After determining a diagnosis and completing a full evaluation, doctors will recommend a course of treatment for their patients. It is important to know that the pre-treatment evaluation for nasopharyngeal cancer will often involve testing for the presence of HPV and/or Epstein-Barr virus (EBV) DNA in the tumor cells. In general, there are three different options for the treatment of nasopharyngeal cancers that can be used alone or in combination.
Surgery
Surgery may be used to biopsy a nasopharyngeal mass and obtain a diagnosis; however, it does not play a significant role in the treatment of nasopharyngeal cancer. This is because of the deep location of nasopharyngeal tumors as well as their proximity to critical nerves and blood vessels. Rarely, surgery will be used to remove small local recurrences that are able to be resected.
Radiation
For nasopharyngeal cancer, radiation therapy is the mainstay of primary treatment. In this type of treatment, an external beam of radiation is directed at the tumor in order to destroy the rapidly dividing cancer cells. Radiation is used alone in early stage cancers; however, it is given with chemotherapy in more advanced cases.
Chemotherapy
Chemotherapy is generally not used alone as a primary treatment for nasopharyngeal cancer, but rather is commonly used in combination with radiation therapy for intermediate to high stage cancers. However, if additional treatment is needed following primary therapy, adjuvant chemotherapy is given without radiation.
General Treatment Options for Nasopharyngeal Cancer
These options depend on T, N, and M stages.
T1, N0, M0
For these small cancers, the recommended treatment is radiation to the nasopharynx and possibly the neck.
T1, N1-3 T2-4, Any N
- For cancers in these stages, the treatment options include:
- Radiation with or without chemotherapy.
- Induction chemotherapy.
- Enrollment in a clinical trial.
- If there is evidence of cancer remaining in the neck after treatment has been completed, a neck dissection is recommended.
Any T, Any N, M1
- For these cancers, in which the disease has spread outside of the head and neck to other parts of the body, the treatment options include:
- Radiation to the nasopharynx and the neck, along with chemotherapy.
- A course of chemotherapy, followed by radiation.
- Enrollment in a clinical trial.
