Treatment options for nasopharyngeal cancer

Your doctor and healthcare team will talk to you about your treatment and the options you have. They will explain its benefits and the possible side effects.

The most common treatments for nasopharyngeal cancer are:

• radiotherapy
• chemotherapy with radiotherapy (chemoradiotherapy)
• chemotherapy  on its own 
• surgery

Deciding what treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

Most people are referred to a head and neck cancer MDT. Or you might be referred to the ear, nose and throat (ENT) multidisciplinary team. You might go to a different hospital if your local hospital doesn't have a specialist MDT.

The treatment you have depends on:

• where your cancer is

• its size and whether it has spread (the stage)

• the type of cancer

• your general health and level of fitness

Your doctor will talk to you about your treatment, its benefits and the possible side effects.

The MDT usually includes:

Head and neck surgeons

There are different types of head and neck surgeons.

ENT surgeons are specialists who treat ear, nose, throat and neck conditions. 

Maxillofacial surgeons train as both doctors and dentists. They specialise in conditions of the mouth, jaw, face and neck. They also do reconstructive surgery.

Plastic surgeons do reconstructive surgery. Some people might have plastic surgery after head and neck cancer surgery. 

Oncologist

An oncologist is a cancer doctor who specialises in treating cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist).

Restorative dentist

A restorative dentist specialises in replacing lost tissues and teeth.

They assess your teeth before you have treatment. And may recommend that you have some teeth removed if they are decaying or loose. This is so they don't cause problems later on. 

The restorative dentist also gives you advice on how to look after your mouth and teeth during and after treatment. You may also see a dental hygienist to help keep your mouth and teeth clean. And reduce the risk of infection.

Head and neck clinical nurse specialist

Your clinical nurse specialist (CNS) is a qualified nurse who has specialist knowledge of cancers of the head and neck. They help to organise care between doctors and the other health professionals you need to see. They also support you through your treatment, and make sure you have the information you need to understand your cancer and treatment.

Speech and language therapist

Speech and language therapists play an important role in helping you with:

• communication

• speech

• swallowing difficulties (dysphagia)

They will start supporting you before treatment. This continues during and after treatment.

Other healthcare professionals

You might also see an eye doctor (ophthalmologist). This is because some nasopharyngeal cancers can spread to the eyes and inside the skull.

Other healthcare professionals may include:

• a head and neck histopathologist

• a head and neck radiologist

• a dietitian

• social workers and benefits advisers

The MDT may also include health professionals who look after people with advanced nasopharyngeal cancer. They can help with symptom control. They include:

• the palliative care team
• a clinical nurse specialist for palliative care

Treatment overview

You might have one or more treatments. This depends on the stage of your cancer. 

Radiotherapy is the main treatment for early or locally advanced nasopharyngeal cancer. You might have radiotherapy alone or with chemotherapy. Radiotherapy with chemotherapy is called chemoradiotherapy.

For advanced nasopharyngeal cancer, you usually have chemotherapy. 

Surgery is usually only used if the cancer comes back after the original treatment. 

Radiotherapy

Radiotherapy on its own, can cure most early stage nasopharyngeal cancers. This is usually stage 1. Some stage 2 nasopharyngeal cancers might also be treated with radiotherapy. Radiotherapy is also usually given to treat the lymph nodes in the neck. 

You usually have chemoradiotherapy for more advanced nasopharyngeal cancers.

Chemotherapy

You might have chemotherapy if the nasopharyngeal cancer has:

• spread to the lymph nodes in your neck
• spread to other parts of your body, such as the lungs or bones
• come back after treatment (recurred)

You might have:

• chemoradiotherapy
• chemotherapy on its own

The treatment you have depends on several things including the size of your cancer and whether it has spread (the stage).

If you have chemotherapy on its own, you usually have 2 or more chemotherapy drugs together. Using a combination of drugs can work better than using one drug on its own, but there are more side effects.

