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Treatments and drugs
By Mayo Clinic staffYou and your doctor work together to devise a treatment plan based on several factors, such as the stage of your cancer, the type of cells involved, your treatment goals, your overall health and the side effects you're willing to tolerate.
Many people aren't diagnosed with nasopharyngeal carcinoma until it has spread, probably because the nasopharnyx isn't easy to examine and symptoms of this cancer mimic those of many other conditions. As nasopharyngeal carcinoma becomes more advanced, it also becomes more difficult to treat successfully.
Treatment for nasopharyngeal carcinoma usually begins with radiation therapy, or a combination of radiation and chemotherapy. While surgery is the mainstay of treatment for many cancers, navigating the nasopharynx with surgical tools is delicate. Nasopharyngeal carcinoma is particularly sensitive to radiation therapy, making it or combined chemoradiotherapy the first line of treatment.
Radiation
Radiation therapy destroys quickly growing cells, including cancer cells, in the area where the beams are focused. During treatment you're positioned on a table and a large machine is maneuvered around you to the precise spot where it can target your cancer. You typically receive radiation treatment five days a week for six or seven weeks. Some doctors are using a newer form of radiation called intensity-modulated radiation therapy (IMRT). This type of radiation is more effective at contouring to the shape of the tumor, so it may affect fewer healthy cells.
Radiation therapy carries a risk of side effects, including temporary skin changes, hearing loss, dry mouth and difficulty swallowing. Your nasopharynx is situated among some delicate organs, such as your brain, spinal cord, thyroid gland, eyes and ears. Your radiation therapy team works to protect these organs, but that can't always be done.
Internal radiation therapy (brachytherapy) is sometimes used in recurrent nasopharyngeal carcinoma. With this treatment, radioactive seeds or wires are positioned in the tumor or very close to it.
Chemotherapy
Unlike radiation therapy, which is focused on one part of your body, chemotherapy medications travel throughout your body. Chemotherapy works by attacking quickly growing cells, including cancer cells. Some healthy cells are also killed by chemotherapy, which can cause side effects, including fatigue, hair loss, and nausea and vomiting. Chemotherapy may be used to treat nasopharyngeal carcinoma in three ways:
- Chemotherapy at the same time as radiation therapy. This is called concomitant therapy or chemoradiotherapy. Chemotherapy enhances the effectiveness of radiation therapy. Using the two treatments together may reduce the need for high doses of radiation, which can reduce the side effects associated with radiation therapy. However, side effects of chemotherapy are added to the side effects of radiation therapy, making concomitant therapy more difficult to tolerate.
- Chemotherapy after radiation therapy. This is called adjuvant chemotherapy. Your doctor might recommend adjuvant chemotherapy after radiation therapy alone or after concomitant therapy. Adjuvant chemotherapy is used to attack any remaining cancer cells in your body, including those that may have broken off from the original tumor and spread elsewhere. Some controversy exists as to whether adjuvant chemotherapy actually improves survival in people with nasopharyngeal carcinoma. Many people who undergo adjuvant therapy after concomitant therapy are unable to tolerate the side effects and must discontinue treatment.
- Chemotherapy before radiation therapy. This is called neoadjuvant chemotherapy. It works in the same way as adjuvant chemotherapy, but it's administered before radiation therapy alone or before concomitant therapy. However, little research has been done on neoadjuvant chemotherapy, so it's not considered a standard treatment.
What chemotherapy drugs you receive and how often will be determined by your doctor. The side effects you're likely to experience will depend on which drugs you receive.
Surgery
Surgery is not often used as a treatment for nasopharyngeal carcinoma. Surgery to remove cancerous lymph nodes in the neck is the most common surgery for nasopharyngeal carcinoma. Surgery to remove a tumor from the nasopharynx requires surgeons to make an incision in the roof of your mouth in order to access the area to remove the cancerous tissue.
