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The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on July 7, 2021.

Nasopharyngeal cancer

Nasopharyngeal cancer is relatively rare and starts in the upper throat (pharynx), behind the nose (naso), just above the roof of the mouth.

The tissues in this area are mucous membranes, which produce fluids to keep them moist. They’re also constantly exposed to environmental toxins and infectious germs, such as viruses and bacteria. Everything breathed in goes through this area.

Though generally uncommon, nasopharyngeal cancer may be more frequent in certain populations. Fewer than one in 100,000 people in the United States develop the disease, though it is more common in other parts of the world, according to a review in StatPearls.

Causes and risk factors of nasopharyngeal cancer

While there’s no one certain cause of nasopharyngeal cancer, research has linked a few factors to an increased risk of developing this tumor.

One of the most interesting links is exposure to the very common Epstein-Barr virus (EBV), which causes mononucleosis. Many samples of nasopharyngeal tumors have incorporated pieces of this virus in their cellular genome. Many people who develop nasopharyngeal cancer also have evidence of an active EBV infection in their blood.

It may be that some people react to EBV infection in ways that encourage this cancer to develop, based on their genetics or another factor. Patients with high levels of EBV in their blood don’t respond as well to treatment and may be at higher risk for the tumor to spread or become deadly. There are still many mysteries about how this virus is related to the development of nasopharyngeal cancer.

Other known risk factors include:

  • Age. Risk increases slowly through life.
  • Gender. Nasopharyngeal tumors are more common in people born male.
  • Place of residence and ethnicity. This cancer is more common in parts of Asia and Africa, as well as in Greenland and northwest Canada. In the United States, nasopharyngeal cancer occurs more frequently among Inuits in Alaska and people of Asian and Pacific Islander descent.
  • Diet. Eating a diet higher in salt-cured meat and fish seems to increase the risk of developing nasopharyngeal cancer (while increased consumption of nuts, legumes, fruits and vegetables may be protective).
  • Family history. The link between family history and the risk of developing nasopharyngeal cancer may have to do with genetics or shared environmental factors—researchers aren’t completely sure.
  • Tobacco and alcohol. Smoking tobacco and drinking heavily may play a role.

Because this cancer is rare, there are still many unanswered questions about its causes. In most cases, the patient doesn’t have preventable risk factors.

Types of nasopharyngeal cancer

Cancers of the nasopharyngeal area are typically squamous cell carcinomas that don’t behave as other head and neck cancers do.

The most common type is called nasopharyngeal carcinoma (NPC), which arises out of the cells that line these passageways. Based on how they look under a microscope, doctors have categorized NPCs into three types:

  • Non-keratinizing undifferentiated carcinoma—the most common NPC form in the United States
  • Keratinizing squamous cell carcinoma—most often associated with EBV infection (70 to 80 percent of the time, according to StatPearls).
  • Non-keratinizing differentiated carcinoma—also related to EBV.

There’s essentially no difference in how these cancers are treated, though non-keratinizing types seem to respond better to treatments. Overall, what matters most is the stage at which cancer is found, diagnosed and treated.

Other than NPCs, there are two rare cancers that may crop up in the nasopharynx:

  • Lymphoma may develop from white blood cells that set up shop in the nasopharyngeal area of the body.
  • Adenocarcinoma may develop from the salivary or mucous glands that line the nasopharynx, though they occur more commonly in the nose and mouth.

Symptoms of nasopharyngeal cancer

For most people, nasopharyngeal cancer doesn’t cause symptoms until it's advanced. People who are at higher risk because of gender, ethnicity or other risk factors should keep an eye out for certain signs of NPCs. Although they’re most likely caused by less serious diseases, it’s important to visit a doctor if any of these symptoms arise:

  • A lump or two in the neck (toward the back)
  • Ear symptoms such as hearing loss, tinnitus, ear pain, a feeling of fullness in the ear, recurring ear infections
  • Nose symptoms such as nasal blockages or persistent stuffiness, nosebleeds
  • Facial pain or numbness, headaches
  • Trouble opening the mouth, breathing or talking
  • Eye problems such as blurry or double vision

Diagnosis of nasopharyngeal cancer

If nasopharyngeal cancer is suspected, the doctor may start by physically examining the patient’s neck and throat and asking questions about personal and family history.

