling a certain distance. This means that proton beam radiation may be able to deliver more radiation to the tumor and do less damage to nearby normal tissues. Although this approach is promising in theory, it hasn’t been proven to be better than x-ray techniques like IMRT. Also, the machines needed for proton therapy are very expensive, and so this treatment is not widely available.

Doctors are also studying the best schedule for giving radiation therapy. External beam radiation treatments are usually given once a day, 5 days a week, for many weeks in a row. Studies are now under way to see if schedules that either give the doses over fewer days or give smaller doses twice a day might be more effective.

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.

Nasopharyngeal cancer (NPC) is most often diagnosed when a person goes to a doctor because of symptoms such as a lump in the neck. The doctor will take a history, do an exam, and then may refer the patient to a specialist and/or order some tests.

Medical history and physical exam

If you have any signs or symptoms that suggest you might have nasopharyngeal cancer, your doctor will want to get your complete medical history to learn about your symptoms and any possible risk factors, including your family history.

A physical exam will be done to look for signs of NPC or other health problems. During the exam, the doctor will pay special attention to the head and neck area, including the nose, mouth, and throat; the facial muscles, and the lymph nodes in the neck.

If your doctor suspects you may have a tumor or other problem in the nose or throat, he or she may order imaging tests (such as CT or MRI) to look at the head and neck area more closely. Your doctor may also refer you to an otolaryngologist (a doctor specializing in ear, nose, and throat problems, also sometimes called an ENT doctor), who will do a more thorough exam of the nasopharynx. The nasopharynx is a difficult area to examine. Most other kinds of doctors do not have the specialized training or equipment to do a thorough exam of this part of the body.

Exams of the nasopharynx

The nasopharynx is located deep inside the head and is not easily seen, so special techniques are needed to examine this area. There are 2 main types of exams used to look inside the nasopharynx for abnormal growths, bleeding, or other signs of disease. Both types of exams are usually done in the doctor's office.

• For indirect nasopharyngoscopy, the doctor uses special small mirrors and lights placed at the back of your throat to look at the nasopharynx and nearby areas.
• For direct nasopharyngoscopy, the doctor uses a fiber-optic scope known as a nasopharyngoscope (a flexible, lighted, narrow tube inserted through the nose) to look directly at the lining of the nasopharynx. You will have numbing medicine sprayed into your nose before the exam to make it easier. This is the method most often used to carefully examine the nasopharynx.

If a tumor starts under the lining of the nasopharynx (in the tissue called the submucosa), it may not be possible to see it directly on physical exam, which is why imaging tests such as CT scans (see below) may be needed as well.

Biopsy

Symptoms and the results of exams can suggest that a person might have NPC, but the actual diagnosis is made by removing cells from an abnormal area and looking at them under a microscope. This is known as a biopsy. Different types of biopsies may be done, depending on where the abnormal area is.

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.

Fine needle aspiration (FNA) biopsy

An FNA biopsy may be used if you have a suspicious lump in or near your neck. For this procedure, the doctor uses a thin, hollow needle attached to a syringe to aspirate (withdraw) a few drops of fluid containing cells and tiny fragments of tissue. A local anesthetic (numbing medicine) may be used on the skin where the needle will be inserted might be numbed with a local anesthetic but sometimes this is not needed.

The doctor places the needle directly into the mass for about 10 seconds and withdraws cells and a few drops of fluid. The cells are then looked at under a microscope to see if they are cancerous.

An FNA biopsy can help determine if an enlarged lymph node in the neck area is caused by a response to an infection, the spread of cancer from somewhere else (such as the nasopharynx), or a cancer that begins in lymph nodes – called a lymphoma. If the cancer started somewhere else, the FNA biopsy alone might not be able to tell where it started. But if a patient already known to have NPC has enlarged neck lymph nodes, FNA can help determine if the spread of NPC caused the lymph node swelling.

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.

Computed tomography (CT) scan

The CT scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines them into images of slices of the part of your body that is being studied.

Before the pictures are taken, you may get an IV (intravenous) line through which a kind of contrast dye (IV contrast) is injected. This helps better outline structures in your body. You may also be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. It may not be needed for CT scans of the nasopharynx.

The injection can cause some flushing (redness and warm feeling). Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies or have ever had a reaction to a contrast material used for x-rays.

