Nasopharyngeal Cancer

What is it?

It is a tumor typical of populations of Southeast Asia, the Maghreb and the Mediterranean basin, rare in Western countries (with an incidence of 1.1 cases per 100,000 people in Europe), which in Italy affects 0.5 cases per 100,000 people, mostly young, mostly between the ages of 40 and 50, with an incidence twice as high in men as in women.

It arises from the posterior part of the nose, different from nasopharyngeal tumors (anterior part), and the known causes are smoking habits and/or infection with Epstein Barr virus (EBV), which also causes a disease known as “kissing disease” or mononucleosis.

Nasopharyngeal carcinoma is a tumor that tends to progress both locally, affecting structures near the pharynx (parapharynx), nasal cavity (nasal passages) and the bony base on which the brain rests (skull base), and regionally (cervical lymph nodes) and distantly (metastases), affecting other body parts such as the skeleton, liver, distant lymph nodes and lungs.

Anatomically, three types of nasopharyngeal carcinoma are distinguished:

  • nonkeratinizing carcinoma (differentiated or undifferentiated);
  • keratinizing spinocellular carcinoma;
  • basaloid spinocellular carcinoma.

The main prognostic factors are:

  • tumor size (T);
  • size and number of lymph nodes involved (N);
  • carcinoma type and presence of EBV-DNA in the tumor and plasma.

Which are the symptoms?

An initial laryngeal tumor most often manifests as a change in the voice (dysphonia), but if the tumor is more extensive, it may also manifest as difficulty and pain when swallowing, which may extend all the way up to the ear. Tumors are less common with shortness of breath: shortness of breath can occur at night, when stressed, or in the case of a large tumor, difficulty breathing can also occur even when resting.

  • hearing loss
  • nasal obstruction
  • nasal bleeding
  • ear pain
  • enlarged cervical lymph nodes

How is it diagnosed?

A prompt specialized otolaryngologic examination is needed, supported by an endoscopic examination called fibroscopy and associated, if suspected, with radiologic studies such as: magnetic resonance imaging (MRI) of the face and neck with and without contrast media (mdc) and, if necessary, positron emission tomography (PET).

The diagnosis of cancer must be confirmed by a nasopharyngeal biopsy or, if that is not possible, a biopsy of a suspicious lymph node with additional search for EBV DNA in the tumor and in the blood.

Suggested exams

How is it treated?

Treatment of early stages is with radiotherapy alone, while locally advanced disease requires a combined approach involving simultaneous chemotherapy and radiotherapy.

In more advanced forms, chemotherapy or salvage surgery is currently used in selected cases.

The combination of immunotherapy and radiotherapy for locally advanced nasopharyngeal tumors is currently under study (link to studies), so there is no evidence to suggest that it will be used in the near future.

These treatments may be combined with radiotherapy for symptomatic or bleeding/fracture risk areas and surgical treatment of individual metastases.

Suggested procedures

Where do we treat it?

Within the San Donato Group, you can find Nasopharyngeal Cancer specialists at these departments:

Are you interested in receiving the treatment?

Contact us and we will take care of you.