Nasopharynx Cancer: Symptoms, Causes and Treatment

Nasopharyngeal cancer is a common subtype of head and neck cancers. These cancers show significant differences from other head and neck malignancies in terms of etiological, epidemiological, histopathological features, biological behavior of the disease and treatment. Therefore, nasopharynx cancers should be considered separately from other head and neck malignancies. The treatment of this type of cancer, which is difficult to diagnose early, is usually done with radiotherapy and chemotherapy.

What is nasopharyngeal cancer?

Nasopharynx; It is a region located at the base of the skull, behind the nose, known as the nasal cavity. The nasopharynx connects the nose to the back of the throat and larynx. The air taken from the nose first passes into the nasopharynx, then down the back of the throat, into the larynx, and then into the trachea until it reaches the lungs. Uncontrolled proliferation of cells in the nasopharynx causes nasopharyngeal cancer.

Several different types of cancer can develop in the nasopharynx. The most common types of nasopharynx cancer are as follows:

• Nasopharynx Carcinoma: The most common type of nasopharynx cancer is nasopharyngeal carcinoma. This cancer is characterized by the uncontrolled proliferation of epithelial cells lining the surface of the nasopharynx region, forming tumor tissue. Nasopharynx carcinoma; There are three different subtypes: nonkeratinized undifferentiated (undifferentiated), nonkeratinized differentiated (differentiated) and keratinized squamous cell. Although the treatment methods for these 3 subtypes of cancer are the same, the cause of the cancer and the response to treatment may differ between subtypes.

• Lymphoma: Lymphoma, which is characterized by excessive proliferation of lymphocytes, which are elements of the immune system, can also affect the nasopharynx.

• Minor Salivary Gland Cancers (Adenocarcinoma and Adenoid Cystic Carcinoma, etc.): These types of cancer, which originate from the cells of the minor salivary glands, are seen especially in the nose and mouth areas.

What are the risk factors?

Despite the studies, the genetic changes that play a role in cancer development are not well understood. Environmental factors include eating habits, cooking on wood fire, air pollution, chemical vapors and previous nasal (Ebstein Barr virus) infections. However, although there is strong evidence for each of the three factors that are said to play a role in the etiology of laryngeal cancer, it suggests that more than one factor plays a role together with complex carcinogenesis mechanisms.

The incidence of the disease increases slowly during adolescence, leading to a peak in distribution at ages 40-50. It is stated that there is a second increase in some regions during adolescence. Nasopharynx cancers are four to five times more common in men than in women.

What are the symptoms of nasopharynx cancer?

Symptoms of nasopharyngeal cancer may initially resemble those of more common diseases such as upper respiratory tract infection or chronic nasal congestion. For this reason, cancer diagnosis may not be made by looking at the symptoms in the early stages of the disease and may be delayed. Additionally, the disease may not cause any symptoms in the early stages.

The most common symptoms in nasopharynx cancer can be listed as follows:

• Swelling in the lymph nodes in the neck area
• nasal congestion
• ringing in the ear
• Hearing loss (one-sided is more stimulating)
• Persistent ear infection that does not improve despite treatment
• Sore throat
• Headache
• Blood in saliva
• Nose bleeding

What causes nasopharyngeal cancer?

Cancer; It develops as a result of one or more genetic mutations, causing cells to divide faster than normal, expand into surrounding tissues, and spread (metastasize) to other parts of the body. In nasopharynx carcinomas, these mutations are seen mainly in epithelial cells and the cancer originates from these cells. The most common factor causing nasopharyngeal carcinoma is the virus called Epstein Barr Virus (EBV). However, many environmental, racial and genetic factors play an important role in etiology.

There are some risk factors that increase the chance of developing nasopharynx cancer:

• Gender: Nasopharynx cancer is more common in men than in women.

• Age: Although nasopharynx cancer can be seen at any age, it most commonly peaks between the ages of two. Firstly, in the 20-30s and secondly, after 50-60 years of age.

• Pickled Foods: While cooking foods such as salted canned foods and salted fish, various chemicals are contained in the food vapor. The progression of these chemicals to the nasopharynx along with breathing is a risk for cancer formation. Exposure to pickled and cooked foods at an early age further increases this risk.

• Epstein Barr Virus: EBV is a common virus that causes flu-like illness in the body. Mononucleosis disease is also caused by EBV. This virus plays a role in the formation of a group of cancer types, including nasopharyngeal cancer.

• Family History: People who have a family member diagnosed with nasopharynx cancer also have a higher risk of developing cancer.

• Smoking: Smoking poses a risk for nasopharynx cancer.

• Race: It is more common in Far Eastern countries, especially China, or in those who migrate from here to other regions of the world.

Is it possible to make an early diagnosis?

Suspicious lesions and/or patient complaints can be examined early through regular annual general health checks.

How is the diagnosis made?

