Nasopharyngeal Cancer (Upper Throat Cancer): Symptoms, Stages, and Treatment

Nasopharyngeal cancer is a malignant tumor originating in the upper part of the throat behind the nose, characterized by abnormal cell proliferation in the nasopharynx and often associated with Epstein-Barr virus infection and genetic susceptibility.

Symptoms of nasopharyngeal cancer include persistent nasal congestion, nosebleeds, hearing loss, and neck lymph node enlargement, reflecting local tumor growth and regional spread, which commonly leads to delayed diagnosis due to nonspecific early clinical findings.

Risk factors for upper throat cancer involve genetic predisposition, consumption of salt-cured foods, smoking, and viral infections, particularly Epstein-Barr virus, contributing to cellular mutations and oncogenic transformation within nasopharyngeal epithelial tissues.

Diagnosis and treatment of nasopharyngeal carcinoma rely on imaging, biopsy, and staging, followed by radiotherapy and chemotherapy protocols, as this cancer type is highly radiosensitive and requires multidisciplinary management for optimal prognosis and survival outcomes.

Definition	Nasopharyngeal cancer is a type of cancer that develops in the nasopharynx, located behind the nasal cavity and at the top of the throat. Typically originating from epithelial cells, it is rare but more common in certain regions.
Symptoms	Nasal congestion, nosebleeds, a feeling of fullness in the ear or hearing loss, swelling in the neck (enlarged lymph nodes), facial pain or numbness, sore throat, headache.
Causes	Epstein-Barr virus (EBV) infection, genetic predisposition, consumption of processed foods (salty and smoked foods), smoking, and alcohol use.
Risk Factors	EBV infection, Asian origin (especially common in Southern China), familial predisposition, smoking, consumption of processed foods.
Diagnostic Methods	Endoscopy of the nasopharynx, biopsy, blood tests (EBV antibody test), imaging methods (CT, MRI, PET scans), ultrasound.
Staging	From early stage (T1) to advanced stage (T4), depending on tumor size and spread to surrounding tissues. Additionally, the TNM staging system is applied based on lymph node status and metastasis.
Treatment Options	Radiotherapy (usually the first choice), chemotherapy, chemoradiotherapy (combined treatment), surgery (rarely used). Targeted therapies in advanced stages.
Complications	Hearing loss, radiation-induced dry mouth and mouth sores, difficulty swallowing, loss of sensation in the neck, spread of cancer to nearby tissues or lymph nodes, skin reactions from radiotherapy.
Prevention	Protection against EBV infections, reducing processed food consumption, avoiding smoking and alcohol, eating a healthy diet, and having regular check-ups if there are genetic risk factors.
Follow-up and Lifestyle	Regular doctor visits after treatment, attention to oral and throat health, supportive treatments for radiation-induced dry mouth and swallowing difficulty, nutritional support.

Ear, Nose, Throat, Head and Neck Surgery Specialist
Prof. Dr. Murat Topdağ

Born in Malatya in 1978, Murat Topdağ completed his primary and secondary education, then attended high school in Istanbul. He graduated from the English program of Cerrahpaşa Tıp Fakültesi. Prof. Dr. Murat Topdağ is married and has two children.

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What Is Nasopharyngeal Cancer (Upper Throat Cancer)?

: nazofarenks karsinomu PET Taraması görüntüsü

Nasopharyngeal cancer is a type of cancer that develops in the nasopharynx, the area connecting the nasal cavity to the oral cavity. In adults, the presence of a lesion or mass in this region is often an indication of serious health issues. This type of cancer includes both benign (noncancerous) and malignant (cancerous) tumors.

While nasopharyngeal carcinomas are commonly seen in adults, diseases such as lymphoma and leukemia can also affect this area. In children, benign tumors and, rarely, soft tissue cancers are found in the nasopharynx.

Nasopharyngeal cancer has three main types:

Type 1: Squamous cell nasopharyngeal carcinoma (SCC)
Type 2: Non-keratinizing, well-differentiated nasopharyngeal carcinoma
Type 3: Undifferentiated nasopharyngeal carcinoma

Among these types, type 3 responds most rapidly to therapy and has the lowest likelihood of recurrence after treatment. On the other hand, type 1 squamous cell nasopharyngeal carcinoma carries a risk of recurrence even after treatment.

The pathological examination of suspicious tissues in the nasopharynx is vital for determining whether these tissues are benign or malignant. Therefore, any mass or lesion in the nasopharynx should be carefully evaluated.

In adults, any tissue change in this area, particularly for malignancies such as lymphoma or leukemia, should be assessed for cancer. This approach plays a critical role in early diagnosis and in determining effective treatment strategies.

What Are the Causes of Nasopharyngeal (Upper Throat) Cancer?

