Cancers that occur in the nasopharynx, or nasal passages, are among the most common cancers in Türkiye. This area is the transition area between the nose and mouth and is visualized using an endoscope or mirror.

Adenoids, a common condition in children, also form in the nasopharynx. Adenoids are lymphoid tissue found frequently in every child and serve as the body's defense mechanism. However, lymphoid tissue formation in the nasopharynx is not expected in adults. If a lesion or mass is found in the nasopharynx of an adult, a thorough examination is essential.

Cancers that occur in the nasopharynx are called nasopharyngeal cancer. This type of cancer can present as either benign or malignant tumors. Type 3 nasopharyngeal cancer responds most quickly to treatment and has a low risk of recurrence after treatment. Type 1 squamous cell nasopharyngeal carcinoma, on the other hand, can recur after treatment.

There are three types of nasopharynx cancer:

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

Additionally, cancers such as leukemia and lymphoma are frequently observed in the nasopharynx. Therefore, it is important to obtain pathological examination of suspicious tissue samples to obtain information about the tissue's nature. This examination helps determine whether the tissue is benign or at risk of cancer.

Causes of nasopharynx cancer

Multiple factors may play a role in the development of nasopharyngeal cancer. Environmental factors, genetic predisposition, and viruses play important roles.

• Environmental factors: Environmental factors such as air pollution and exposure to chemical vapors may increase the risk of nasopharyngeal cancer.
• Genetic predisposition: A family history of nasopharyngeal cancer may increase a person's risk.
• Epstein Barr Virus (EBV): EBV has been linked to nasopharyngeal cancer. It is important for individuals who test positive for EBV to have regular nasopharyngeal exams.
• Smoking: Smoking increases the risk of nasopharyngeal cancer.
• Dietary habits: Factors such as poor dietary habits, excessive consumption of smoked foods, and cooking over wood fires may increase the risk of nasopharyngeal cancer.

Nasopharyngeal cancer usually occurs during adolescence, typically between the ages of 40 and 50, and affects men more frequently. Therefore, a healthy lifestyle should be adopted to avoid or reduce these risk factors. Regular health checkups and early diagnosis in at-risk individuals are important.

Symptoms of nasopharynx cancer

Symptoms of nasopharynx cancer may include:

• Neck lumps: Among the most common symptoms are neck lumps. These lumps are usually painless but can reach noticeable sizes.
• Unilateral otitis media: In adults, a mass in the nasopharynx can obstruct the eustachian tube, leading to unilateral otitis media. This occurs due to impaired ear ventilation.
• Nasal congestion: Nasopharyngeal cancer can cause nasal congestion. This congestion is usually one-sided, leaving the other nostril free.
• Nosebleeds: Nasopharyngeal cancer can also cause nosebleeds. These can be frequent and difficult to stop.
• Persistent middle ear infection: Unilateral middle ear infections may be a sign of nasopharyngeal cancer and should be examined.
• Ear buzzing and congestion: Nasopharyngeal cancer can cause ear-related complaints such as ear buzzing and congestion.
• Cranial nerve involvement: In some cases, nasopharyngeal cancer can affect the cranial nerves, causing symptoms such as vision problems and pain.

These symptoms suggest nasopharyngeal cancer, and a specialist should be consulted. Early diagnosis and treatment can prevent disease progression and increase the chance of a cure.

Diagnosis of nasopharyngeal cancer

Diagnosis of nasopharyngeal cancer is usually made through the following steps:

• Physical Examination: In any suspected case, a physical examination is the first step in identifying abnormalities in the nasopharynx. The otolaryngologist examines the nasopharynx using an endoscope or mirror to identify potential tumors or other abnormalities.
• Imaging tests: If necessary, imaging techniques such as tomography (CT scan), magnetic resonance imaging (MRI), or positron emission tomography (PET CT) may be used. These tests help assess the tumor's size, location, and possible spread.
• Biopsy : When a suspicious lesion is detected, a biopsy is taken from the nasopharynx. This procedure allows the abnormal tissue to be examined under a microscope to confirm the presence and type of cancer cells. A definitive diagnosis is based on the biopsy results.
• Neck evaluation: Nasopharyngeal cancer can sometimes cause lymph node enlargement in the neck. Therefore, the lymph nodes in the neck area are also examined, and imaging tests such as CT scans or PET/CT scans may be used to evaluate possible metastatic spread.

