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    Nasopharyngeal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - General Information About Nasopharyngeal Cancer

    continued...

    Prognosis

    Major prognostic factors adversely influencing outcome of treatment include the following:[8]

    • Large tumor size.[9][Level of evidence: 3iiiA]
    • A higher tumor (T) stage.
    • The presence of involved neck nodes.

    Other factors linked to diminished survival that were present in some, but not all, studies include the following:

    • Age.
    • World Health Organization (WHO) grade I.
    • Long interval between biopsy and initiation of radiation therapy.
    • Diminished immune function at diagnosis.
    • Incomplete excision of involved neck nodes.
    • Pregnancy during treatment.
    • Locoregional relapse.
    • Certain EBV antibody titer patterns.

    Small cancers of the nasopharynx are highly curable by radiation therapy, and patients with these small cancers have shown survival rates of 80% to 90%.[10]

    Moderately advanced lesions without clinical evidence of spread to cervical lymph nodes are often curable, and patients with these lesions have shown survival rates of 50% to 70%.

    Follow-up

    Follow-up for patients includes the following:

    • Routine periodic examination of the original tumor site and neck.
    • CT or PET-CT scan.
    • MRI scan.
    • Blood work.
    • EBV titers.

    Monitoring of patients should include the following:

    • Surveillance of thyroid and pituitary function.
    • Dental and oral hygiene.
    • Jaw exercises to avoid trismus.
    • Evaluation of cranial nerve function, especially as it relates to vision and hearing.
    • Evaluation of systemic complaints to identify distant metastasis.

    Although most recurrences occur within 5 years of diagnosis, relapse can be seen at longer intervals. The incidence of second primary malignancies is less than after treatment of tumors at other head and neck sites.[11]

    Poorly differentiated squamous cell cancer has been associated with EBV antibodies.[4,12] High-titer antibodies to virus capsid antigen and early antigen, especially of high IgA class, or high titers that persist after therapy, have been associated with a poorer prognosis.[13] This finding remains under evaluation.

    Tumors of many histologies can occur in the nasopharynx, but this discussion, like the American Joint Committee on Cancer nasopharynx staging, refers exclusively to WHO grade I-, II-, and III-type nasopharyngeal carcinoma.

    References:

    1. Chien YC, Chen JY, Liu MY, et al.: Serologic markers of Epstein-Barr virus infection and nasopharyngeal carcinoma in Taiwanese men. N Engl J Med 345 (26): 1877-82, 2001.
    2. Decker J, Goldstein JC: Risk factors in head and neck cancer. N Engl J Med 306 (19): 1151-5, 1982.
    3. Chen L, Gallicchio L, Boyd-Lindsley K, et al.: Alcohol consumption and the risk of nasopharyngeal carcinoma: a systematic review. Nutr Cancer 61 (1): 1-15, 2009.
    4. Feinmesser R, Miyazaki I, Cheung R, et al.: Diagnosis of nasopharyngeal carcinoma by DNA amplification of tissue obtained by fine-needle aspiration. N Engl J Med 326 (1): 17-21, 1992.
    5. Cummings CW, Fredrickson JM, Harker LA, et al.: Otolaryngology - Head and Neck Surgery. Saint Louis, Mo: Mosby-Year Book, Inc., 1998.
    6. Mendenhall WM, Werning JW, Pfister DG: Treatment of head and neck cancer. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 729-80.
    7. Laramore GE, ed.: Radiation Therapy of Head and Neck Cancer. Berlin: Springer-Verlag, 1989.
    8. Sanguineti G, Geara FB, Garden AS, et al.: Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of local and regional control. Int J Radiat Oncol Biol Phys 37 (5): 985-96, 1997.
    9. Lee CC, Huang TT, Lee MS, et al.: Clinical application of tumor volume in advanced nasopharyngeal carcinoma to predict outcome. Radiat Oncol 5: 20, 2010.
    10. Bailet JW, Mark RJ, Abemayor E, et al.: Nasopharyngeal carcinoma: treatment results with primary radiation therapy. Laryngoscope 102 (9): 965-72, 1992.
    11. Cooper JS, Scott C, Marcial V, et al.: The relationship of nasopharyngeal carcinomas and second independent malignancies based on the Radiation Therapy Oncology Group experience. Cancer 67 (6): 1673-7, 1991.
    12. Neel HB 3rd, Pearson GR, Taylor WF: Antibodies to Epstein-Barr virus in patients with nasopharyngeal carcinoma and in comparison groups. Ann Otol Rhinol Laryngol 93 (5 Pt 1): 477-82, 1984 Sep-Oct.
    13. Lin JC, Chen KY, Wang WY, et al.: Detection of Epstein-Barr virus DNA the peripheral-blood cells of patients with nasopharyngeal carcinoma: relationship to distant metastasis and survival. J Clin Oncol 19 (10): 2607-15, 2001.

    This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http:// cancer .gov or call 1-800-4-CANCER.

    WebMD Public Information from the National Cancer Institute

    Last Updated: May 28, 2015
    This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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