You need to lie still on a table while the scan is being done. During the test, the table slides in and out of the scanner, a ring-shaped machine that completely surrounds the table. You might feel a bit confined by the ring you have to lie in while the pictures are being taken.

A CT scan of the head and neck can provide information about the size, shape, and position of a tumor and can help find enlarged lymph nodes that might contain cancer. CT scans or MRIs are important in looking for cancer that may have grown into the bones at the base of the skull. This is a common place for nasopharyngeal cancer to grow. CT scans can also be used to look for tumors in other parts of the body.

Magnetic resonance imaging (MRI) scan

Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into very detailed images of parts of the body. A contrast material called gadolinium is often injected into a vein before the scan to better see details.

MRI scans may be a little more uncomfortable than CT scans. They take longer – often up to an hour. You may be asked to lie on a table that slides inside a large tube, which is confining and can upset people with a fear of enclosed spaces. Special, “open” MRI machines can sometimes help with this if needed, but the drawback is that the images may not be as clear. The MRI machine makes buzzing and clicking noises that you may find disturbing. Some places will provide earplugs to help block this noise out.

Like CT scans, MRIs can be used to try to determine if the cancer has grown into structures near the nasopharynx. MRIs are a little better than CT scans at showing the soft tissues in the nose and throat, but they’re not quite as good for looking at the bones at the base of the skull, a common place for nasopharyngeal cancer to grow.

Positron emission tomography (PET) scan

For a PET scan, you receive an injection of a form of radioactive sugar (known as fluorodeoxyglucose or FDG). The amount of radioactivity used is low. Because cancer cells in the body are growing rapidly, they absorb large amounts of the sugar. After about an hour, you are moved onto a table in the PET scanner. You lie on the table for about 30 minutes while a special camera creates a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your whole body.

Your doctor may use this test to see if the cancer has spread to your lymph nodes. It can also help give the doctor a better idea of whether an abnormal area on a chest x-ray may be cancer. A PET scan can also be useful if your doctor thinks the cancer may have spread but doesn’t know where.

Some machines are able to do both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET with the more detailed appearance of that area on the CT.

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.

Routine blood counts and blood chemistry tests

Routine blood tests can help determine a patient’s overall health. These tests can help diagnose malnutrition, anemia (low red blood counts), liver disease, and kidney disease. And they may suggest the possibility of spread of the cancer to the liver or bone, which may prompt further testing.

In people getting chemotherapy, blood tests are important to see if the treatment is damaging the bone marrow (where new blood cells are made), liver, and kidneys.

Epstein-Barr virus (EBV) DNA levels

In some patients, the blood level of EBV DNA may be measured before and after treatment to help show how effective treatment is.

After someone is diagnosed with nasopharyngeal cancer (NPC), doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.

The earliest stage of NPC is stage 0, also known as carcinoma in situ (CIS). The other main stages range from I (1) through IV (4). Some stages are split further, using capital letters (A, B, etc.). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

How is the stage determined?

The staging system most often used for nasopharyngeal cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

• The extent of the main tumor (T): How far has the tumor grown into nearby structures?
• The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes in the neck? If so, how large are they?
• The spread (metastasis) to distant sites (M): Has the cancer spread to distant parts of the body? (The most common sites of spread are the lungs, liver, bones, or lymph nodes in distant parts of the body.)

These categories are determined mainly based on the results of any exams, biopsies, and imaging tests that have been done (as described in How Is Nasopharyngeal Cancer Diagnosed?). Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. 

Once the T, N, and M categories of the cancer have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.

The system described below is the most recent AJCC system for NPC, effective January 2018. 

NPC staging can be complex. If you have questions about your cancer's stage and what it might mean for you, ask your doctor to explain it to you in a way you understand.

Stages of nasopharyngeal cancer

• TX: Main tumor cannot be assessed due to lack of information.
• NX: Nearby lymph nodes cannot be assessed due to lack of information.

About 3 out of 4 people with NPC complain of a lump or mass in the neck when they first see their doctor. There may be lumps on both sides of the neck towards the back. The lumps are usually not tender or painful. This is caused by the cancer spreading to lymph nodes in the neck, making them larger than normal. Lymph nodes are glands or organs that contain collections of immune system cells that are found throughout the body. Normally, they are smaller than the size of a pea.

