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Treatment decisions

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
  • your general health and level of fitness

Your doctor will talk to you about your treatment, its benefits and the possible side effects.

The main treatments

Your doctor 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. Its mainly used when the cancer comes back after the original treatment.


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.


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 together 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.


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 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. And also because the cancer responds to radiotherapy and chemotherapy.

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
  • 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) there are several treatment options. You may have radiotherapy again. Or you might have chemotherapy on its own. In some circumstances, you might have surgery to remove the tumour. 

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. The treatment depends on how far the cancer has spread.

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.

Advanced cancer that is unlikely to get better

Your doctor might suggest further treatment with radiotherapy, chemotherapy or both. The aim in this situation 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

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

A second opinion

Some people might want to get a second opinion before starting treatment. You can ask your specialist or GP to refer you to a doctor specialising in nasopharyngeal cancer. It can be better to arrange a second opinion through your specialist because they can send all your notes and test results with you.

Having a second opinion doesn't usually mean that the new doctor takes over your treatment and care. They discuss with you and your current doctor which they feel is the best treatment for you. 

It can take time to arrange a second opinion, which might mean that your treatment is delayed for a while. Remember also that several specialists will be involved in your care as part of your multi disciplinary team. Between them, they discuss the best way to treat your cancer.

Last reviewed: 
05 Mar 2018
  • Nasopharyngeal carcinoma: United Kingdom National Multidisciplinary Guidelines
    R Simo and others
    Journal of Laryngology and Otology, 2016. Volume 130, Supplement 2, Pages 97-103

  • Nasopharyngeal cancer: EHNS-ESMO-ESTRO clinical practice guidelines for diagnosis, treatment and follow up
    AT Chan and others
    Annals of Oncology, 2012. Volume 23, Supplement 7, Pages 83-85

  • Cancer: Principles and Practice of Oncology (10th edition)
    VT DeVita , TS Lawrence, SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

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