Chemoradiotherapy

Having chemotherapy and radiotherapy at the same time is called chemoradiotherapy. The chemotherapy makes the cancer cells more sensitive to the radiotherapy.

You might have this treatment if your cancer has grown into the tissue around the nasopharynx, or into the nearby lymph nodes . 

Chemoradiotherapy can be quite a tough treatment to have. The side effects can be more severe than the side effects of radiotherapy or chemotherapy on their own. So you have tests first to see if you’re fit enough to have it.

Surgery

Surgery is not a common treatment for nasopharyngeal cancer. This is because the area is difficult to get to and is surrounded by important nerves and blood vessels. And also because the cancer responds well to radiotherapy and chemotherapy.

Your specialist might suggest surgery to remove the cancer if it comes back quite soon after treatment with radiotherapy. And is suitable to remove by surgery. 

You might have surgery to remove lymph nodes in your neck if the cancer has come back (recurrence). This is called a neck dissection. 

Immunotherapy

Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.

You might have immunotherapy for some types of nasopharyngeal cancer that has come back (recurred). Or spread to other parts of the body. The treatments you might have include:

• nivolumab 
• pembrolizumab

Talk to your doctor if you want to know more about these treatments for nasopharyngeal cancer.

Treatment by stage

The stage shows the size of the cancer and whether it has spread. It helps your doctor decide on what treatment they offer you.

Stage 1 nasopharyngeal cancer

Radiotherapy is the main choice of treatment for stage 1 nasopharyngeal cancers.

With stage 1 cancers there is no sign that the cancer has spread to the lymph nodes. But you may have radiotherapy to the nodes in your neck, just in case any cancer cells have strayed there.

Stage 2 nasopharyngeal cancer

For stage 2 nasopharyngeal cancers you might have:

• radiotherapy to the tumour and the lymph nodes in your neck
• chemoradiotherapy

Stage 3 or 4A nasopharyngeal cancer

For stage 3 and stage 4A nasopharyngeal cancers, you might have:

• chemotherapy before chemoradiotherapy
• chemoradiotherapy on its own 
• radiotherapy to the tumour and the lymph nodes in your neck

Nasopharyngeal cancer that has spread to other parts of the body (stage 4B)

Your doctor might suggest treatment with chemotherapy or radiotherapy or both. The aim in this situation is to shrink the cancer and help to control your symptoms. This is called palliative treatment. Although it is not likely to cure your cancer, it could control it for some time.

If your cancer is advanced your doctor will refer you to a palliative care team. Palliative care specialists care for people in the final stages of their illness. But they also work with people with any stage of cancer. They can give expert help including:

• controlling symptoms such as pain, sickness and breathing problems
• supporting you with diet and physical care
• helping you have the best possible quality of life, whether you are at home or in a hospital or hospice

Nasopharyngeal cancer that has come back (recurrence)

The treatment you might have for nasopharyngeal cancer that has come back depends on where in your body the cancer is.

For cancer that has come back in the same area (the primary site) there are several treatment options. You might have surgery alone or radiotherapy after surgery. Or you might have radiotherapy on its own or with chemotherapy (chemoradiotherapy). 

For cancer that has come back in the lymph nodes in your neck, you are most likely to have surgery to remove them. This is called a neck dissection. You might also have radiotherapy. 

For cancer that comes back in another part of your body, you are likely to have chemotherapy. You might also have radiotherapy to the area the cancer has spread to, such as the bones.

Having treatment for advanced nasopharyngeal cancer

Deciding about treatment can be difficult when you have advanced cancer. This means the cancer has spread to other parts of the body. 

It helps to understand:

• what treatment can do for you
• how it might affect your quality of life
• what side effects you might have

Your doctor or specialist nurse can talk to you about the benefits and possible side effects. You can ask them questions.

You might also find it helps to talk things over with a close relative, a friend or a counsellor at the hospital.

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

A second opinion

A second opinion means seeing another GP or specialist doctor. They will give their view on your diagnosis or treatment. This might mean going to a different NHS hospital or GP surgery. Or you can pay to see a doctor privately.