Nasopharyngeal Cancer Patient Guide

This guide has been prepared to inform patients diagnosed with nasopharynx (back of the nose) cancer

This guide has been prepared to inform patients diagnosed with nasopharynx (back of the nose) cancer and their relatives throughout the process.

This document is for general information purposes only; For personal medical decisions, be sure to consult your ear, nose and throat / radiation oncology specialist.

Contents

1. Introduction: What is Nasopharyngeal Cancer?3

• Introduction: What is Nasopharyngeal Cancer?3

2. Risk Factors4

• Risk Factors4

3. Signs and Symptoms5

• Signs and Symptoms5

4. Diagnostic Process6

• Diagnostic Process6

5. Staging and Prognosis7

• Staging and Prognosis7

6. Treatment Options: Radiotherapy and Chemotherapy8

• Treatment Options: Radiotherapy and Chemotherapy8

7. Treatment Options: The Role of Surgery9

• Treatment Options: The Role of Surgery9

8. Post-Treatment Process10

• Post-Treatment Process10

9. Nutrition and Quality of Life11

• Nutrition and Quality of Life11

10. Psikososyal Destek12

• Psikososyal Destek12

11. Tracking and Control Process13

• Tracking and Control Process13

12. Pre-treatment Checklist14

• Pre-treatment Checklist14

13. Post-Treatment Checklist15

• Post-Treatment Checklist15

1. Introduction: What is Nasopharyngeal Cancer?

• Introduction: What is Nasopharyngeal Cancer?

The nasopharynx is the region located behind the nasal cavity, just below the base of the skull, and forms the upper part of the throat. The opening point of the Ostaki tubes, which provide air passage to the middle ear, is also in this region. Nasopharyngeal cancer develops as a result of uncontrolled proliferation of cells in this area.

Nasopharyngeal cancer has a different epidemiological and biological profile than other head and neck cancers. It has a particularly strong association with Epstein-Barr virus (EBV) and is significantly more common in some geographic regions and ethnic groups. Because of its location close to the base of the skull, it can affect the cranial nerves as the disease progresses.

The most common first symptom of nasopharyngeal cancer is a painless swelling in the neck; Therefore, diagnosis usually begins with a neck examination.

2. Risk Factors

• Risk Factors

Risk factors that play a role in the development of nasopharynx cancer differ from other head and neck cancers and include viral, nutritional and genetic elements.

Epstein-Barr virus (EBV) infection: Strongly associated with nasopharyngeal cancer

Epstein-Barr virus (EBV) infection: Strongly associated with nasopharyngeal cancer Frequent consumption of salted and pickled foods (especially salted fish)

Cigarette and tobacco product use

Familial history and genetic predisposition seen in some ethnic groups

Formaldehit gibi kimyasallara mesleki maruziyet

3. Signs and Symptoms

• Signs and Symptoms

Symptoms of nasopharynx cancer may occur in the form of various complaints related to nose, ear and nerve functions due to the location of the tumor.

Most Common First Finding

Painless swelling or a palpable mass in the neck (enlarged lymph node) is the first symptom noticed in the majority of patients

Other Symptoms

Other Symptoms

Unilateral nasal congestion or nosebleed

Unilateral hearing loss or feeling of fullness in the ear

Ringing in the ears (tinnitus)

Persistent or recurring headache

Double vision or facial numbness (due to cranial nerve involvement, in advanced stage) These symptoms can often be confused with benign conditions such as sinusitis or otitis media; For complaints that are unilateral and do not respond to treatment, it is recommended to consult an ear, nose and throat specialist.

4. Diagnostic Process

• Diagnostic Process

The diagnosis of nasopharynx cancer is made through a staged evaluation process and includes some additional tests specific to this cancer.

4.1 Nazofarengoskopi

4.1 Nazofarengoskopi

The nasopharynx region is directly visualized with the help of a thin instrument with a camera on its tip (fiberoptic or rigid endoscope). This procedure can be performed under office conditions and allows biopsy to be taken from suspicious tissue.

4.2 Biyopsi

4.2 Biyopsi

A small piece taken from the suspicious tissue is examined in the pathology laboratory. A definitive diagnosis can only be made with a biopsy result.

4.3 EBV DNA Testi

4.3 EBV DNA Testi

Measuring the level of Epstein-Barr virus DNA in the blood can both aid in the diagnostic process and is used as an important marker in monitoring relapse after treatment.

4.4 Imaging Methods

4.4 Imaging Methods

Magnetic Resonance Imaging (MRI): It is the gold standard in evaluating skull base and adjacent soft tissue extension

Computed Tomography (CT): Used to evaluate the involvement of bone structures

Computed Tomography (CT): Used to evaluate the involvement of bone structures

PET-CT: Used to investigate distant organ spread (metastasis)

PET-CT: Used to investigate distant organ spread (metastasis)

4.5 Evreleme

4.5 Evreleme

After all diagnostic tests are completed, the disease is staged according to the internationally accepted TNM system. The presence of skull base and cranial nerve involvement directly affects staging and treatment plan.

5. Staging and Prognosis

• Staging and Prognosis

The TNM system consists of three basic components: T (size of the tumor and its spread to neighboring structures, especially the skull base), N (regional lymph node involvement) and M (distant organ metastasis). The combination of these components allows the disease to be classified from Stage 0 to Stage IV.

Although nasopharyngeal cancer tends to spread early to the neck lymph nodes, it is a type of tumor with high sensitivity to radiotherapy. For this reason, even in advanced stages, treatment success rates may be more positive compared to some other head and neck cancers.

