What do we mean by 'Nasopharyngeal Cancer'? It is a type of Throat Cancer that starts in or behind the nose. If it's not the cancer type you're looking for, please explore the information about other types of Throat Cancers or other types of Head and Neck Cancers.
Following a diagnosis of Nasopharyngeal Cancer, your cancer care team will discuss the treatment options, including the possibility of participating in a clinical trial, that are suitable for you. This is also a good time to consider if you would like a second opinion. The most suitable treatment for Nasopharygneal Cancer depends on many things including:
Watch a 3D video explainer about Nasopharyngeal Cancer:
It uses high-energy waves to destroy or damage cancer cells. The most common radiation therapy approach for Nasopharyngeal Cancer is called external beam radiation. This type of radiation therapy applies radiation from outside the body.
Radiation Therapy may be given using:
Intensity Modulated radiation Therapy (IMRT) or Volumetric Arc Therapy (VMAT) or Tomotherapy, which use different ways to deliver radiation very precisely, minimising the radiation that gets to healthy parts of the body surrounding the cancer.
Stereotactic radiation therapy which delivers a large and precise dose of radiation in one or a few visits. It can be used as part of radiation therapy to increase the dose of radiation to the nasopharynx cancer. It is sometimes used to treat cancer that has come back.
You might need to have some of your teeth taken out, this will depend on the area being treated and the dose of radiation therapy. It is important to take out any broken or infected teeth before radiation therapy. Taking out unhealthy teeth after radiation therapy can cause problems with the jaw bone.
Your cancer and its treatment can make it hard to eat and drink. Your doctor will recommend you see a dietitian to maximise your nutrition during treatment as well as while you are recovering. Sometime feeding tubes may be recommended depending on the area being treated and the dose of radiation therapy. There are two common types of feeding tubes:
Gastrostomy tube (sometimes called a PEG tube): this type of tube is inserted through your abdominal wall into your stomach, with part of the tube staying outside the stomach. A syringe can be attached to the tube to give you food this way if needed. The tube is inserted using a camera through the mouth into the stomach (gastroscopy) or using a CT scanner to guide insertion directly through the skin. If a PEG tube is needed, your doctor will organise this before starting your radiation therapy
Nasogastric tube: this type of tube goes through the nose down into the stomach and is usually used for short periods (days or weeks). A nasogastric tube can be inserted at any time (before, during or after treatment).
There are many other aspects of supportive care that are available, ask your doctor if you have any specific needs.
The side-effects of radiation therapy start around two weeks into treatment and progress through treatment to peak in the last week or just after treatment ends. The side effects start to improve 2-3 weeks after the end of treatment.
the dose of radiation therapy
the area being treated
whether or not chemotherapy is added to the radiation.
tiredness
skin irritation in the treated area e.g. redness, dryness and itching, weeping skin, scaling or sometimes skin breakdown (sores)
nasal irritation, blockage and crusting
ulcers in the mouth and throat that make it painful or difficult to chew or swallow
sticky or thick saliva
altered taste, which is usually a loss of taste or, sometimes, an unpleasant taste in the mouth
blocked ears from inflammation within ear canals.
Most side effects are short lived and may go away within 4–6 weeks of finishing radiation therapy. Some side effects may last for months after you finish radiation therapy and some may be permanent.
Long-term side effects of radiation therapy include:
dry mouth (called xerostomia) and difficulty eating dry food such as bread/biscuits due to lack of saliva. With modern radiation techniques, some recovery of saliva may be expected up to two years after radiation therapy
inability to eat certain foods, in particular sensitivity to spicy or acidic foods
gum and tooth problems from lack of saliva
crusty nasal discharge
worse hearing or deafness may occur, although with modern radiation therapy techniques the risk of this side effect can be greatly reduced
underactive thyroid gland
Chemotherapy uses medicines to destroy or damage cancer cells. For Nasopharyngeal Cancers, chemotherapy is usually given into a vein through a needle with a cannula (tube) attached.
There are a number of different types of chemotherapy that may be used to treat Nasopharyngeal Cancers:
This is when chemotherapy is given before radiation therapy to help shrink large cancers and make them easier to target with radiation therapy. Sometimes chemotherapy is added to definitive radiation therapy (chemoradiation).
This is when chemotherapy is given after surgery, usually in combination with radiation therapy (called concurrent chemoradiation). It is usually given once a week during radiation treatment. Adding chemotherapy makes the radiation more effective at destroying cancer cells, but also leads to increased side effects for most patients.
Sometimes chemotherapy is added to definitive radiation therapy (chemoradiation). It is usually used for advanced stage nasopharyngeal cancers. This may be given once every 3 weeks or once a week throughout the duration of radiation therapy. This makes the radiation more effective at killing cancer cells but also leads to more side effects in most people.
In cases where cancer is considered incurable, because it may be too large or has spread too much to be removed by surgery, palliative chemotherapy may be suitable. Palliative chemotherapy does not aim to cure a cancer, but helps to slow the growth of cancer and reduce symptoms. It is important to remember that palliative chemotherapy is not as intense as other types and is much less likely to have significant side effects.
Before you start treatment, your medical oncologist will choose one or more chemotherapy medication that will be best to treat the type of cancer you have. The particular chemotherapy medications used will depend on:
whether the treatment is curative or palliative
when it is used
your medical history
The side effects of chemotherapy depend on the medication used and and how much you are given by your doctor (the dose). The most common medications are cisplatin, carboplatin and 5-Fluoruracil (5-FU). Each person responds to chemotherapy differently. Some people may experience a few side effects while others may not experience any at all. The following are common side effects of chemotherapy:
a feeling of wanting to vomit (nausea) or vomiting
more side effects of radiation, if you have chemotherapy at the same time as radiation
loss of feeling in the fingers and toes
kidney damage (caused by some medications)
hearing loss/thinning
ringing in the ears
rash
higher risk of infection (if the chemotherapy reduces the number of white cells in the blood).
Your doctor will explain details of the surgery, general risks and side effects of surgery. Ask your doctor if you have questions. They may recommend:
stopping blood thinners (e.g. aspirin) before surgery to reduce the risk of bleeding
special stockings to reduce the risk of blood clots
early mobilisation (i.e. not staying in bed) to reduce the risk of blood clots and chest infection
antibiotics to lower the risk of wound infection.
If you smoke, it is important that you consider stopping smoking before starting treatment to help reduce the risk of infection and help you recover after your treatment.
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