Facts and figures about nasoharynx
Nasopharynx cancer is very rare; only around 240 new cases are diagnosed in the UK each year. Higher incidence in men, male to female ratio is approximately 3:1. Much higher incidence in patients of South Asian/Chinese background. Age related, in Caucasians the highest incidence is in the 50-60 years age group and in those of Chinese background it is in the 30-40 years age group.
Risk factors include smoking, formaldehyde and wood dust exposure, chronic ear, nose and throat conditions and genetics (particularly if a first degree relative has been diagnosed with nasopharyngeal cancer) and may include a poor diet, particularly lacking in fruit and vegetables, high intake of cured and salted fish and carrying the Epstein Barr virus (EBV). These are usually squamous cell carcinomas and are often diagnosed late as symptoms can be similar to cold/flu like symptoms.
- Blocked nose, nosebleeds, blood stained nasal discharge.
- Double vision.
- Difficulty in swallowing (dysphagia).
- Hearing loss (usually unilateral).
- Fluid collection in the ear.
- Numbness in the lower part of the face.
- Swelling/lumps in the neck.
Diagnosis of nasoharynx
Investigation may include:
- Physical examination.
- Blood tests.
- Chest x-ray.
- Biopsy – tissue samples taken from the affected area.
- Nasendoscopy- tissues samples may be taken for biopsy.
- Panendoscopy- tissues samples may be taken for biopsy
- Fine needle aspiration (FNA) - if there are any lumps/swelling in the neck which could indicate possible node involvement) a thin needle may be used to collect cells from the area for analysis.
- CT scan.
- MRI scan.
Depends on several factors:
- The type of tumour.
- The size and position of the tumour.
- The stage of the cancer.
- General health.
Surgery is rarely used for nasopharyngeal tumours as this area is difficult to access and is surrounded by important blood vessels and nerves. Consequently, radiotherapy tends to be the main treatment, although neck dissections may be recommended if the disease is found to have recurred in the nodes post radiotherapy.
Radiotherapy is known to cure most early stage nasopharyngeal tumours. Radiotherapy may also be given in combination with chemotherapy (chemoradiation) if the cancer cells have spread into the surrounding tissues or lymph nodes. However, the side effects from chemoradiation are quite severe so patients need to be generally in good health to tolerate the treatment.
Radiotherapy can have unpleasant chronic side effects which includes a dry mouth (xerostomia- most common late side effect) due to the potential damage to the salivary glands where saliva is produced. However, trials have proved that in suitable cases where Intensity Modulated Radiotherapy (IMRT) has been used to treat head and neck cancers the incidence of xerostomia is significantly reduced.
Image guided radiotherapy (IGRT) also enables the radiotherapy to be precisely delivered to the intended area which reduces potential radiation dose to healthy tissues and allows the radiography team to monitor any changes in the patients shape. This is important as head and neck patients often lose weight during treatment which can affect the aligning of the radiotherapy treatment. In some cases, it may be necessary to make a new headshell and replan the patient’s radiotherapy treatment.
It is important to achieve precise alignment for accuracy in delivering radiotherapy, therefore in most cases it is necessary for a ‘headshell’ to be produced. This is achieved by using a specialised thermoplastic material which can be heated in warm water and then is laid over the patient’s face to form an accurately fitting customised shell which can then be used for the planning CT scan and for all the radiotherapy treatments. It is a painless procedure which is clearly explained by the radiographers prior to the procedure.
Chemotherapy may be advised in combination with radiotherapy or if there is disease in the surrounding tissues or lymph nodes. It may also be used on its own if the disease has spread to other parts of the body.