Prognosis varies from person to person; The most accurate information should be obtained from the physician team carrying out the treatment.

6. Treatment Options: Radiotherapy and Chemotherapy

• Treatment Options: Radiotherapy and Chemotherapy

Radyoterapi (IMRT)

Radiotherapy is the primary treatment method for nasopharyngeal cancer. Intensity-modulated radiotherapy (IMRT) technique offers precise planning while delivering a high dose to the tumor while protecting critical structures such as the surrounding eye, salivary glands and brainstem.

Chemotherapy and Chemoradiotherapy

In advanced disease, chemotherapy is usually administered simultaneously with radiotherapy (chemoradiotherapy). In some cases, additional courses of chemotherapy may be given before or after radiotherapy.

Radiotherapy planning requires special attention and experience due to the proximity to the eyes, salivary glands and hearing organs.

7. Treatment Options: The Role of Surgery

• Treatment Options: The Role of Surgery

Surgery is not the primary treatment method for nasopharynx cancer, unlike other head and neck cancers. The main reason for this is that the nasopharynx is located close to the skull base and is in an area that is difficult to reach surgically.

Kurtarma Cerrahisi

In limited cases that relapse after radiotherapy or do not respond fully to treatment, salvage surgery called nasopharyngectomy may be considered. This is a special surgical approach performed in experienced centers.

Boyun Diseksiyonu

If there is persistent or recurrent lymph node involvement in the neck after radiotherapy, it may be necessary to surgically remove these lymph nodes with neck dissection.

Although the role of surgery in nasopharyngeal cancer is limited, it can make a significant contribution to the success of treatment in selected cases.

8. Post-Treatment Process

• Post Treatment Process

Management of side effects that may occur after radiotherapy and chemotherapy is of great importance for long-term quality of life.

Dry Mouth (Xerostomia)

Dry mouth is a common side effect as the salivary glands are affected by radiotherapy. Consuming plenty of fluids, saliva substitutes and regular dentist follow-up help manage this condition.

Jaw Stiffness (Trismus)

Stiffness that may occur in the tissues around the jaw may restrict mouth opening. Regular jaw exercises are effective in preventing and reducing this stiffness.

Hearing Monitoring and Dental Care

Regular hearing tests and strict dental care after treatment are recommended to detect possible late side effects early.

9. Nutrition and Quality of Life

• Nutrition and Quality of Life

Suggestions in Case of Dry Mouth

Consume meals by moistening them with sauces, broths or liquids

Drink water frequently in small sips

Avoid dry, hard and crumbly foods

Recommendations in Case of Difficulty in Swallowing

Prepare food with a soft consistency

Choose small and frequent meals

If necessary, use high-calorie liquid nutritional supplements

Dietitian and dentist support significantly increases the quality of life during and after the treatment process.

10. Psikososyal Destek

• Psikososyal Destek

Nasopharyngeal cancer treatment can create a significant emotional burden on both the patient and the family due to the long-term radiotherapy process and permanent effects such as dry mouth and hearing changes.

Do not hesitate to seek psychological counseling and professional support when necessary Joining support groups for head and neck cancer patients may be helpful in sharing similar experiences Involving family members in the process is supportive for both the patient and their relatives Social workers can provide guidance on practical and financial issues during the treatment process

11. Tracking and Control Process

• Tracking and Control Process

Regular follow-up after treatment is completed is critical for both detecting possible recurrence early and monitoring treatment-related late side effects. Periodic monitoring of EBV DNA level is an important tool in the follow-up of nasopharyngeal cancer.

Things to Consider About Relapse Symptoms

Things to Consider About Relapse Symptoms

A new lump or mass in the neck

Nasal congestion or resumption of bleeding

New changes in hearing or headache

Unexplained weight loss or persistent pain

12. Pre-Treatment Checklist

• Pre-Treatment Checklist

Completing the following steps before starting radiotherapy and/or chemotherapy will help the treatment process proceed more safely and regularly.

Medical Preparation

☐ All blood tests and imaging results were completed and shared with the physician ☐ Dentist evaluation and necessary dental treatments were completed before radiotherapy ☐ An initial evaluation was made with a hearing test (audiometry) ☐ Radiotherapy planning CT (simulation) and mask preparation completed

Lifestyle and General Preparation

☐ If possible, smoking was stopped before treatment

☐ If possible, smoking was stopped before treatment

☐ Nutritional status was evaluated, and if necessary, a dietitian was consulted

☐ Transportation and companion planning was made during the treatment

☐ The weekly schedule for radiotherapy sessions has been clarified

Do not hesitate to ask any questions you may have to your doctor or nurse at the final check-up before the treatment.

13. Post Treatment Checklist

• Post Treatment Checklist

Having clarified the following issues after the treatment is completed will facilitate the healing process and enable early detection of possible problems.

Maintenance and Follow-up

Maintenance and Follow-up

☐ Oral and dental care routine (fluoride gel, regular dental check-up) has become clear ☐ Jaw opening exercises have been learned and are practiced regularly

☐ Feeding and swallowing evaluation was performed

☐ Information was given about skin care (radiotherapy area)

Rehabilitation and Communication

☐ Hearing check appointment scheduled

☐ First control examination and EBV DNA follow-up date is determined ☐ It is known when and to whom to contact in case of emergency (alarm symptoms) ☐ Psychosocial support resources and support groups were contacted This checklist is intended as a general guide; Personalized instructions should always be followed as a priority.

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