Typically, a specialist doctor focused on the ear, nose and throat (ENT) may perform a more thorough exam of the face, neck and throat. A hearing test may be used to determine whether the growth is causing hearing loss.

An ENT’s diagnosis may include imaging tests to get a better look at the nasopharynx, which is deep inside the skull and hard to access. The doctor may look through mirrors with a light (indirect nasopharyngoscopy) or insert a flexible wire with a camera and light attached (direct nasopharyngoscopy) into the nasopharynx to take a look.

Additional screenings using computed tomography (CT), magnetic resonance imaging (MRI) or other scans may also help the doctor inspect under the surface of the nasopharyngeal tissues to see whether there’s a tumor in any surrounding areas.

If any abnormal growths are detected in the imaging tests, the doctor may order a biopsy to learn whether the growth is cancerous. During a biopsy, a small sample of the potentially cancerous growth is removed and examined under a microscope. There are two main ways to take a biopsy:

  • Endoscopically—using a lighted camera with a biopsy tool attached
  • Fine needle aspiration—using a needle to take a bit of tissue

Blood tests may be done to look for general health signals and to test for signs of an active EBV infection—and potentially also evidence of a human papillomavirus (HPV) infection, which is a risk factor for other cancers of the head and neck.

Treatment of nasopharyngeal cancer

The information doctors gather through imaging studies and biopsy testing may help them determine the stage of cancer. The stage is a way that doctors classify cancers based on the tumor’s size, location, spread and other characteristics that may affect the patient’s prognosis.

Stages are used to compare different patients with similar tumors. The stage guides a treatment path, which is based on how other people with similar cancers made progress with these interventions.

Treatment for nasopharyngeal cancer depends on the stage at which it’s diagnosed. The earlier, the better, for both survival rates and treatment options. Early stages may be treated with radiation therapy, which uses high-energy waves to damage and destroy cancer cells.

More advanced stages of nasopharyngeal cancers are treated with chemotherapy in addition to radiation. Chemotherapies are drugs that are specifically designed to attack and damage fast-growing cells in the body, including cancer cells. The most common chemotherapy used for nasopharyngeal cancers is cisplatin, which is sometimes given alongside fluorouracil (5FU). If the tumor has spread, two or more chemotherapy drugs may be given together.

Other treatments that may be used include immunotherapies, which are drugs that turn the immune system against cancer cells. The immunotherapies Keytruda® (pembrolizumab) and Opdivo® (nivolumab) are used for NPCs that have returned or spread after treatment.

The immunotherapy drug toripalimab has been added to the American Society of Clinical Oncology’s first-line treatments for nasopharyngeal cancers. A trial of 289 patients showed that this immunotherapy, along with chemotherapy, significantly delayed disease progression.

Doctors may also recommend surgery to remove potentially cancerous lymph nodes if the cancer has spread. A targeted drug, Erbitux® (cetuximab), which specifically attacks cells by targeting epidermal growth factor receptors, may be used as well.

Survival rates for nasopharyngeal cancer

Survival rates for cancers are generally determined by stages. In the National Cancer Institute’s (NCI) survival rate database called Surveillance, Epidemiology, and End Results (SEER) Program, these stages are categorized as localized, regional and distant.

  • Localized cancers are within the tissue where they developed
  • Regional stage cancers have spread to nearby areas
  • Distant stage cancers have spread to distant parts of the body

Five years after diagnosis, 85 percent of patients diagnosed with localized nasopharyngeal cancers are still alive, according to the American Cancer Society, which uses the NCI’s SEER database. For the regional stage diagnosis, this number is 71 percent. If the nasopharyngeal cancer has already spread and is diagnosed as “distant,” the five-year survival rate is 49 percent. On average, the survival rate for nasopharyngeal cancers is 61 percent.

These numbers represent cases diagnosed before 2016, as there are no five-year survival rates for cases diagnosed after that time yet.

Anyone diagnosed with nasopharyngeal cancer should speak with his or her doctor about treatment options. There have been many new additions to the treatment arsenal in the past few years.

Survival rates may be improving with new treatment options—and as with every cancer, new approaches are being tested all the time in clinical trials. Generally, survival rates have been improving in the past decade due to new treatments and earlier detection.

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