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Treatment decisions

Find out how your doctor decides what treatment you need, and which types of treatment you might have.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • where your cancer is
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

The main treatments

Your treatment depends on the stage and type of your cancer, and your general health and fitness. Your doctors might suggest one type of treatment or a combination of treatments.

Radiotherapy is the main treatment for nasopharyngeal cancer. You might have radiotherapy alone, or with chemotherapy (this is called chemoradiotherapy).

Surgery is not often used to treat nasopharyngeal cancer, because the area is so difficult to reach.

Radiotherapy

Radiotherapy is the main treatment for nasopharyngeal cancer. You might have it on its own or with chemotherapy (chemoradiotherapy).

Radiotherapy on its own cures most early stage nasopharyngeal cancers. This includes stage 1 nasopharyngeal cancers and some people with stage 2 cancers  

For locally advanced nasopharyngeal cancer, you usually have chemoradiotherapy.

Chemotherapy

You might have chemotherapy if nasopharyngeal cancer has spread to:

  • the lymph nodes in your neck
  • other parts of your body, such as the lungs or bones

You might have:

  • chemotherapy combined with radiotherapy (chemoradiotherapy)
  • chemotherapy on its own

You might have chemotherapy before radiotherapy. This aims to shrink the tumour and make it easier to treat with radiotherapy.

You might have 2 or more chemotherapy drugs together. Using 2 or more drugs together sometimes works better than using one drug.

Chemoradiotherapy

Having chemotherapy and radiotherapy at the same time is called chemoradiotherapy. The chemotherapy makes the cancer cells more sensitive to the radiotherapy.

You might have this treatment if your cancer has grown into the tissue around the nasopharynx, or into the nearby lymph nodes. 

Chemoradiotherapy can be quite a tough treatment to have. The side effects can be more severe than the side effects of radiotherapy or chemotherapy on their own. So you have tests to see if you’re fit enough to have it.

Surgery

Surgery is not a common treatment for nasopharyngeal cancer. This is because the area is very difficult to get to and is surrounded by important nerves and blood vessels.

The surgery you are most likely to have is to remove lymph nodes. You might have this if your doctor thinks they could contain cancer cells.

Your specialist might suggest surgery to remove your tumour if:

  • your cancer comes back quite soon after treatment with radiotherapy, or
  • you have a rare type of nasopharyngeal cancer such as adenocarcinoma

Treatment by stage

The stage of a cancer means how far it has grown and whether it has spread. It helps your doctor decide what kind of treatment would be best for you.

Stage 1

Radiotherapy is the main choice of treatment for stage 1 nasopharyngeal cancers.

With stage 1 cancers there is no sign that the cancer has spread to the lymph nodes. But you may have radiotherapy to the nodes in your neck, just in case any cancer cells have strayed there.

Stage 2

For stage 2 nasopharyngeal cancers you might have:

  • radiotherapy to the tumour and the lymph nodes in your neck
  • chemotherapy and radiotherapy together (chemoradiotherapy)

Stage 3 or 4

For stage 3 and stage 4A and 4B nasopharyngeal cancers, you might have:

  • chemotherapy before or after chemoradiotherapy
  • chemotherapy and radiotherapy together (chemoradiotherapy) 
  • radiotherapy to the tumour and the lymph nodes in your neck

Nasopharyngeal cancer that has come back

The treatment you might have for nasopharyngeal cancer that has come back depends on where in your body the cancer is.

For cancer that has come back in the same place (called the primary site) you usually have radiotherapy again. Or you might have chemotherapy on its own. In some circumstances, you might have surgery to remove the tumour, but this is less common.

For cancer that has come back in the lymph nodes in your neck, you are most likely to have surgery to remove them. This is called a neck dissection. You might have more radiotherapy, but this is less likely.

For cancer that comes back in another part of your body, you are likely to have chemotherapy. You might have radiotherapy if cancer has spread to your bones.

Sometimes your doctor might suggest new drugs that are being tested as part of a clinical trial.

Advanced cancer that is unlikely to get better

Your doctor might suggest further treatment with radiotherapy, chemotherapy or both for advanced nasopharyngeal cancer that is unlikely to get better. The aim is to shrink the cancer and help to control your symptoms. This is called palliative treatment. Although it is not likely to cure your cancer, it could control it for some time.

If your cancer is very advanced your doctor will refer you to a palliative care team for expert control of your symptoms. Palliative care specialists care for people in the final stages of their illness, but they also work with people with any stage of cancer. They can give expert help including:

  • controlling symptoms such as pain, sickness and breathing problems
  • supporting you with diet and physical care
  • helping you have the best possible quality of life, whether you are at home or in a hospital or hospice

Choosing your treatment

You might want to get a second opinion before you have your treatment. It can sometimes be a good idea to seek the advice of more than one specialist. A second opinion might confirm what your own specialist has said. It could also give you more information and help you feel more confident about your treatment plan.

But a second opinion means just that. It does not mean that the second doctor will take over your care. Your original specialist usually still manages your treatment. Remember also that several specialists are likely to be involved in your care as part of your multidisciplinary team. Between them, they discuss the best way to treat your cancer.

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to improve treatment by:

  • making existing treatments better
  • developing new treatments

Information and help

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About Cancer generously supported by Dangoor Education since 2010.