Nasopharyngeal Cancer, from the CureRays guide library.

Nasopharyngeal cancer forms high in the throat behind the nose; because surgery there is difficult, radiation — usually with chemotherapy — is the main, often curative treatment.

What it is.

Nasopharyngeal cancer is a cancer that begins in the nasopharynx — the upper part of the throat, located behind the nose and above the soft part of the roof of the mouth, where the back of the nose meets the top of the throat. This area is tucked deep inside the head, near the base of the skull, the ear canals, and important nerves, which makes surgery there very difficult. That is why nasopharyngeal cancer is treated differently from most other head and neck cancers: radiation, usually combined with chemotherapy, is the main treatment rather than surgery. The disease is strongly linked to the Epstein-Barr virus (the same common virus that causes mononucleosis) and is more common in parts of Asia and North Africa, though it can occur anywhere. Early symptoms — a lump in the neck, a blocked or bleeding nose, ringing or fullness in one ear, or hearing changes — can be subtle. The good news is that nasopharyngeal cancer is very sensitive to radiation, and many patients are cured.

How radiation treats it.

Radiation uses focused high-energy x-rays to damage the DNA inside tumor cells so they can no longer grow and divide. Nasopharyngeal cancer is unusually sensitive to radiation, which is fortunate because the tumor sits deep behind the nose where surgery is very difficult. Modern intensity-modulated radiation therapy (IMRT) shapes the dose precisely around the tumor and the lymph nodes in the neck while protecting the brain, spinal cord, eyes, ears, and salivary glands nearby. Radiation is usually combined with chemotherapy, which makes the cancer cells even more vulnerable. Treatments are painless and brief, given over a series of short daily sessions across several weeks. Side effects depend on the area treated and may include temporary dry mouth, taste changes, sore throat, or skin irritation, many of which improve over time. For nasopharyngeal cancer, radiation is not a supporting tool — it is the main, often curative treatment.

The ways we can treat it.

Intensity-modulated radiation (IMRT). Computer-shaped radiation beams wrap the dose tightly around the tumor and at-risk lymph nodes while sparing the brain, spinal cord, eyes, and salivary glands — the standard way to treat this cancer.

Chemoradiation. Radiation given together with chemotherapy works better than radiation alone for most stages, because the chemotherapy makes cancer cells more vulnerable to the radiation.

Re-irradiation / stereotactic boost. For cancer that returns in the nasopharynx, highly focused radiation can sometimes deliver an additional precise dose to control the disease while limiting harm to nearby tissue.

Questions we hear often.

Why isn't nasopharyngeal cancer treated with surgery? The nasopharynx sits deep behind the nose, near the base of the skull and important nerves and blood vessels, making surgery very difficult. Fortunately, this cancer is highly sensitive to radiation, so radiation — usually with chemotherapy — is the main and often curative treatment instead.

What does the Epstein-Barr virus have to do with it? Most nasopharyngeal cancers carry the Epstein-Barr virus, a common virus that also causes mononucleosis. Having the virus is very common and does not mean you'll get this cancer, but in these tumors doctors can measure the virus's DNA in the blood to help guide diagnosis and follow-up.

Can nasopharyngeal cancer be cured? Yes. Because it responds so well to radiation, many patients — especially those whose cancer is found before it spreads to distant organs — are cured. Combining radiation with chemotherapy further improves the chance of cure for more advanced disease.

This guide is informational only. It is not medical advice — please confirm anything here with your care team.