Nasopharyngeal Cancer

ON THIS PAGE: You will find a drawing of the head and neck region, including the location of the nasopharynx. Use the menu to see other pages.

For medical illustrations showing the different stages of nasopharyngeal cancer, please visit the Stages section.

The next section in this guide is Risk Factors and Prevention . It describes the factors that may increase the chance of developing NPC. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for nasopharyngeal cancer (NPC). You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

• Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

• Lower the number of people who develop the disease

Learn more about the basics of cancer screening .

Screening information for nasopharyngeal cancer

Regular health and dental screenings are important for people who routinely drink alcohol, currently use tobacco products, or have used tobacco products in the past. People who use alcohol and tobacco should receive a general screening examination at least once a year. This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck.

If anything unusual is found, then the doctor will recommend a more extensive examination using 1 or more of the diagnostic procedures described in the Diagnosis section. When detected early, cancer of the head and neck has a much better chance of being cured.

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems NPC can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How nasopharyngeal cancer (NPC) is diagnosed

There are many tests used for diagnosing NPC. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

The following tests may be used to diagnose NPC:

• Physical examination and blood tests. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. The doctor will look for any abnormalities in the nose, mouth, throat, and tongue, often using a light and/or mirror to get a clearer view. A blood test to check for antibodies against the EBV virus may be done at the same time. See the Risk Factors and Prevention section for more information about EBV.

• Endoscopy. An endoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is inserted through the mouth or nose to examine the head and neck areas. Sedation is giving medication to become more relaxed, calm, or sleepy. When an endoscopy is done to look into the nasopharynx, it is called a nasopharyngoscopy.

• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The type of biopsy performed will depend on the location of the cancer.

  During a fine needle aspiration , cells are removed using a thin needle inserted directly into the tumor. The cells are examined under a microscope during cytologic examination for signs of cancer. The biopsy may be performed using local anesthesia or general anesthesia. Local anesthesia is an injection that numbs the area where a procedure is being done, while general anesthesia makes a person unconscious during a major procedure, such as surgery.

• X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. Sometimes, a barium swallow may be required before having an x-ray. The barium coats the mouth and throat to enhance the image on the x-ray. An x-ray of the skull and chest may be needed to learn more about the extent of NPC.

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue such as the tonsils and base of the tongue. An MRI is more sensitive than a CT scan in detecting a tumor of the nasopharynx and any possible spread to nearby tissues or lymph nodes. MRI can be used to measure a tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.

• Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The amount of radiation in the tracer is too low to be harmful. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image.

• Neurological tests. During these examinations, the doctor tests a person’s nerve function, especially the sense of touch in their face and the motor function of certain nerves in the head and neck area.

• Hearing test. The doctor may perform a hearing test if it seems that fluid could be in the middle ear.

• Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan . However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with nasopharyngeal cancer (NPC). Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for NPC. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How nasopharyngeal cancer is treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan, which usually combines different types of treatments. This is called a multidisciplinary team . The team may include:

• Medical oncologist, a doctor who treats cancer using systemic therapies such as chemotherapy and immunotherapy.

• Radiation oncologist, a doctor who specializes in treating cancer using radiation therapy.

• Surgical oncologist, a doctor who treats cancer using surgery.

• Otolaryngologist, a doctor who treats ear, nose, and throat problems.

• Maxillofacial prosthodontist, a specialist who performs restorative surgery in the head and neck areas.

• Oncologic dentist or oral oncologist, dentists experienced in caring for people with head and neck cancer.

• Physical therapist, a health care professional who helps patients improve their physical strength and ability to move.

• Speech-language pathologist, this professional specializes in communication and swallowing disorders. A speech-language pathologist helps patients regain their speaking, swallowing, and oral motor skills after cancer treatment that affects the head, mouth, and neck.

Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Many cancers of the nasopharynx can be cured, especially if they are found early. Descriptions of the common types of treatments used for NPC are listed below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

The main treatment for NPC is radiation therapy. It is often given in combination with chemotherapy. This approach may be called concomitant chemoradiotherapy. Surgery for NPC is occasionally used, mainly to remove lymph nodes after chemoradiotherapy or to treat NPC that has come back after initial treatment.