Other possible symptoms of NPC include:

• Hearing loss, ringing in the ear, or feeling of fullness in the ear (especially on one side only)
• Ear infections that keep coming back
• Nasal blockage or stuffiness
• Nosebleeds
• Headache
• Facial pain or numbness
• Trouble opening the mouth
• Blurred or double vision

Ear infections are common in children, but are less common in adults. If you develop an infection in one ear and you have not had ear infections in the past, it is important to have a specialist examine your nasopharynx. This is especially true if you don't have an upper respiratory tract infection (like a “cold”) along with the ear infection.

Many of the symptoms and signs of NPC are more often caused by other, less serious diseases. Still, if you have any of these problems, it's important to see your doctor right away so the cause can be found and treated, if needed.

Cancer survivors can be affected by a number of health problems, but often their greatest concern is facing cancer again. If a cancer comes back after treatment it is called a “recurrence.” But some cancer survivors may develop a new, unrelated cancer later. This is called a “second cancer.” No matter what type of cancer you have had, it is still possible to get another (new) cancer, even after surviving the first.

Unfortunately, being treated for cancer doesn’t mean you can’t get another cancer. People who have had cancer can still get the same types of cancers that other people get. In fact, certain types of cancer and cancer treatments can be linked to a higher risk of certain second cancers.

Survivors of cancer of the nasopharynx can get any second cancer, but they have an increased risk of:

• Cancer of the tongue
• Cancer of the nose and nasal cavity
• Cancer of the esophagus
• Colon cancer
• Cancer of the cervix
• Kidney cancer
• Cancer of the bone and joints
• Non-Hodgkin lymphoma

Follow-up after treatment

After completing treatment for cancer of the nasopharynx, you should still see your doctor regularly. Your doctor may order tests to look for signs that the cancer has come back or spread. These tests are also useful in finding some second cancers, particularly a new lung cancer or cancer of the mouth or throat. Experts don’t recommend any other tests to look for second cancers in patients who don’t have symptoms. Let your doctor know about any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or second cancer.

Survivors of nasopharyngeal cancers should follow the American Cancer Society guidelines for the early detection of cancer and stay away from tobacco products. Smoking increases the risk of getting certain second cancers as well as other health problems.

To help maintain good health, survivors should also:

• Achieve and maintain a healthy weight
• Adopt a physically active lifestyle
• Consume a healthy diet, with an emphasis on plant foods
• Limit consumption of alcohol to no more than 1 drink per day for women or 2 per day for men

These steps may also lower the risk of some cancers.

See Second Cancers in Adults for more information about causes of second cancers.

Nasopharyngeal cancer (NPC) is fairly rare. In most parts of the world (including the United States), there is less than one case for every 100,000 people each year. In 2015, about 3,200 cases will occur in the United States.

This cancer is, however, much more common in certain parts of Asia and North Africa, particularly in southern China. It is also more common among Inuits of Alaska and Canada, and among some immigrant groups in the United States, such as recent Chinese and Hmong immigrants.

The risk of NPC increases slowly throughout life, but it can occur in people of any age, including children. About half of the people with NPC in the United States are younger than 55 years old.

A risk factor is anything that affects a person’s chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person's age or family history, can’t be changed.

But risk factors don’t tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get the disease. And many people who get the disease may have few or no known risk factors.

Scientists have found several risk factors that make a person more likely to develop nasopharyngeal cancer (NPC). These include:

• Gender
• Ethnicity and where you live
• A certain kind of diet
• Infection with the Epstein-Barr virus
• Genetic factors
• Family history

Smoking, alcohol, and some workplace exposures may also increase the risk of this cancer.

These risk factors are discussed in more detail below

Gender

NPC is found about twice as often in males as it is in females.

Race/ethnicity and where you live

NPC is most common in southern China (including Hong Kong), Singapore, Vietnam, Malaysia, and the Philippines. It is also fairly common in Northwest Canada and Greenland.

People of south China have a lower risk of NPC if they move to another area that has lower rates of NPC (like the US or Japan), but their risk is still higher than for people who are native to areas with lower risk. Over time, their risk seems to go down. The risk also goes down in new generations. Although whites born in the United States have a low risk of NPC, whites born in China have a higher risk.

