Nasopharyngeal Cancer

Nasopharyngeal cancer starts in the nasopharynx, the space behind the nose and above the soft palate. It is rare in Europe and the Americas and much more common in southern China, South-East Asia, North Africa and parts of the Middle East.

It differs from other head and neck cancers in its causes and in its treatment. The area is hard to reach surgically and the tumour is very sensitive to radiation, so radiotherapy, usually with chemotherapy, is the main treatment.

Symptome

• A painless lump in the upper neck, the most common first sign
• Blocked nose on one side or blood-stained nasal discharge
• Hearing loss, ringing or a blocked feeling in one ear, from fluid behind the eardrum
• Recurrent ear infections in an adult
• Headache or facial pain and numbness
• Double vision from involvement of nerves at the skull base

Ursachen und Risikofaktoren

The non-keratinising type, which dominates in high-incidence regions, is closely linked to Epstein-Barr virus together with inherited susceptibility and diet, particularly salt-preserved fish and other preserved foods eaten from childhood. A first-degree relative with the disease raises the risk several times. The keratinising type, seen more in low-incidence countries, is related to smoking and alcohol. Occupational exposure to wood dust and formaldehyde contributes in some cases.

Wie es diagnostiziert wird

• Nasendoscopy and biopsy: A thin camera through the nose shows the tumour, and tissue is taken under local or general anaesthetic.
• MRI of the skull base and neck: The key scan, showing spread into the skull base, nerves and lymph nodes.
• PET-CT: Stages the rest of the body.
• Plasma EBV DNA: A blood test that reflects tumour burden, used at diagnosis and in follow-up.
• Hearing, dental and eye assessments: Carried out before radiotherapy begins.

Behandlungsmöglichkeiten

• Intensity-modulated radiotherapy (IMRT): Daily treatment for six to seven weeks, shaped to spare the salivary glands, inner ears, optic nerves and brainstem. It is used alone for the earliest stage.
• Concurrent chemoradiotherapy: Cisplatin given during radiotherapy for stage II to IVA disease.
• Induction chemotherapy: Gemcitabine and cisplatin before chemoradiotherapy in locally advanced cases.
• Treatment of recurrence: Endoscopic surgery through the nose, re-irradiation or neck dissection in selected patients.
• Systemic therapy for advanced disease: Chemotherapy combined with immunotherapy.
• Supportive care: Nutrition support, mouth care, swallowing exercises and long-term checks on thyroid function and hearing.

Wenn es dringend ist

Heavy nosebleeds, sudden double vision, severe headache or difficulty breathing need emergency care locally. An adult with a persistent neck lump or one-sided glue ear should have the nasopharynx examined without delay.

Reisen nach Türkiye zur Behandlung

Treatment lasts about seven weeks, and the hardest side effects (sore mouth, difficulty eating, fatigue) peak in the final weeks and the month after, so treating abroad means staying roughly two to three months with someone to help you. Where modern IMRT or proton planning is not available at home, that may be worth it. Otherwise, a remote review of staging and the radiotherapy plan can add value without relocation. Dental work needed before radiotherapy should be completed at least two weeks ahead.

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