Treatment Options, by Stage of Nasopharyngeal Cancer
Your cancer care team will recommend treatment options depending on the extent of the cancer at its site of origin and how far the cancer has spread, if at all. Nasopharyngeal cancer (NPC) in children is treated largely the same way as NPC in adults.
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.
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 receive chemoradiation (chemotherapy given along with radiation therapy to the nasopharynx and neck lymph nodes). The chemotherapy (chemo) drug most often used is cisplatin, but sometimes another drug is used as well. 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.
If cancer is still in the lymph nodes after this treatment, surgery (neck dissection) may be done to remove the lymph nodes.
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.
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 your cancer returns after treatment, the choices available to you depend on the location and extent of the cancer, which treatments were used the first time around, and your overall health. It is important to understand the goal of any further treatment – whether it is 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 using an approach 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 in this procedure, so it’s not available at all medical centers.
Recurrent NPC in regional (neck area) lymph nodes can sometimes be treated by additional radiation therapy. But if doctors believe that more radiation would cause serious side effects or if the initial response to radiation was incomplete, surgery (neck dissection) may be used instead.
Cancer that recurs in distant sites is usually treated with chemotherapy. If chemotherapy has been given already, different chemo drugs may be tried. The targeted drug cetuximab may be given along with chemo, generally on a clinical trial.
If chemo is no longer working, a newer 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.
New drug treatments being tested in clinical trials and new surgical procedures may help some patients 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 distant spread of the cancer. For example, if the cancer has spread to the spine, radiation therapy may be given to the area to relieve pain and reduce the chances of further complications. Even if a cure is not possible, it is important to remember that there are many options to relieve symptoms of advanced cancer.
Last Medical Review: January 15, 2015 Last Revised: March 2, 2017