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For medical questions, we encourage you to review our information with your doctor.
Since these cancers are not common in the US and are located near many critical structures in your head and neck, it’s very important to go to a cancer center that has experience treating these cancers. This will help coordinate care between cancer specialists to make a complete treatment plan and might help people live longer.
If you smoke, you should quit. Smoking during chemotherapy treatment can cause more side effects and can cause . It can give you a higher chance of getting an infection and is linked to worse outcomes. Smoking after treatment might also increase the risk of the cancer coming back and of getting another new cancer. Quitting smoking (before treatment starts, if possible) is the best way to improve your chances of survival. It is never too late to quit. For help, see How To Quit Using Tobacco.
Chemotherapy (chemo) is the use of anti-cancer drugs to treat cancer. These drugs are most often given into a vein (IV) or by mouth which allows them to enter the bloodstream and reach most parts of the body.
Chemo may be used in different ways to treat nasopharyngeal cancer (NPC):
Chemo drugs for nasopharyngeal cancer are usually given by mouth or into a vein (IV) as an infusion over a certain period of time. This can be done in a doctor’s office, infusion center, or in a hospital setting.
Often, a slightly larger and sturdier IV is required in the system for chemo. These IVs are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take blood for tests. There are many kinds of CVCs. The most common types are the port and the PICC line.
Chemotherapy is given in cycles: one drug or a combination of drugs given on a set schedule, followed by a rest period. Common schedules of chemo cycles can be once a week, once every 3 weeks, or once every 4 weeks. The schedule depends on the drugs used. The chemo schedule repeats to start the next cycle.
Adjuvant or induction chemo is often given for 2 or 3 months, depending on the drugs used.
Chemo might not be a good option for people in poor health, but advanced age by itself should not keep anyone from getting chemo.
Cisplatin is the chemo drug used most often to treat NPC. It can be used alone or as part of chemoradiation (see below). Or it may be combined with another drug, 5-fluorouracil (5-FU) or gemcitabine, to be given after chemoradiation or as induction chemotherapy. Sometimes, carboplatin might be used if cisplatin is not a good choice.
Some other drugs that might also be helpful in treating NPC with or without radiation include:
A chemo drug may be used alone or combined with other drugs. Combining drugs can often shrink tumors better but tend to cause more side effects.
Chemoradiation is chemotherapy given at the same time as radiation. It has been shown to shrink nasopharyngeal tumors more than either treatment alone and is helpful for people whose cancers are locally advanced. But this combined approach can be hard to tolerate, especially for people in poor health.
A preferred schedule is to give a dose of cisplatin every 3 weeks (for a total of 2 to 3 doses) during radiation. For people who cannot tolerate cisplatin, carboplatin might be used with radiation instead.
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles also divide quickly. This can lead to certain side effects.
The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Common short-term side effects can include:
Chemo can also affect the blood-producing cells of the bone marrow, which can lead to:
Along with the risks above, some side effects are seen more often with certain chemo drugs. For example, 5-FU often causes diarrhea. This might need to be treated with drugs like loperamide. Cisplatin, docetaxel, and paclitaxel can cause nerve damage (called neuropathy). This can lead to numbness and tingling in the hands and feet or hearing loss. This often improves once treatment is stopped, but for some people it can last a long time. Cisplatin can also damage kidneys . To help prevent this, intravenous (IV) fluid is given before and after each dose.
These side effects usually go away over time after treatment ends. Once chemo starts, let your health care team know if you have side effects, so they can be treated. There are ways to prevent or treat many of them . For example, many drugs are available to help prevent or treat nausea and vomiting. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to keep side effects from getting worse.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
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National Cancer Institute. Drugs Approved for Head and Neck Cancer. May 16, 2019. Accessed at www.cancer.gov/about-cancer/treatment/drugs/head-neck
on September 29, 2020.
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 23, 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 23, 2018.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Head and Neck Cancers, Version 3.2021 – April 27, 2021. Accessed at www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf on May 20, 2021.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Smoking Cessation. V.1.2021 – February 18, 2020. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/smoking.pdf on May 20, 2021.
Petkar I, Bhide S, Newbold K, Harrington K, Nutting C. Practice patterns for the radical treatment of nasopharyngeal cancer by head and neck oncologists in the United Kingdom. Br J Radiol. 2018 Feb 13:20170590.
Wong KCW, Hui EP, Lo KW, et al. Nasopharyngeal carcinoma: an evolving paradigm. Nat Rev Clin Oncol. 2021;18(11):679-695. doi:10.1038/s41571-021-00524-x.
Yoshida EJ, Luu M, David JM, et al. Facility Volume and Survival in Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys. 2018;100(2):408-417. doi:10.1016/j.ijrobp.2017.09.038.
Last Revised: August 1, 2022
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