Treating Nasopharyngeal Cancer

The usual treatment for these early-stage cancers is radiation therapy aimed at the tumor.

In these stages, the cancer probably has not yet spread but the nearby lymph nodes in the neck are treated with radiation therapy as well. This is preventive (prophylactic) radiation. It is done because some people may have cancer cells in these lymph nodes that can’t be found by imaging or other methods.

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.

Most people with stage II NPC get chemoradiation to the nasopharynx and neck lymph nodes. This is chemotherapy given along with radiation therapy.

Cisplatin is the chemo drug most often used. Chemoradiation is usually followed by more chemo. Most studies have found chemoradiation helps people live longer than radiation therapy alone. However, adding chemo can lead to more side effects, which can affect quality of life. Before starting this treatment, it’s important to understand the possible side effects.

If cancer is still in the lymph nodes after any of the above treatments, surgery might be done to remove the main tumor, if possible, and the lymph nodes.

People with stage III NPC are usually treated with one of the following options:

• Clinical trial
• Chemotherapy first, called induction chemo, followed by chemoradiation to the nasopharynx and neck lymph nodes
• Chemoradiation to the nasopharynx and neck lymph nodes followed by chemotherapy alone
• Chemoradiation to the nasopharynx and neck lymph nodes

Induction chemo followed by chemoradiation can help some people live longer. Common chemo drug combinations used in induction chemo are:

• Gemcitabine with cisplatin
• Docetaxel with cisplatin and 5-FU

If cancer cells are still in the lymph nodes after any of the above treatments, surgery might be done to remove the main tumor, if possible, and the lymph nodes.

The usual treatment for stage IVA or IVB nasopharyngeal cancer is chemo, often with cisplatin and one other drug.

• If there is no sign of the cancer after chemo, chemoradiation might be given to try to kill any remaining cancer cells.
• Chemoradiation as the first treatment is another option in some cases.
• Immunotherapy is another option to treat some of these cancers, either alone or along with chemo.

If there are still signs of cancer after the initial chemo, different chemo drugs may be tried. Chemotherapy plus the targeted drug cetuximab (Erbitux) or immunotherapy may be other options.

Recurrent cancer is cancer that comes back after treatment. It can come back in or near the same place it started (local recurrence) or spread to organs such as the lungs or bone (distant recurrence).

If nasopharyngeal cancer returns after treatment, your choices will depend on where it returns, the extent of the cancer, which treatments were used the first time around, and your overall health.

It's important to understand the goal of any further treatment. Ask your cancer care team whether your treatment plan is meant to cure the cancer, to slow its growth, or to help relieve your symptoms.

Endoscopic surgery

Some tumors that recur in the nasopharynx can be removed through the nose by endoscopic surgery. This is a specialized surgery that should only be done by a surgeon with a great deal of experience, so it’s not available at all medical centers.

Recurrent NPC in neck lymph nodes

Recurrent NPC in neck lymph nodes can sometimes be treated with radiation therapy a second time. In select cases, highly targeted techniques such as proton radiation therapy may be considered to help limit radiation exposure to nearby normal tissues.

If doctors believe more radiation would cause serious side effects, or if the cancer didn't respond to radiation the first time, surgery (neck dissection) might be used instead. The radiation oncology doctor will carefully review your options.

Distant recurrence

If the cancer recurs in distant part of the body, options might include chemotherapy, immunotherapy, or both. If chemo has been given already, different chemo drugs may be tried. The targeted drug cetuximab might be given along with chemo.

Clinical trials

New drug treatments and new surgical procedures being tested in clinical trials might help some people with recurrent NPC, as well as improve knowledge that could help others with NPC in the future.

If the cancer can’t be cured

If the cancer can’t be cured, further treatments might be aimed at slowing its growth or relieving symptoms caused by the cancer.

For example, if the cancer has spread to the spine, radiation may be given to the area to relieve pain and reduce the chances of further problems. Even if a cure is not possible, it's important to remember that there are many options to relieve symptoms of advanced cancer.