To diagnose nasopharynx cancer, first the patient’s detailed medical history is taken, his symptoms, if any, are questioned, and it is investigated whether he has the risk factors for cancer. Afterwards, a physical examination is performed. It may be significant to have palpable swelling in the neck area during examination for nasopharyngeal cancer.

For diagnosis, nasal endoscopy may be performed to examine the nasopharynx more closely and in detail. In this method, a thin tube-shaped instrument with a light source and camera at the end is advanced from the nose to the nasopharynx. In this way, the presence of a possible tumor in the area from the nose to the nasopharynx is examined. Nasal endoscopy is usually performed without anesthesia or under local (regional) anesthesia. If a structure that may suggest cancer is observed during the procedure, a biopsy sample is taken from this tissue. As a result of the pathological examination of the tissue sample taken, it is revealed whether the mass is benign or malignant (cancerous). If the tissue sample is compatible with nasopharynx cancer, parameters such as the subtype and stage of the cancer can also be revealed by pathological examination.

After nasopharyngeal cancer is diagnosed, imaging methods are used to check how much the cancer has spread to the surrounding tissues and whether it has spread to other parts of the body. Imaging methods such as Magnetic Resonance Imaging (MRI), Positron Emission Scintigraphy (PET) and Computed Tomography (CT) can be used.

The stage of the cancer is determined in the light of the pathology results and the information obtained from imaging methods. This staging is very important in determining the treatment protocol to be applied to the patient.

What are the stages of the disease?

The most important point in deciding on curative or palliative treatment is good staging. It is absolutely necessary to perform distant metastasis screening with a good evaluation. 5-10% of patients have distant metastases at the time of diagnosis. For this reason, the amount of examinations can be increased, especially in relation to the stage of the local and regional disease. It is extremely important to perform distant metastasis screening, especially in advanced nodal disease (N3a, N3b).

How is nasopharynx cancer treated?

Radiotherapy (Ray Therapy)

Radiotherapy, also known as radiation therapy, is a method that uses rays to destroy cancer cells. External beam radiotherapy is usually used for the treatment of nasopharyngeal carcinoma. In this method, the patient is laid on a flat table and a machine moving around it sends a beam to the exact spot where the tumor is located.

In small-sized nasopharynx cancers, only radiotherapy may be sufficient as treatment. However, for large tumors, it may be necessary to give radiotherapy and chemotherapy together.

In internal beam radiotherapy, also known as brachytherapy, the beam source is placed inside or very close to the tumor. Brachytherapy is especially used in the treatment of recurrent nasopharynx cancers.

Radiotherapy applied to the head and neck area may cause side effects such as skin rash, dry mouth, hearing loss, difficulty in swallowing, and sores in the mouth. If side effects develop, the patient may be given medications to alleviate the problem.

Chemotherapy

Chemotherapy is a treatment method used to kill cancer cells chemically. In chemotherapy, drugs can be given orally or intravenously.

Radiotherapy and chemotherapy are often used together in the treatment of nasopharyngeal cancer. In patients who can tolerate it, using these two methods simultaneously increases the effect of the treatment. However, due to the side effects of both methods occurring simultaneously, simultaneous treatment may not be applicable for every patient. In these patients, a treatment scheme is usually determined as first radiotherapy and then chemotherapy.

Surgical

Surgery is not a first-line method in the treatment of nasopharynx cancer. In case of tumor recurrence in both the nasopharynx and neck region after radiotherapy and/or chemotherapy treatment, surgery can be performed using endoscopic or open techniques for the tumor in the nasopharynx. Rescue neck dissection is performed on the neck area to remove cancerous lymph nodes.

Nasopharyngeal cancer is a type of cancer that is very common in societies where tobacco use is widespread, such as our country. Lack of symptoms in the early stages of the disease may create a negative situation in terms of early diagnosis and treatment. Even in the presence of neck swelling, nasal congestion, nosebleeds, and especially unilateral hearing loss that does not respond to treatment, it will be useful to consult an Ear, Nose, and Throat Diseases doctor at the nearest health center and have the necessary checks done.

Treatment Complications

Treatment complications can be divided into two parts: complications of radiation therapy and chemotherapy. It is possible to evaluate complications related to radiotherapy in two parts: acute and late complications. Acute reactions seen during radiation treatment of nasopharynx malignancies and within three months after treatment are mostly seen in rapidly proliferating tissues (such as mucosa, skin, bone marrow) that are within the treatment area. In addition to the parameters of the treatment (fraction dose, total dose, total treatment time and irradiation volume, etc.), the patient’s age, general condition, radiation therapy or simultaneous chemotherapy and the nature of the surgery performed before radiation therapy are other factors that affect acute reactions.

Is it possible to be protected?

Healthy nutrition, lifestyle and regular physical activity will ensure that the immune system is strong and the general body defense is effective.