In the United States, NPC is most common in Asian and Pacific Islanders (particularly Chinese Americans), followed by American Indian and Alaskan natives, African Americans, whites, and Hispanics/Latinos.

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.

Epstein-Barr virus infection

Almost all NPC cells contain parts of the Epstein-Barr virus (EBV), and most people with NPC have evidence of infection by this virus in their blood. Infection with EBV is very common throughout the world, often occurring in childhood. In the United States, where infection with this virus tends to occur in slightly older children, it often causes infectious mononucleosis (“mono”), usually in teens.

The link between EBV infection and NPC is complex and not yet completely understood. EBV infection alone is not enough to cause NPC, since infection with this virus is very common and this cancer is rare. Other factors, such as a person’s genes, may affect how the body deals with EBV, which in turn may affect how EBV contributes to the development of NPC.

Genetic factors

A person’s genes may affect their risk for NPC. For example, just as people have different blood types, they also have different tissue types. Studies have found that people with certain inherited tissue types have an increased risk of developing NPC. Tissue types affect immune responses, so this may be related to how a person's body reacts to EBV infection.

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.

Other possible risk factors

Tobacco and alcohol use: Most (but not all) studies have found that smoking may contribute to the development of NPC, especially the keratinizing type. Some studies have linked heavy drinking to this type of cancer. More research is needed to define these links, but they seem to be much weaker than the link between tobacco and alcohol use and most other types of cancers that start in the throat.

Workplace exposures: Some studies have suggested that workplace exposure to formaldehyde or wood dust may increase the risk of NPC. Still, not all studies have shown this and this link isn’t clear.

The exact cause of most cases of nasopharyngeal cancer (NPC) is not known. But scientists have found that the disease is linked with certain diets, infections, and inherited characteristics, which are described in the section called What Are the Risk Factors for Nasopharyngeal Cancer? Research is being done to learn more about these causes.

In recent years, scientists have studied how the Epstein-Barr virus (EBV) may cause cells in the nasopharynx to become cancerous, but much still remains to be learned. In developed countries, most people infected with EBV develop only infectious mononucleosis (mono), and their immune system is able to recognize and destroy the virus. These people recover without any long-term problems. But in some cases, pieces of viral DNA mix with the DNA of cells in the nasopharynx.

DNA is the chemical in each of our cells that makes up our genes, the instructions for how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than how we look. Some genes contain instructions for controlling when cells grow and divide into new cells. Viruses such as EBV also contain DNA. When a cell is infected with the virus, the viral DNA may mix with the normal human DNA. EBV DNA may instruct the cells of the nasopharynx to divide and grow in an abnormal way.

But EBV infection only rarely results in NPC, so other factors probably play a role in whether or not it causes cancer. Eating a diet high in salt-cured fish and meat seems to increase the ability of EBV to cause NPC. Studies show that foods preserved in this way may produce chemicals that can damage DNA. The damaged DNA alters a cell’s ability to control its growth and replication.

Some studies suggest that inheriting certain tissue types may contribute to a person’s risk of developing NPC. Because the tissue type plays a role in the function of the immune system, some scientists suspect that an abnormal immune reaction to EBV infection may be involved. The details of how certain tissue types might increase NPC risk are still being worked out.

Most people in the United States who develop nasopharyngeal cancer (NPC) have no avoidable risk factors, so their cancers could not have been prevented. The possible links with tobacco and heavy alcohol use are not clear, so it’s not known if avoiding these can lower a person’s risk of NPC. However, both tobacco and alcohol use have clearly been linked to a number of other cancers, as well as other health problems, so avoiding them can have many health benefits.

Because certain dietary factors have been linked with NPC risk, reducing or eliminating some types of food may lower the number of cases in parts of the world where NPC is common, such as southern China, northern Africa, and the Arctic region. Descendants of Southeast Asians who immigrated to the United States and eat a typical American diet, for example, have a lower risk of developing NPC. But these dietary factors are not thought to account for all cases of NPC in most other parts of the world. Other factors, such as genetics, are likely to play a part as well.

In the United States and other countries where nasopharyngeal cancer (NPC) is fairly rare, most doctors do not recommend routine screening for this cancer (screening is testing for cancer in people without any symptoms). There are no simple, non-invasive exams or blood tests that can reliably find this cancer early.