Although curing the cancer is the primary goal of treatment, preserving the function of the nearby organs and tissues is also very important. When doctors plan treatment, they consider how it might affect a person’s quality of life, including how a person feels, looks, talks, eats, and breathes.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for NPC because there are different treatment options. Learn more about making treatment decisions .

The common types of treatment used for NPC are described below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

• Radiation therapy

• Chemotherapy

• Immunotherapy

• Surgery

• Physical, emotional, and physical side effects of cancer

• Metastatic NPC

• Remission and chance of recurrence

• If treatment does not work

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

There are different types of radiation therapy that a doctor may recommend for NPC. Radiation therapy may also be combined with chemotherapy during treatment. When this is done, it is called chemoradiotherapy or concurrent chemotherapy (see “Chemotherapy” below).

• External-beam radiation therapy. The most common type of radiation therapy used to treat NPC is called external-beam radiation therapy, which aims radiation from a machine outside the body at the tumor. A method of external-beam radiation therapy, known as intensity-modulated radiation therapy (IMRT), allows more effective doses of radiation therapy to be delivered, while reducing damage to healthy cells and causing fewer side effects. The American Society of Clinical Oncology (ASCO) recommends IMRT for all people with stage II to stage IVA NPC.

• Proton therapy. Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Proton therapy may be used as part of the treatment for some tumors at the base of the skull to lower the radiation dose to nearby structures, such as the optic nerves in the eye and the brainstem. Proton therapy may also be an option for later-stage NPC that is located close to parts of the central nervous system, which includes the brain and spinal cord.

• Stereotactic radiosurgery. Stereotactic radiosurgery delivers radiation therapy precisely to the tumor. This can be used to treat a tumor that has grown into the base of the skull or a tumor that has recurred at the base of the brain or skull.

• Brachytherapy. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. To treat NPC with internal radiation therapy, a doctor surgically implants tiny pellets or rods that contain radioactive materials in or near the cancer location. The implant is left in place for several days while the person stays in the hospital. This approach is most often used to treat NPC that has come back after the first treatment, but it may also be used to treat the original tumor.

Before starting radiation treatment for any head and neck cancer, people should receive a thorough examination from an oncologic dentist. An oncologic dentist is a dentist with experience caring for the dental and oral health of people with cancer. Since radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before cancer treatment begins. After radiation therapy for NPC, dental care should continue to help prevent further dental problems. People may receive fluoride treatment to prevent dental cavities. Read more about dental and oral health .

Other side effects of radiation therapy to the head and neck may include redness or irritation of the skin in the treated area, dry mouth or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue, mouth sores, sore throat, pain or difficulty swallowing, swelling called lymphedema, appetite loss because of changes in a person's sense of taste, hearing loss because of a buildup of fluid in the middle ear, and earwax buildup that dries out because of the radiation therapy’s effect on the ear canal.

Radiation therapy may also cause a condition called hypothyroidism in which the thyroid gland slows down. The thyroid gland is located in the neck. Hypothyroidism causes people to feel tired and sluggish and to gain weight. As a result, every person who receives radiation therapy to the neck area should have their thyroid checked regularly. Read more about thyroid problems caused by cancer treatment .

There are numerous studies underway to find ways to reduc e or better relieve the side effects of radiation therapy . Talk with your doctor before treatment begins about ways to prevent or manage side effects. Learn more about the basics of radiation therapy .

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle them.

The types of medications for nasopharyngeal cancer include:

• Chemotherapy

• Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Chemotherapy

The main type of systemic therapy used for NPC is chemotherapy. Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A combination of chemotherapy and radiation therapy is commonly used to treat NPC. The use of chemotherapy before radiation therapy is also being studied.

Common ways to give chemotherapy include:

• An intravenous (IV) tube placed into a vein using a needle

• In a pill or capsule that is swallowed (orally)

• A shot (injection) into a muscle, under the skin, or directly into the cancerous tumor

ASCO recommends chemotherapy in the following situations for people with stage II to stage IVA NPC.

• For a stage II tumor that has spread to the lymph nodes, chemoradiotherapy may be recommended. Chemoradiotherapy is when chemotherapy and radiation therapy are given during the same time period.

• For a stage II tumor that has not spread to the lymph nodes, chemotherapy may still be offered if there are signs that the cancer may spread.

