Treatment Options, by Stage of Nasopharyngeal Cancer

Your cancer care team will recommend treatment options depending on the stage – the extent of the cancer in the nasopharynx and if and how far the cancer has spread. Nasopharyngeal cancer (NPC) in children is treated largely the same way as NPC in adults. Experts agree that the best way to treat NPC in the more advanced stages is in a clinical trial.

Stages 0 and I

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

The cancer has not yet spread to lymph nodes in these stages, but the nearby lymph nodes in the neck are usually treated with radiation therapy as well. This is preventive (prophylactic) radiation. It's done because 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.

Stages II, III, IVA, and IVB

These cancers have spread outside of the nasopharynx, which may mean spread to lymph nodes in the neck or above the collarbone.

Patients with these stages of NPC usually get chemoradiation (chemotherapy given along with radiation therapy) to the nasopharynx and neck lymph nodes. The chemo drug most often used is cisplatin, but sometimes it's given along with another drug. This is usually followed by more chemo, most often with cisplatin plus 5-FU. Most studies have found that chemoradiation helps patients live longer than just radiation therapy alone. But adding chemo leads to more side effects, which can affect quality of life. It’s important to understand what the side effects are likely to be before starting this treatment.

Other treatment options in these stages include induction chemo followed by chemoradiation or just chemoradiation.

If cancer is still in the lymph nodes after this treatment, surgery (neck dissection) may be done to remove the lymph nodes.

Stage IVC

These NPCS 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's no sign of the cancer after chemo, either 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 chemo, another chemo regimen using different drugs may be tried. Chemotherapy plus the targeted drug cetuximab (Erbitux®) may be another option.

Recurrent nasopharyngeal cancer

Cancer is called recurrent when it come backs after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone). If NPC returns after treatment, your choices depend on the location and 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 – whether it's to try to cure the cancer, to slow its growth, or to help relieve symptoms – as well as the likelihood of benefits and risks.

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

Recurrent NPC in regional (neck) lymph nodes can sometimes be treated with radiation therapy. But if doctors believe that more radiation would cause serious side effects or if the cancer didn't respond to radiation the first time, surgery (neck dissection) may be used instead.

Cancer that recurs in distant sites is usually treated with chemotherapy. If chemo has been given already, different chemo drugs may be tried. The targeted drug cetuximab may be given along with chemo, but this is usually done as part of a clinical trial.

If chemo is no longer working, an option might be treatment with an immunotherapy drug such as pembrolizumab (Keytruda®) or nivolumab (Opdivo®). These drugs can help the body’s own immune system attack the cancer. (See Cancer Immunotherapy to learn more.)

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

If the cancer can’t be cured, further treatments may 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.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

National Cancer Institute. Nasopharyngeal Cancer Treatment (Adult) (PDQ®)–Patient Version. March 1, 2018. Accessed at www.cancer.gov/types/head-and-neck/patient/adult/nasopharyngeal-treatment-pdq on April 24, 2018.

National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Head and Neck Cancers, Version I.2018 -- February 15, 2018. Accessed at www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf on April 24, 2018.

Last Medical Review: September 24, 2018 Last Revised: September 24, 2018

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