But in some parts of the world such as China, where NPC is common, some people are being screened routinely for this cancer. They are first selected because their blood shows evidence of infection with the Epstein-Barr virus, although EBV infection is much more common than NPC. They are given regular exams of the nasopharynx and neck. This approach can also be used in families when one member has developed NPC. It isn’t known if this strategy lowers the death rate from this cancer.

Sometimes NPC can be found early if it causes symptoms that make patients seek medical attention. The symptoms may even seem unrelated to the nasopharynx (for example, a constant feeling of fullness in one ear). But in most people, NPCs may not cause symptoms until they have reached an advanced stage.

If cancer keeps growing or comes back after one kind of treatment, it is possible that another treatment plan might still cure the cancer, or at least shrink it enough to help you live longer and feel better. But when a person has tried many different treatments and has not gotten any better, the cancer tends to become resistant to all treatment. If this happens, it’s important to weigh the possible limited benefits of a new treatment against the possible downsides. Everyone has their own way of looking at this.

This is likely to be the hardest part of your battle with cancer – when you have been through many medical treatments and nothing's working anymore. Your doctor may offer you new options, but at some point you may need to consider that more treatment is not likely to improve your health or change your outcome or survival.

If you want to continue to get treatment for as long as you can, you need to think about the odds of it having any benefit and how this compares to the possible risks and side effects. In many cases, your doctor can estimate how likely it is the cancer will respond to the treatment you are considering. For instance, the doctor may say that more treatment might have about a 1 in 100 chance of working. Some people are still tempted to try this. But it is important to think about and understand your reasons for choosing this plan.

No matter what you decide to do, you need to feel as good as you can. Make sure you are asking for and getting treatment for any symptoms you might have, such as nausea or pain. This type of treatment is called palliative care.

Palliative care helps relieve symptoms, but is not expected to cure the disease. It can be given along with cancer treatment, or can even be cancer treatment. The difference is its purpose – the main purpose of palliative care is to improve the quality of your life, or help you feel as good as you can for as long as you can. Sometimes this means using drugs to help with symptoms like pain or nausea. Sometimes, though, the treatments used to control your symptoms are the same as those used to treat cancer. For instance, radiation might be used to help relieve bone pain caused by cancer that has spread to the bones. Or chemo might be used to help shrink a tumor and keep it from blocking the bowels. But this is not the same as treatment to try to cure the cancer. You can learn more about the changes that occur when curative treatment stops working, and about planning ahead for yourself and your family, in our documents Nearing the End of Life and Advance Directives.

At some point, you may benefit from hospice care. This is special care that treats the person rather than the disease; it focuses on quality rather than length of life. Most of the time, it is given at home. Your cancer may be causing problems that need to be managed, and hospice focuses on your comfort. You should know that while getting hospice care often means the end of treatments such as chemo and radiation, it doesn’t mean you can’t have treatment for the problems caused by your cancer or other health conditions. In hospice the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult time. You can learn more about hospice in our document called Hospice Care.

Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends – times that are filled with happiness and meaning. Pausing at this time in your cancer treatment gives you a chance to refocus on the most important things in your life. Now is the time to do some things you’ve always wanted to do and to stop doing the things you no longer want to do. Though the cancer may be beyond your control, there are still choices you can make.

For many people with nasopharyngeal cancer (NPC), treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.

It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are leading full lives. Our document Living With Uncertainty: The Fear of Cancer Recurrence, gives more detailed information on this.

For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty. Our document When Cancer Doesn’t Go Away talks more about this.

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.

Seeing a new doctor

At some point after your cancer diagnosis and treatment, you may find yourself seeing a new doctor who does not know anything about your medical history. It is important that you be able to give your new doctor the details of your diagnosis and treatment. Make sure you have the following information handy:

• A copy of your pathology report(s) from any biopsies or surgeries
• If you had surgery, a copy of your operative report(s)
• If you stayed in the hospital, a copy of the discharge summary that doctors prepare when patients are sent home
• If you had radiation therapy, a copy of your treatment summary
• If you had chemotherapy or targeted therapy, a list of your drugs, drug doses, and when you took them
• Copies of any imaging tests, such as CT scans and MRIs, which can often be placed on a DVD

The doctor may want copies of this information for his records, but always keep copies for yourself.