: One of the causes of nasopharyngeal cancer is inhaling polluted and chemical air

Multiple factors influence the development of nasopharyngeal cancer. Environmental factors have a significant impact on this disease. Air pollution and exposure to chemical substances increase the risk. In addition, genetic predisposition also plays an important role in this type of cancer. A family history of nasopharyngeal cancer raises an individual’s risk.

Environmental factors

Air pollution
Exposure to chemical vapors

Genetic predisposition

Viruses, especially the Epstein-Barr virus (EBV), are strongly associated with nasopharyngeal cancer. Individuals infected with EBV should be examined more thoroughly for this type of cancer. Smoking is another factor that increases the incidence of the disease.

Eating habits and the types of foods consumed also play a role in the development of nasopharyngeal cancer. In particular, excessive consumption of smoked foods and foods cooked over wood fire increases cancer risk.

Nasopharyngeal cancer most commonly affects men and generally appears between the ages of 40 and 50. Understanding risk factors is vital for early diagnosis and treatment. Therefore, individuals at risk are advised to undergo regular health check-ups and make lifestyle changes.

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What Are the Symptoms of Nasopharyngeal Cancer?

Nasopharyngeal cancer presents itself in adults with various symptoms. Often, patients first consult a doctor upon noticing lumps in the neck area. These lumps are abnormal enlargements of the lymph nodes.

Other common symptoms in adults include unilateral middle ear infections. These infections occur due to a blockage in the Eustachian tube, which impairs ear aeration. Thus, the presence of a mass in the nasopharynx can be the underlying cause of such infections.

Symptoms of nasopharyngeal cancer include:

Enlarged lymph nodes in the neck that appear as lumps
Nasal congestion
Nosebleeds
Unilateral and persistent middle ear infections
A ringing sensation and blockage in the ear
Complaints related to cranial nerve involvement, such as vision problems and pain

Patients experiencing these symptoms should definitely seek medical advice. Early diagnosis is crucial in the treatment of nasopharyngeal cancer. Therefore, signs such as unilateral ear infections should not be ignored, and a nasopharyngeal examination must be done promptly. The effectiveness of treatment increases when the diagnosis is made quickly and accurately.

Nasopharyngeal Cancer Staging

In 2018, the American Joint Committee on Cancer updated its staging system. This was triggered by advances in imaging techniques and improved treatment outcomes. The TNM classification is based on the size of the tumor and the area of spread. It is split into three main categories: primary tumor, nodal metastasis, and distant metastasis.

Primary Tumor (T):

T0: No tumor detected, but an EBV-positive cervical node is present.
Tis: Carcinoma in situ, no invasive tumor.
T1: Tumor affecting the nasopharynx, oropharynx, and nasal cavity.
T2: Tumor has spread to the parapharyngeal areas and adjacent soft tissues.
T3: Tumor involves the skull base, pterygoid bones, and paranasal sinuses.
T4: Tumor shows cranial nerve deficits and has spread to the hypopharynx and other areas.

Nodal Metastasis (N):

N0: No lymph node involvement.
N1: Unilateral cervical or retropharyngeal lymph node involvement is present.
N2: Bilateral cervical lymph node involvement is detected.
N3: A large node or a node below a certain level is involved.

Distant Metastasis (M):

M0: No distant metastasis.
M1: Distant metastasis is present.

Staging is grouped into different levels based on tumor size and extent of spread. For example, Stage 0 and Stage I indicate limited tumor size with no nodal involvement, whereas Stage II and Stage III involve a greater extent of disease. Stage IVA and IVB represent the most advanced tumor spread and usually require more aggressive treatment approaches.

How Is Nasopharyngeal Cancer Diagnosed?

Nasopharyngeal cancer is initially suspected during a physical examination. At this point, specialists first listen to the patient’s complaints and conduct a physical check. Then, if a detailed examination of the nasopharynx is required, modern medical imaging methods are used, including:

Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Positron Emission Tomography (PET CT)

These imaging techniques allow clear visualization of any mass or abnormality in the nasopharynx. If something suspicious is detected on these images, the ENT (Ear, Nose, and Throat) specialist immediately recommends a biopsy. During the biopsy, a small tissue sample from the nasopharynx is collected and examined in a laboratory to determine:

The type of mass or swelling
Whether it is benign or malignant

For patients diagnosed with nasopharyngeal cancer, the treatment plan is shaped according to the stage of the disease and the type of mass.

Radiotherapy and chemotherapy are generally used together. Benign tumors can be managed with surgery or regular monitoring. Early detection is crucial because the success of treatment directly depends on diagnosing the disease in its early stages.

How Is Nasopharyngeal Cancer Treated?

Nasopharyngeal cancer is a disease that can be treated, especially if detected at an early stage. The main treatment methods are radiotherapy and chemotherapy. Therefore, after determining the cancer type through a biopsy, an appropriate treatment plan is created.

Certain types of cancer, such as Type 3 undifferentiated carcinoma, respond quickly to radiotherapy. Thus, early diagnosis and regular follow-up, combined with therapy, yield promising results.

