Nasopharyngeal cancer is a type of cancer that grows in the nasopharynx. The nasopharynx is an area that includes the upper portions of the throat and the area behind the nose. While this cancer is rare in the United States, it is more common in Southeast Asia. Symptoms indicative of nasopharyngeal cancer include swollen lymph nodes in the neck, blood in saliva, nasal bleeding, frequent ear infections, sore throats, hearing loss, and headaches. Unfortunately, nasopharyngeal cancer can be difficult to detect in its early stages. Doctors perform a health history and physical examination to diagnose this form of cancer, and a nasal endoscopy is typically needed. In a nasal endoscopy, a tube with a camera may be used to closely examine the inside of the nasal passages and throat. If any abnormalities are found, a biopsy of the area will be taken. Risk factors for nasopharyngeal cancer include eating salt-cured foods and having had the Epstein-Barr virus. The methods described below are often used in the treatment of nasopharyngeal cancer.
Chemotherapy is the use of specific chemicals to target and kill cancer cells. Some forms of chemotherapy can be taken orally, and others are given intravenously. Chemotherapy is often used at several stages of nasopharyngeal cancer, and it is usually the first line of treatment for patients whose cancers have spread beyond their head and neck. Since some chemotherapy medications make the body more sensitive to radiation (another type of cancer treatment), they may be used at the same time as radiation, in a process known as chemoradiation. Chemotherapy may also be given before or after a patient has completed radiation treatments. Typically, chemotherapy is given in cycles of three to four weeks each. After each cycle, patients have a short period to rest and recover. Cisplatin and 5-fluorouracil (5-FU) are two of the most common chemotherapy medications used to treat this form of cancer. Side effects include vomiting, hair loss, nausea, diarrhea, increased risk of infection, mouth sores, fatigue, and easy bruising.
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Also known as radiation, radiotherapy uses highly concentrated doses of targeted radiation to destroy cancerous cells. X-rays and protons are two of the radiation types most often used in cancer treatment. For nasopharyngeal cancer, radiotherapy is usually delivered with the external beam method, which is similar to having a simple x-ray taken. The patient lies on a table, and a machine rotates around them to deliver the radiation. The machine does not touch the patient, and this treatment is painless. Small nasopharyngeal tumors can sometimes be successfully treated using radiation alone. Most patients with this type of cancer will receive radiation five times a week for approximately seven weeks. Since the head and neck are particularly sensitive to radiation, side effects include severe mouth ulcers, dry mouth, hearing loss, and temporary redness at the targeted site. Occasionally, mouth sores may make it difficult to eat or drink, and doctors may recommend the use of a feeding tube until the sores heal.
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Surgical removal of nasopharyngeal tumors is typically only recommended for very small tumors. This area of the body is difficult to reach, and tumors usually respond well to other treatment methods. As a result, surgical removal is rarely used as the main treatment for this nasopharyngeal cancer. However, surgery is often used to remove nasopharyngeal tumors that have spread to lymph nodes in the neck. In these cases, a neck dissection surgery will be performed. In a partial neck dissection procedure, only lymph nodes closest to the tumor are removed. A modified radical neck dissection is used for more advanced cases and involves removing lymph nodes from one side of the neck. These lymph nodes are located between the jaw and the collarbone. Some nerve and muscle tissue must be removed as well, though the main nerve that supplies the shoulder muscle is left in place. In the most advanced cases of nasopharyngeal cancer, doctors may opt to perform a radical neck dissection. Also called a comprehensive neck dissection, the procedure removes almost all of the lymph nodes from a single side of the neck, and muscles, nerves, and veins are removed too.
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Biologic drugs, also known as targeted therapies, teach the body's immune system to attack cancer cells. These drugs have fewer side effects than chemo, and they can be effective even for patients with advanced stages of cancer who did not improve with other treatments. One of the main types of biologic drugs used in the treatment of nasopharyngeal cancer is cetuximab. This medicine is a monoclonal antibody, a synthetic form of a particular protein found in the human immune system. Cetuximab targets a protein known as epidermal growth factor receptor, which is found in abundance on the surface of nasopharyngeal cancer cells. Other monoclonal antibodies used for this type of cancer include pembrolizumab and nivolumab. Potential side effects of these medications include itching, nausea, rash, fatigue, shortness of breath, decreased appetite, cough, and vitiligo.
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Palliative Symptom Management
Palliative symptom management, which is also called palliative care or comfort care, focuses on quality of life instead of aggressive or curative treatment. Cancer patients may experience anxiety, depression, diarrhea, constipation, decreased appetite, fatigue, and nausea as a result of their disease or treatment regime. Palliative symptom management aims to treat and reduce these side effects so patients and their families can enjoy quality time together. Although palliative care focuses on patient comfort, it can be used alongside curative treatment. Depending on patient preference, palliative care may be received at specialist palliative centers or the patient's home. The palliative care team typically consists of nurses, nurse practitioners, and doctors. Mental health professionals or religious personnel may also be part of the patient's palliative care team. Palliative care patients receive frequent evaluation from their care team, and palliative specialists also provide support for family members.