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Blog, Head and Neck Cancer

Staging and Treatment of Nasopharyngeal Cancer


Staging systems are used to describe the severity of cancer based on the size, extent of invasion, and spread to different body parts. It helps to determine treatment strategy and disease prognosis. TNM is the most commonly used system for staging nasopharyngeal cancers by the medical community. “T” stands for “Tumor Size”, “N” for “Lymph Nodes”, and “M” for “Metastasis”. Numbers and/or letters after T (is, 0, 1, 2, 3, and 4), N (0, 1, 2, and 3), and M (0 and 1) provide more details about each of these factors. Once T, N, and M categories are determined through different diagnostic techniques, this information is combined to assign an overall stage (from 0 to IV) to the disease.

Apart from the stage of disease, the selection of treatment usually depends upon the location of disease, patient’s preference, the performance status of the patient, along with other factors. Following are the preferred treatment approaches for different stages of nasopharyngeal cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

Stage TNM Score Stage Description

 

Preferred Treatment
0 Tis N0 M0 Carcinoma in situ or cancerous lesion is present only in the superficial nasopharyngeal layer. For Stage 0 to I cancers, radiotherapy is considered as the preferred treatment. Prophylactic radiation treatment to nearby lymph nodes is also generally recommended to be employed as the primary treatment.
I T1 N0 M0 The primary tumor is limited to the nasopharynx, or extension to the oropharynx and/or nasal cavity without para-pharyngeal involvement. No spread to nearby lymph nodes or distant body parts.
II T2 N0-1 M0 The primary tumor has invaded into the para-pharyngeal space, and/or an adjacent structure such as medial pterygoid, lateral pterygoid, or prevertebral muscles. The disease might or might not have spread to cervical lymph node(s) on one side and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. No spread to distant body parts. For Stage II to IVB cancers (locoregionally advanced disease), a combination of radiotherapy and chemotherapy is usually employed as the first-line treatment. This may be followed by more chemotherapy to treat any remaining cancer cells. Surgery may also be employed to remove lymph nodes with remnant cancer cells.

Some physicians prefer to start treatment with chemotherapy alone (induction therapy). In case of shrinkage of the tumor, further treatment may involve radiotherapy and chemotherapy. In case of no shrinkage, surgery may be employed. Patients should be followed-up closely for any sign of disease recurrence.

T0-1 N1 M0 No primary tumor or primary tumor limited to the nasopharynx. The disease has spread to cervical lymph node(s) on one side and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. No spread to distant body parts.
III T3 N0-2 M0

 

The primary tumor has invaded into the skull base, cervical vertebra, pterygoid structures, and/or paranasal sinuses. The disease might or might not have spread to cervical lymph node(s) on both sides and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. No spread to distant body parts.
T0-2 N2 M0 No primary tumor or the primary tumor with invasion into the para-pharyngeal space, and/or an adjacent structure. The disease has spread to cervical lymph node(s) on both sides and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. No spread to distant body parts.
IVA Any T N3 M0 No primary tumor to the primary tumor with invasion into the para-pharyngeal space, and/or an adjacent structure, and/or intracranial extension. The disease has spread to cervical lymph node(s) on one or both sides with lymph nodes measuring >6 cm. No spread to distant body parts.
T4 N0-2 M0 The primary tumor has invaded into the cranium, cranial nerves, hypopharynx, orbit, parotid gland, and/or extensive invasion beyond the lateral pterygoid muscle. The disease might or might not have spread to cervical lymph node(s) on both sides and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. No spread to distant body parts.
IVB Any T Any N M1 No primary tumor or a primary tumor that might have invaded an adjacent structure or a vital structure. The disease might or might not have spread to nearby lymph nodes. The disease has spread to a distant body part, such as the lungs.

Palliative Treatment: It helps in improving the overall quality of life by providing relief from the symptoms and by reducing the suffering caused by HNC and its treatment. It is generally given as supportive care for advanced staged HNCs, along with other treatments. It may include but not limited to: using drugs or other interventions to reduce pain, bleeding, and other symptoms; surgical interventions like gastrostomy or tracheostomy to support nutrition or respiration; support and counselling for speech, swallowing, and oral hygiene-related problems; and radiation therapy to palliate pain, bleeding, obstructive problems, etc.

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes, a patient’s choice and health condition are also important to make a treatment choice. Following are ultimate goals of Staging and Treatment of Nasopharyngeal Cancer:

  • Prolongation of life
  • Reduction of symptoms
  • Improvement of overall quality of life

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