Treatment Options by Stage of Nasopharyngeal Cancer

Treatment of nasopharyngeal cancer (NPC) is based largely on the stage (extent) of the cancer, but other factors are also important, such as your overall health and your personal preferences. NPC in children is treated largely the same as it is in adults. Your doctor can explain your cancer stage and which treatment plan is right for you.

Talk to your doctor if you have any questions about the recommended treatment plan. Ask if the treatment will change how you look, talk, breathe, and eat. Your doctor will probably tell you that the best way to treat NPC in the more advanced stages is in a clinical trial.

Smoking during cancer treatment is linked to more side effects, worse outcomes, and less benefit from treatment. It is best to stop smoking completely before starting treatment. Smoking also increases the risk of the cancer coming back after treatment as well as the risk of getting a new cancer.  Quitting smoking for good is the best way to improve your survival.

Stages 0 and I (1)

The usual treatment for these early-stage cancers is radiation therapy aimed at the tumor.

In these stages the cancer probably has not yet spread, but the nearby lymph nodes in the neck are treated with radiation therapy as well. This is preventive (prophylactic) radiation. It's done because some patients may have cancer cells in these lymph nodes that can’t be found by imaging or other methods. Although there are too few cancer cells in the lymph nodes to cause them to be enlarged, these cells could continue to grow and spread if not destroyed by radiation therapy.

Stage II (2)

Most people with stage II (2) NPC get chemoradiation (chemotherapy given along with radiation therapy) to the nasopharynx and neck lymph nodes. The chemo drug most often used is cisplatin. Chemoradiation is usually followed by more chemo. Most studies have found that chemoradiation helps people live longer than just radiation therapy alone. But adding chemo can lead to more side effects, which can affect quality of life. It’s important to understand what the side effects are likely to be before starting this treatment.

If cancer is still in the lymph nodes after any of the above treatments, surgery to remove the main tumor (if possible) and the lymph nodes may be done.

Stages III (3) and IVA (4A)

People with stage III or IVA NPC are usually treated with:

• Chemotherapy first (sometimes called induction chemo) followed by chemoradiation to the nasopharynx and neck lymph nodes OR
• Chemoradiation to the nasopharynx and neck lymph nodes sometimes followed by chemotherapy alone OR
• Chemoradiation to the nasopharynx and neck lymph nodes

Induction chemo followed by chemoradiation can help some people live longer. Common chemo drug combinations used in induction chemo are:

• Gemcitabine plus cisplatin, or
• Docetaxel with cisplatin and 5-FU

If cancer cells are still in the lymph nodes after any of the above treatments, surgery to remove the main tumor (if possible) and the lymph nodes may be done.

Stage IVB (4B)

The usual treatment for Stage IVB (4B) NPC is chemo, often with cisplatin and one other drug. If there's no sign of the cancer after chemo, either radiation therapy or chemoradiation is given to try to kill any remaining cancer cells. Another option in some cases is to give chemoradiation as the first treatment. Immunotherapy is another option to treat some of these cancers, either alone or along with chemo.

If there are still signs of cancer after the initial chemo, different chemo drugs may be tried. Chemotherapy plus the targeted drug cetuximab (Erbitux) or immunotherapy may be other options.

Recurrent nasopharyngeal cancer

Cancer is called recurrent when it come backs after treatment. It can come back in or near the same place it started (local) or spread to organs such as the lungs or bone (distant). If NPC returns after treatment, your choices depend on where it returns, the extent of the cancer, which treatments were used the first time around, and your overall health. It's important to understand the goal of any further treatment whether it's to try to cure the cancer, to slow its growth, or to help relieve symptoms.

Some tumors that recur in the nasopharynx can be removed through the nose by surgery (called endoscopic surgery). This is a specialized surgery that should only be done by a surgeon with a great deal of experience with it, so it’s not available at all medical centers.

Recurrent NPC in neck lymph nodes can sometimes be treated with radiation therapy a second time. But if doctors believe that more radiation would cause serious side effects or if the cancer didn't respond to radiation the first time, surgery (neck dissection) may be used instead. The radiation oncology doctor will carefully review your options. 

If the cancer recurs in distant sites, options might include chemotherapy or immunotherapy (or both). If chemo has been given already, different chemo drugs may be tried. The targeted drug cetuximab may be given along with chemo.

New drug treatments and new surgical procedures being tested in clinical trials may help some people with recurrent NPC, as well as improve knowledge that can help others with NPC in the future.

If the cancer can’t be cured, further treatments may be aimed at slowing its growth or relieving symptoms caused by the cancer. For example, if the cancer has spread to the spine, radiation may be given to the area to relieve pain and reduce the chances of further problems. Even if a cure is not possible, it's important to remember that there are many options to relieve symptoms of advanced cancer.