Diagnosis of Nasopharyngeal Cancer

Diagnosis of Nasopharyngeal Cancer

The following tests and procedures may be used to diagnose nasopharyngeal cancer:
  • Physical exam of the throat: An exam in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.
  • Nasoscopy: A procedure to look inside the nose for abnormal areas. A nasoscope is inserted through the nose. A nasoscope 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 for signs of cancer.
  • 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.
  • Head and chest x-rays: An x-ray of the skull and 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.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. 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, 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.
  • 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. PET scans may be used to find nasopharyngeal cancers that have spread to the bone.
  • Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
 

Prognosis

The prognosis (chance of recovery) and treatment options depend on the following:
  • The stage of the cancer (whether it affects part of the nasopharynx, involves the whole nasopharynx, or has spread to other places in the body).
  • The type of nasopharyngeal cancer.
  • The size of the tumor.
  • The patient’s age and general health
 

Stages of Nasopharyngeal Cancer

The process used to find out whether cancer has spread within the nasopharynx or to other parts of the body is called staging. The results of the tests used to diagnose nasopharyngeal cancer are often also used to stage the disease. Cancer spreads in the body through tissue, lymph system or blood. When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. The following stages are used for nasopharyngeal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the nasopharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and is found in the nasopharynx only.

Stage II

Stage II nasopharyngeal cancer is divided into stage IIA and stage IIB as follows:
  • Stage IIA: Cancer has spread from the nasopharynx to the oropharynx (the middle part of the throat that includes the soft palate, the base of the tongue, and the tonsils), and/or to the nasal cavity.
  • Stage IIB: Cancer is found in the nasopharynx and has spread to lymph nodes on one side of the neck, or has spread to the area surrounding the nasopharynx and may have spread to lymph nodes on one side of the neck. The involved lymph nodes are 6 centimeters or smaller.
 

Stage III

In stage III nasopharyngeal cancer, the cancer:
  • is found in the nasopharynx and has spread to lymph nodes on both sides of the neck and the lymph nodes are 6 centimeters or smaller; or
  • has spread into the soft tissues (oropharynx and/or nasal cavity) and to lymph nodes on both sides of the neck and the lymph nodes are 6 centimeters or smaller; or
  • has spread beyond the soft tissues into areas around the pharynx and to lymph nodes on both sides of the neck and the lymph nodes are 6 centimeters or smaller; or
  • has spread to nearby bones or sinuses and may have spread to lymph nodes on one or both sides of the neck and the involved lymph nodes are 6 centimeters or smaller.
 

Stage IV

Stage IV nasopharyngeal cancer is divided into stage IVA, stage IVB, and stage IVC as follows:
  • Stage IVA: Cancer has spread beyond the nasopharynx and may have spread to the cranial nerves, the hypopharynx (bottom part of the throat), areas in and around the side of the skull or jawbone, and/or the bone around the eye. Cancer may also have spread to lymph nodes on one or both sides of the neck, and the involved lymph nodes are 6 centimeters or smaller.
  • Stage IVB: Cancer has spread to lymph nodes above the collarbone and/or the involved lymph nodes are larger than 6 centimeters.
  • Stage IVC: Cancer has spread beyond nearby lymph nodes to other parts of the body.
 

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.