• For stage III to stage IVA NPC, either induction chemotherapy plus chemoradiotherapy or chemoradiotherapy plus adjuvant chemotherapy are recommended. Induction chemotherapy is the first treatment given with the intent to cure the cancer. Induction chemotherapy is given before chemoradiotherapy. Adjuvant chemotherapy is given after the chemoradiotherapy.

• For large stage III tumors that do not involve the lymph nodes, chemoradiotherapy with or without induction or adjuvant chemotherapy is recommended.

Regimens for induction chemotherapy may include combinations of gemcitabine (Gemzar) and cisplatin (Platinol); docetaxel (Taxotere) with cisplatin and 5-fluorouracil (5-FU); cisplatin and 5-fluorouracil; cisplatin and capecitabine (Xeloda); or docetaxel and cisplatin. Regimens for adjuvant chemotherapy should include cisplatin, 5-fluorouracil, and/or carboplatin (Paraplatin).  Recent studies are examining the use of immunotherapy in addition to chemotherapy for NPC as well.

When chemoradiotherapy is used to treat NPC, cisplatin, nedaplatin (Aqupla), carboplatin, or oxaliplatin (Eloxatin) should be used when possible.  There may be reasons your oncologist chooses a particular chemotherapy based on your unique circumstance.

This information is based on the joint guideline from the Chinese Society of Clinical Oncology and ASCO, “ Chemotherapy in Combination with Radiotherapy for Definitive-intent Treatment of Stage II to IVA Nasopharyngeal Carcinoma .” Please note that this link takes you to another ASCO website.

Each drug or combination of drugs can cause specific side effects, and it is important to talk with your doctor about which side effects to expect and if any may become permanent. Side effects of chemotherapy may include fatigue, nausea, vomiting, hair loss, dry mouth, diarrhea, constipation, and loss of appetite, often due to a change in a person's sense of taste.

In addition, chemotherapy can weaken the immune system and cause open sores in the mouth, which can lead to infection. In general, chemotherapy in combination with radiation therapy increases these side effects. Nutritional support may be necessary during treatment due to these side effects. Talking with an oncology dietitian may help. Listen to a podcast about ways to manage eating challenges after treatment.

Learn more about the basics of chemotherapy .

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Immunotherapy (updated 12/2022)

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system's ability to attack cancer cells.

ASCO recommends that a certain type of immunotherapy, called a PD-1 inhibitor, be offered to patients with recurrent and/or metastatic nasopharynx cancers. PD-1 inhibitor options may include toripalimab (Tuoyi), camrelizumab (AiRuiKa), or tislelizumab, as well as pembrolizumab (Keytruda) and nivolumab (Opdivo), based on availability in your region.  Many times, these drugs are given to patients whose nasopharynx cancers have come back or spread after receiving chemotherapy. Your doctor will discuss whether the use of immunotherapy either by itself or in combination with chemotherapy is appropriate.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

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Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is occasionally used for NPC, but it is not a common treatment choice because the area is hard to reach and lies close to cranial nerves and blood vessels.

If the doctor suspects that the cancer has spread to the lymph nodes, surgical removal of lymph nodes in the neck may be recommended. This type of surgery is called a neck dissection. For undifferentiated carcinoma of the nasopharynx, neck dissection is sometimes needed.

A neck dissection may cause numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. These side effects are caused by damage to nerves in the area. Depending on the type of neck dissection, weakness of the lower lip and arm may go away after a few months. However, it is possible that weakness will be permanent if a nerve is removed or damaged as part of a dissection. Swelling called lymphedema may also be possible. Facial disfigurement may need to be addressed using reconstructive or plastic surgery. Before your operation, talk with your surgeon in detail about what you can expect and if another surgery will be needed for reconstruction. If there are changes to your appearance, talk with your health care team about ways to cope and finding support services.

Learn more about the basics of cancer surgery .

