Childhood Nasopharyngeal Cancer Treatment (PDQ®)

Last modified: 2018-01-08
Last downloaded: 2018-06-23

   

General Information About Childhood Nasopharyngeal Cancer

   

Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasal cavity and throat.

Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the nasopharynx. The nasopharynx is made of the nasal cavity (inside of the nose) and top part of the throat. Nasopharyngeal cancer is rare in children younger than 10 and more common in adolescents.

Anatomy of the nasopharynx. The nasopharynx is in the upper part of the pharynx (throat) behind the nose. The nostrils lead into the nasopharynx. An opening on each side of the nasopharynx leads into the ear.   

Being infected with the Epstein-Barr virus increases the risk of nasopharyngeal cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your child's doctor if you think your child may be at risk.

Being infected with the Epstein-Barr virus (EBV) is strongly linked to having nasopharyngeal cancer.

  

Signs and symptoms of nasopharyngeal cancer include painless lumps in the neck and headache.

These and other signs and symptoms may be caused by nasopharyngeal cancer or by other conditions.

Check with your child's doctor if your child has any of the following:

  • Painless lumps in the neck.
  • Headache.
  • Blocked or stuffy nose.
  • Nosebleeds.
  • Pain in the ear.
  • Ear infection.
  • Problems moving the jaw.
  • Hearing loss.
  • Double vision or droopy eyelid.
  

Tests that examine the nasopharynx are used to help detect (find) and diagnose nasopharyngeal cancer.

The following tests and procedures may be used:

Computed tomography (CT) scan of the head and neck. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.

Computed tomography (CT) scan of the head and neck. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.

Positron emission tomography (PET) scan. The child lies on a table that slides through the PET scanner. The head rest and white strap help the child lie still. A small amount of radioactive glucose (sugar) is injected into the child's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do.

Positron emission tomography (PET) scan. The child lies on a table that slides through the PET scanner. The head rest and white strap help the child lie still. A small amount of radioactive glucose (sugar) is injected into the child's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do.

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas of the body, such as the nasopharynx and neck. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the nasopharynx or lymph nodes, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.Computed tomography (CT) scan of the head and neck. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.Positron emission tomography (PET) scan. The child lies on a table that slides through the PET scanner. The head rest and white strap help the child lie still. A small amount of radioactive glucose (sugar) is injected into the child's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do.
  • PET-CT scan : A procedure that combines the pictures from a PET scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself.
  • Endoscopy : A procedure to look at organs and tissues inside the body to check for abnormal areas. A flexible or rigid endoscope is inserted through the nose. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope by a pathologist for signs of disease.
  • Epstein-Barr virus (EBV) tests: Blood tests to check for antibodies to the Epstein-Barr virus and DNAmarkers of the Epstein-Barr virus. These are found in the blood of patients who have been infected with EBV.

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Stages of Nasopharyngeal Cancer

  

After nasopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the nasal cavity and throat or to other parts of the body.

To plan treatment, it is important to know whether cancercells have spread within the nasal cavity or to other parts of the body. The process used to find out if cancer has spread is called staging. Most children with nasopharyngeal cancer are at an advanced stage at the time of diagnosis. Nasopharyngeal cancer spreads most often to the bone, lung, and liver.

The following tests and procedures may be used to find out if cancer has spread:

Bone scan. A small amount of radioactive material is injected into the child's vein and travels through the blood. The radioactive material collects in the bones. As the child lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen.

Bone scan. A small amount of radioactive material is injected into the child's vein and travels through the blood. The radioactive material collects in the bones. As the child lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen.

  • Neurological exam : A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
  • Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest or abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.Bone scan. A small amount of radioactive material is injected into the child's vein and travels through the blood. The radioactive material collects in the bones. As the child lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen.
  

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
  

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatictumor is the same type of cancer as the primary tumor. For example, if nasopharyngeal cancer spreads to the lung, the cancer cells in the lung are actually nasopharyngeal cancer cells. The disease is metastatic nasopharyngeal cancer, not lung cancer.


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Recurrent Nasopharyngeal Cancer

Recurrent nasopharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the nasopharynx or in other parts of the body.

Refractory nasopharyngeal cancer is cancer that does not respond to treatment.


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Treatment Option Overview

  

There are different types of treatment for children with nasopharyngeal cancer.

Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

  

Children with nasopharyngeal cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.

Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine. This may include the following specialists and others:

  

Children and adolescents may have treatment-related side effects that appear months or years after treatment for nasopharyngeal cancer.

Regular follow-up exams are very important. Treatment can cause side effects long after it has ended. These are called late effects.

Late effects of cancer treatment may include:

Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. See the PDQ summary on Late Effects of Treatment for Childhood Cancer.

  

Four types of standard treatment are used:

Chemotherapy 

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

Radiation therapy 

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

Surgery 

Surgery to remove the tumor is done if the tumor has not spread throughout the nasal cavity and throat at the time of diagnosis.

Immunotherapy 

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer.

Two types of immunotherapy are being used or studied to treat children with nasopharyngeal cancer:

  • Interferon affects the division of cancer cells and can slow tumor growth. Interferon is used to treat newly diagnosed nasopharyngeal cancer.
  • EBV-specific cytotoxic T-lymphocytes are a type of immune cell that can kill certain cells, including foreign cells, cancer cells, and cells infected with the Epstein-Barr virus. Cytotoxic T-lymphocytes can be separated from other blood cells, grown in the laboratory, and then given to the patient to kill cancer cells. EBV-specific cytotoxic T-lymphocytes are being studied to treat refractory or recurrent nasopharyngeal cancer.

This type of cancer treatment is also called biotherapy or biological therapy.

  

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Targeted therapy 

Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.

Targeted therapy is being studied for the treatment of childhood nasopharyngeal cancer that has recurred (come back).

  

Treatment for childhood nasopharyngeal cancer may cause side effects.

For information about side effects that begin during treatment for cancer, see our Side Effects page.

  

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

  

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

  

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.


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Treatment Options for Childhood Nasopharyngeal Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Newly Diagnosed Childhood Nasopharyngeal Cancer

Treatment of newly diagnosednasopharyngeal cancer in children may include the following:

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Recurrent Childhood Nasopharyngeal Cancer

Treatment of recurrentnasopharyngeal cancer in children may include the following:

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.


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To Learn More About Childhood Nasopharyngeal Cancer

For more information from the National Cancer Institute about nasopharyngeal cancer, see the following:

For more childhood cancer information and other general cancer resources, see the following:


Back to Top Source: The National Cancer Institute's Physician Data Query (PDQ®) Cancer Information Summaries ( http://www.cancer.gov/cancertopics/pdq)