Treatment options for nasopharyngeal cancer

Radiotherapy is the main treatment for nasopharyngeal cancer. You may have radiotherapy alone or with chemotherapy. Surgery is not often used to treat nasopharyngeal cancer because the area is so difficult to reach. As with many types of cancer, the earlier your cancer is diagnosed, the easier it is to get it under control and possibly cure it. On the next page of this section, there is a description of the likely treatment for each stage of nasopharyngeal cancer.

Which treatment is best for you will depend on

• The type of nasopharyngeal cancer you have
• The stage of your cancer
• Your general health and fitness

Depending on your circumstances your doctors may suggest a single type of treatment or a combination of treatments.

Below are short overviews of each type of treatment. There is more detailed information about radiotherapy, chemotherapy and surgery for nasopharyngeal cancer in this section.

Radiotherapy is the main treatment for nasopharyngeal cancer. You may have it on its own or with chemotherapy. Radiotherapy alone cures most early stage nasopharyngeal cancers (stages 1 and 2). There is information about side effects of radiotherapy for nasopharyngeal cancer in this section. You might have internal radiotherapy as a boost at the end of a course of external therapy, or to treat nasopharyngeal cancer that has come back. For locally advanced nasopharyngeal cancer, chemotherapy is usually combined with radiotherapy.

For nasopharyngeal cancer you may have

• Chemotherapy combined with radiotherapy (known as chemoradiation)
• Chemotherapy on its own

You may have chemotherapy if your cancer has spread to

• The lymph nodes in your neck
• Other parts of your body, for example, the lungs or the bones

You may have chemotherapy before radiotherapy. Doctors call this neo adjuvant chemotherapy or induction chemotherapy. The aim is to shrink the tumour and make it easier to treat with radiotherapy. You may have two or more chemotherapy drugs together. This is called combination chemotherapy. Using two or more drugs together sometimes works better than using one drug. There is more information about chemotherapy for nasopharyngeal cancer, the chemotherapy drugs used, and the side effects of chemotherapy in this section.

Chemoradiation is when you have chemotherapy and radiotherapy at the same time. The chemotherapy makes the cancer cells more sensitive to radiotherapy. You may have chemoradiation if your cancer has grown into the tissue around the nasopharynx or into the nearby lymph nodes. It can be quite a tough treatment to have as the side effects can be more severe. So you will have tests to see if you’re fit enough to have it. 

There is information about the side effects of chemoradiation in the chemotherapy for nasopharyngeal cancer section.

Biological therapies are treatments that act on processes in cancer cells. They work in different ways such as changing the way cells signal to each other or by stimulating the body to attack or control the growth of cancer cells. 

For nasopharyngeal cancer, you may have a biological therapy called cetuximab (also known as Erbitux)

• Alongside radiotherapy for locally advanced nasopharyngeal cancer
• In combination with platinum based chemotherapy for squamous cell cancer that has come back or has spread to other parts of the body

There is information about biological therapies for nasopharyngeal cancer in this section.

Surgery is not a common treatment for nasopharyngeal cancer. This is because the area is very difficult to get to. Also the nasopharynx is surrounded by important nerves and blood vessels. These add to the chances of complications from surgery. For nasopharyngeal cancer, if the cancer has come back in the nodes after radiotherapy, doctors may use surgery to remove the lymph nodes.

If your disease comes back quite soon after treatment with radiotherapy your specialist may suggest surgery to remove your tumour. Or your doctor may suggest surgery if you have a rare type of nasopharyngeal cancer such as an adenocarcinoma. 

If you do have surgery to remove your cancer, you might need more than one operation – one to remove the tumour and another to reconstruct the area, though these are usually done during the same operation when possible. The reconstruction may improve the look of the area after your first operation and help you to breathe, chew and swallow more easily too.

There is more information about surgery for nasopharyngeal cancer in the treating nasopharyngeal cancer section.

Your specialist may advise that radiotherapy is the best treatment for you, because of the stage or position of your cancer. But you may 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 may confirm what your own specialist has said. Also, a second opinion may 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 will usually still manage your treatment.

Do remember that these days cancers are treated by a multidisciplinary team. This means that several specialists are likely to be involved in your care, and between them will discuss the best way to treat your cancer.