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Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Metastatic NPC (updated 12/2022)

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of radiation therapy, immunotherapy, and chemotherapy. Sometimes, surgery may be recommended as well. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Recurrent NPC is usually treated with radiation therapy and/or chemotherapy, and sometimes with surgery. Chemotherapy is used for NPC that has come back in distant sites and was previously treated only with radiation therapy. Chemotherapy may also be used together with radiation therapy to improve the effectiveness of the radiation therapy. This approach is called chemoradiotherapy. Your doctor may suggest clinical trials that are studying new ways to treat recurrent NPC. For instance, a clinical trial of another type of systemic medication therapy, such as immunotherapy or targeted therapy, may be an option. Learn more in the Latest Research section. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from NPC is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about nasopharyngeal cancer (NPC) and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about NPC, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with NPC. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• New medications. As explained in Types of Treatment , immunotherapy is a type of systemic treatment designed to boost the body's natural defenses to fight the cancer. It is an area of active research for NPC. Another type of systemic treatment based on the specific biologic characteristics of a tumor that is being used more often for NPC is called targeted therapy. This approach is being tested in clinical trials. People with NPC should talk with their doctors about the availability of these studies. Learn more about the basics of immunotherapy and targeted therapy .

• Chemotherapy for recurrent or metastatic NPC. A recent phase 3 study found that treating recurrent or metastatic NPC with a combination of gemcitabine (Gemzar) and cisplatin (available as a generic drug) worked better than using a combination of fluorouracil (5FU) and cisplatin.

• Combining therapies. As described in Types of Treatment , doctors continue to research the best combinations of different types of therapies, such as radiation therapy, chemotherapy, and surgery, for different stages of NPC.

• Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current NPC treatments to improve comfort and quality of life for patients. This includes ways to relieve dry mouth (xerostomia), lymphedema , mouth sores , pain , and other side effects.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research regarding NPC, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now .

• Read about research presented during the April 2022 session of the ASCO Plenary Series: Immunotherapy Plus Chemotherapy Helps People With Advanced Nasopharyngeal Cancer

• Listen to an expert-led podcast about research on treatment options for head and neck cancer from the ASCO 2020 Virtual Scientific Program.

• Visit the website of Conquer Cancer, the ASCO Foundation to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance in how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible.

People may receive physical therapy and speech therapy to regain skills, such as speaking and swallowing. Supportive care to manage symptoms and maintain nutrition during and after treatment may be recommended. Some people may need to learn new ways to eat or prepare foods differently. People may look different, feel tired, and be unable to talk or eat the way they used to. Many people experience depression. The health care team can help people adjust and connect them with both physical and emotional support services. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care .

Watching for recurrence or second cancers

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

People treated for NPC should receive regular follow-up medical and dental examinations to check for signs that the NPC has come back or a second cancer (a different type of cancer) has developed. Your doctor may also recommend an MRI or CT scan 6 to 8 weeks after treatment, called a baseline study. If NPC comes back, the baseline study will help the doctors track when the changes began. When they occur, most recurrences of NPC happen within the first 2 to 3 years after treatment, so follow-up visits will be more frequent during those years.

People who have had NPC have a higher risk of developing a second cancer. Researchers are evaluating the benefits of using chemotherapy as a way to prevent a second cancer from developing. This is called chemoprevention .

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

For NPC, doctors may check your thyroid gland function, vision, and hearing to find any cranial nerve damage from radiation therapy or surgery. Periodic ear examinations may also be necessary to remove any dried earwax that has built up. Prevention of dental cavities is also important. Fluoride application is recommended whenever the oral cavity and the salivary glands receive radiation treatment.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of NPC do I have?

• What is the stage of the NPC? What does this mean?

• Can you explain my pathology report (laboratory test results) to me?

Questions to ask before cancer treatment

• What are my treatment options?

• What clinical trials are available for me? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• Should I get an additional consultation or second opinion?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• Can you recommend an oncologic dentist before treatment begins?

• Should I see a speech pathologist before starting treatment?

• If I have questions or problems, who should I call?

Questions to ask about managing side effects

• Who should I contact about any side effects I experience? And how soon?

• What are the possible side effects of each treatment, both in the short term and the long term?

• What can be done to prevent or manage these side effects?

• Will any of my treatments affect my facial appearance? If so, how and for how long?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

Questions to ask about having radiation therapy or therapies using medication

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about having surgery

• What type of surgery will I have?

• Will lymph nodes be removed? If so, what type of dissection will be done? What does this mean?

• Will it be necessary to have reconstruction done to replace lost tissue around the lower jaw bone?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this surgery?

• What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs and symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• When can I expect to recover from the treatment effects?

• Will there be any lasting or late side effects that will need special care?

• What follow-up tests will I need, and how often will I need them?

• What type(s) of rehabilitation will I need after treatment has finished?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers some more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.