Confirming a diagnosis of nasopharyngeal cancer and determining the tumor type are critical in determining appropriate treatment options. Treatment may include surgery, radiation therapy, chemotherapy, or a combination, depending on the tumor type, size, and spread, and the patient's overall health.

Treatment of nasopharynx cancer

Treatment for nasopharyngeal cancer depends on the type of tumor identified at diagnosis, its size, and its spread, as well as the patient's overall health. Treatment typically involves one or a combination of the following:

• Radiotherapy: Radiotherapy is usually the primary treatment option for nasopharyngeal cancer. It uses high-energy radiation to destroy cancer cells. It can be especially effective in rapidly responding types, such as Type 3 Undifferentiated Carcinoma.
• Chemotherapy: Chemotherapy is used with radiation therapy to stop the growth and spread of cancer cells. Chemotherapy can work synergistically with radiation therapy and may be more effective in treating cancer.
• Surgery: In some cases, nasopharyngeal tumors can be surgically removed. However, surgery is usually used in conjunction with radiation therapy or chemotherapy to control the spread of the cancer.
• Targeted therapies: In some cases, newer treatments, such as specific drugs or immunotherapy that target cancer cells, may be used.

Early diagnosis and regular follow-up are crucial in the treatment of nasopharyngeal cancer. If not detected and treated early, the cancer can progress to advanced stages and metastasize. Skull base and nerve involvement are particularly common complications.

Patient age and gender are among the factors that influence treatment success. Advanced age, involvement of lymph nodes in the neck, nerve involvement, and cancer types not caused by the Epstein Bar virus can negatively impact treatment outcome. Successful treatment and patient survival require a multidisciplinary approach and expertise.

How long does nasopharynx treatment take?

Treatment for nasopharyngeal cancer can vary depending on many factors and requires a personalized plan tailored to the individual's situation. Treatment duration can vary depending on the tumor type, size, spread, treatment methods, and the patient's overall health. Treatment typically lasts from a few months to several years. For example:

• Radiotherapy is usually administered in daily sessions over several weeks.
• Chemotherapy can last for several weeks or months, sometimes requiring rest periods between treatment cycles.
• Surgery may take several hours or longer, depending on the size and spread of the tumor, and recovery may take several weeks or longer.
• The follow-up and observation period continues after treatment ends and may include regular doctor visits to monitor the patient's condition.

The first 5 years of treatment are particularly critical for patient survival and the likelihood of recurrence. Regular monitoring may be necessary during this period, and additional treatments may be planned if necessary. Because each patient is unique, the duration of treatment and follow-up schedule are determined individually. Therefore, it is difficult to specify an exact timeframe for nasopharyngeal cancer treatment and may vary depending on the patient's condition.

Is nasopharynx cancer dangerous?

Nasopharyngeal cancer is a serious health problem and can be life-threatening if left untreated. Because the nasopharynx is located at the base of the skull and the back of the neck, cancer can cause various complications if it spreads in this area. As the cancer progresses, it can spread to surrounding tissues and organs, affecting nerves and even causing brain complications.

Nasopharyngeal cancer is a treatable disease, and when diagnosed early and a proper treatment plan is implemented, it can be controlled. However, treatment can be complex and sometimes lengthy and challenging. Therefore, nasopharyngeal cancer is a serious condition, and it's important to fully adhere to your doctor's recommendations and treatment plan throughout the treatment process. Early diagnosis and treatment can increase survival and reduce the risk of complications.