The treatment options of radiotherapy and chemotherapy are also used for other diseases like lymphoma and leukemia.

If nasopharyngeal cancer progresses or remains untreated, it carries a risk of metastasis. This can significantly affect the skull base and nerves. When the disease spreads to the back of the skull or crucial nerves, patients may experience complications like double vision or instability.

Patient demographics also have a considerable effect on treatment outcomes. For instance, men and older adults are more frequently impacted by this cancer type. In addition, lymph node involvement in the neck and nerve involvement in the cranial area can make treatment response more difficult.

Cancer types unrelated to the Epstein-Barr virus can contain additional factors that negatively affect treatment success. Therefore, the treatment process should be planned for each individual patient and tailored according to the disease stage.

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Postoperative Recovery Period

The postoperative period begins in the intensive care unit. The patient usually moves to a regular ward within one or two days. In the ICU, the patient receives one-to-one nursing care, and in the high dependency unit, strict nursing oversight continues. During this period, the surgeon and anesthesiologist closely monitor the patient’s progress.

ICUs are often noisy and busy environments. This setting may feel unfamiliar and confusing for some patients. The patient typically feels drowsy due to anesthesia and painkillers.

After waking from surgery, the patient may be attached to various tubes to support bodily functions. These may include:

IV drips: Provide fluids and, if needed, blood until the patient can eat and drink.
Catheter: Inserted into the bladder to collect and measure urine output.
Feeding tube: Helps deliver liquid nutrition during the recovery period.
Wound drains: Used to prevent fluid accumulation in the surgical area and reduce infection risk.

Additionally, a pulse oximeter clip may be placed on the patient’s finger to measure blood oxygen levels and heart rate. During the first hours, the nurse regularly checks the patient’s temperature and blood pressure.

Oxygen may be supplied via a mask for a time to support breathing. Pain relief is administered during the first week. The patient is instructed to inform the nurse or doctor immediately if pain occurs.

Postoperative wound care is essential. The surgeon usually covers the wound with a dressing. If stitches or clips are used, they are usually removed after about ten days. A visiting nurse may be arranged to help with wound care at home.

The patient is encouraged to get out of bed and move around. Physiotherapists provide neck and shoulder exercises, which can continue for months after surgery.

Throughout the recovery period, special attention is given to the patient’s nutritional needs. Small meals and high-calorie drinks are recommended, which supply the required vitamins, proteins, and carbohydrates. A dietitian may also suggest protein and carbohydrate supplements.

Dietary and Lifestyle Changes for Postoperative Patients

Following nasopharyngeal cancer surgery, patients often need to make specific dietary and lifestyle changes to improve their quality of life. During and after treatment, correct dietary strategies can help alleviate difficulties. Below are some key points to consider during this time:

Patients who have difficulty swallowing during recovery typically follow a soft or liquid diet. This diet reduces throat pain while ensuring adequate nutrition.

Doctors and dietitians decide whether a feeding tube is necessary. If a PEG or RIG tube is indicated, liquid food is delivered through this tube. Such feeding is supported by special formulas containing protein, vitamins, and minerals.

Taste changes caused by radiotherapy can reduce one’s motivation to eat. In such cases, nutritional supplements that offer different flavors can be beneficial. Depending on the patient’s needs, sweet or savory options can be provided. The following nutritional supplements are recommended:

Protein powders
Carbohydrate supplements

A dry mouth is a common issue during and after surgery, making it difficult to eat and speak. Patients may benefit from artificial saliva or medications that stimulate salivary glands. Carrying a water bottle and taking small, frequent sips is also helpful.

Maintaining oral and dental health reduces the risk of infection, making regular dentist visits and a recommended oral care routine essential.

These recommendations help patients with nasopharyngeal cancer become more aware of dietary and lifestyle factors, enabling them to cope more effectively with the challenges they face. Regular contact with the healthcare team is one of the most important forms of support during this process.

Measures to Prevent Nasopharyngeal Cancer

Nasopharyngeal cancer starts in the region behind the nose (the nasopharynx). Although there is no definitive way to prevent this type of cancer, avoiding certain risk factors can lower its likelihood. A key first step is avoiding unhealthy dietary habits. Additionally, harmful substances can lead to serious health problems. Here are some important points to note:

Refrain from using harmful substances such as snuff and cocaine.
Minimize the consumption of smoked foods.
Avoid exposure to chemicals like nitrosamines.
Take precautions against chronic nasal infections.

Preventing Epstein-Barr virus infections can reduce the risk of gene mutations. These factors play a significant role in the development of nasopharyngeal cancer. Additionally, regular health check-ups should be done, and any suspicious situation warrants immediate consultation with a doctor.

Even individuals with risk factors may not develop cancer, whereas those without any risk factors sometimes do. Hence, recommended medical check-ups and lifestyle modifications are critical. These measures can help reduce the risk of nasopharyngeal cancer.