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Tests and diagnosis
By Mayo Clinic staff
Screening
In the United States and in other areas where the disease is rare, routine screening for nasopharyngeal carcinoma isn't done. But in areas of the world where nasopharyngeal carcinoma is much more common, for instance in some areas of China, doctors may offer screenings to people thought to be at high risk of the disease. Screenings may include blood tests to determine whether a person carries the Epstein-Barr virus and what the levels of the virus are, or careful examinations of the nasopharynx using a tiny camera attached to the end of a flexible tube (endoscope).
Diagnosis
Diagnosing nasopharyngeal carcinoma usually begins with a general examination. Your doctor will ask questions about your symptoms. He or she may press on your neck to feel for swelling in your lymph nodes. Because early signs and symptoms of nasopharyngeal carcinoma aren't specific to the disease, the initial diagnosis is difficult to make. It may take months of investigating other avenues before a definitive diagnosis is made.
If nasopharyngeal carcinoma is suspected, your doctor will refer you to an ear, nose and throat specialist (otolaryngologist) who will use an endoscope to see inside your nasopharynx and look for abnormalities. The endoscope may be inserted through your nose or through the opening in the back of your throat that leads up into your nasopharynx. Endoscopy may require local anesthesia.
Your doctor may also use the endoscope or another instrument to take a small tissue sample (biopsy) to be tested for cancer. Beyond diagnosing nasopharyngeal cancer, a biopsy also tells your doctor the type of nasopharyngeal carcinoma you have.
Nasopharyngeal carcinoma is divided into three types based on the appearance of the cells when viewed under a microscope:
- Type 1 is called keratinizing squamous cell carcinoma.
- Type 2 is nonkeratinizing carcinoma.
- Type 3 is called undifferentiated carcinoma.
Which type you have may depend on where you live. Type 1 is the most common type in the United States, while type 3 is the most common type seen in Southeast Asia. Your doctor may factor in your specific type of nasopharyngeal carcinoma when selecting your treatment, though treatments are generally the same for each type.
Staging
Once the diagnosis is confirmed, your doctor orders other tests to determine the extent (stage) of the cancer, such as:
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Computerized tomography (CT). CT scans show whether the cancer has expanded into the surrounding bone. CT scans capture X-ray images, but rather than a couple of views of a certain area, CT scanners capture multiple, small "slices" of your body, giving your doctor a much more detailed view.
Generally, no special preparation is needed for a CT scan, though you may need to have a contrast medium injected through an intravenous line as part of the test. The contrast medium further highlights your body's structures. Rarely, the contrast medium may cause an allergic reaction, so let your doctor know if you've ever experienced an allergic reaction to a contrast medium in the past, and let the doctor know if you have kidney problems, as the dye can adversely affect the kidneys.
For the test, you lie on a table that pulls you into the doughnut-shaped CT scanner. As with an X-ray, you have to lie still while the images are being captured. CT scans usually don't take too long, and some newer machines take only seconds to perform the test.
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Magnetic resonance imaging (MRI). MRI helps show whether the cancer has expanded to nearby soft tissues in your head and neck. This test uses magnets and radio waves to transmit images to a nearby computer. As with CT scans, special preparation usually isn't necessary, but a contrast medium may be used to provide additional detail. MRI scans take longer than X-ray or CT scans do, possibly up to one hour.
Some people are uncomfortable in MRI machines because the space is confined and the machine makes a loud thumping noise during the test. Many MRI centers provide music via headphones to help block out some of the noise. If you're afraid of small spaces or of being confined, talk with your doctor before the test. A mild sedative might make the test more comfortable for you.
- Chest X-ray or CT scan. X-ray or CT scan of the chest may show whether cancer has spread to your lungs.
- Positron emission tomography (PET) scan. PET scans use glucose combined with a radioactive atom to highlight areas where cancer occurs. PET scanners can detect and map the radioactive atoms, which are found more often in cancerous cells because cancer cells use more energy, and thus more glucose, than healthy cells do. This test can be especially useful if your doctor thinks the cancer has spread to distant areas. Some medical centers have combined CT/PET scanners.
- Lymph node biopsy. Doctors check the lymph nodes in your neck (cervical nodes) for signs of cancer by performing a biopsy. In some cases you may undergo surgery to remove an entire lymph node through a small incision in the skin. In other cases a biopsy may be performed using a procedure called fine-needle aspiration, in which your doctor inserts a needle into the lymph nodes to search for cancer cells.
Once your doctor has determined the extent of your cancer, he or she assigns it a stage. The stage is used along with several other factors to determine your treatment plan and your prognosis. The stages of nasopharyngeal carcinoma include:
- Stage 0. The cancer is limited to the lining of the nasopharynx. This is also called nasopharyngeal carcinoma in situ.
- Stage I. Cancer is confined to the nasopharynx.
- Stage II. Cancer has spread beyond the nasopharynx either to your nasal cavity or to the soft tissues of your throat, including the soft palate, the base of your tongue or your tonsils. In stage IIA, the cancer hasn't spread to your lymph nodes. In stage IIB, the cancer has spread to one or more of the lymph nodes on the same side of your neck as the original tumor, but hasn't spread to distant sites.
- Stage III. Cancer has spread to the lymph nodes on both sides of your neck and may or may not have spread to the soft tissues of your throat. Or, cancer has spread to your throat and the lymph nodes on one or both sides of your neck. Or, cancer has spread to nearby bones and the lymph nodes on one or both sides of your neck.
- Stage IV. Cancer has spread to either the nerves in your face, the lower portion of your throat, the bones of your skull or the bones around your eyes. Or cancer has spread to the lymph nodes in your neck, causing them to grow larger than about 2 1/2 inches (about 6 centimeters). Or, cancer has spread to other parts of your body.
Staging in various parts of the world may be done on a different scale. For instance, a staging system used in Asia includes a stage V.
