Diagnosing Nasopharyngeal Cancer

NYU Langone doctors are experienced at diagnosing nasopharyngeal cancer, which develops in the nasopharynx, the top part of the throat.

The nasopharynx is a tube-like structure behind the nasal cavity, which is the empty space above and behind the nose that moistens and filters air. The nasopharynx carries air from the nasal cavity to the throat, which is called the pharynx, helping you to breathe.

Most nasopharyngeal cancers begin in the epithelial cells, which line the nasopharynx. People typically do not experience symptoms when a nasopharyngeal tumor is small.

As the tumor grows, it can spread to nearby lymph nodes, which are small, bean-shaped structures that are part of the lymphatic system. The lymphatic system is a network of vessels, tissues, and organs that circulate lymph, a fluid that contains infection-fighting white blood cells called lymphocytes. Swollen nodes in the neck may be the first noticeable sign of the condition.

Nasopharyngeal cancers can grow and press on one of the two Eustachian tubes. These tubes connect the nasopharynx to the middle ear and help regulate pressure in and drain fluid from the middle ear. Nasopharyngeal cancer affecting the Eustachian tube can cause pain, fluid, or hearing loss in that ear.

As cancer grows it may block a nasal passage, causing a stuffy nose. Some people experience nosebleeds.

Nasopharyngeal cancer can also enter the skull base, an area filled with complex nerves and blood vessels at the base of the brain. The skull base sits behind the eyes and above the nasal cavity and separates the brain from other structures of the head. As a tumor spreads to the skull base, it can press on critical nerves, causing problems with vision, headaches, and facial pain.

Risk Factors for Nasopharyngeal Cancer

Infection with the Epstein–Barr virus (EBV) can increase the risk of developing nasopharyngeal cancer. EBV is spread through bodily fluids, including saliva. Most people become infected with EBV at some point in their lives. Usually, the body fights off the virus, and the infection goes unnoticed. In the United States, EBV is known for causing mononucleosis.

For reasons that are not completely understood, people living in northern Africa, southeast Asia, and southern China are at increased risk of developing nasopharyngeal cancer if they become infected with EBV. Because New York City is home to recent immigrants from these areas, doctors at NYU Langone diagnose and treat a large number of people with nasopharyngeal cancer compared to other medical centers in the United States.

More recently, human papillomavirus (HPV) has been associated with nasopharyngeal cancer. HPV is a member of the herpes virus family and is easily transmitted through skin contact, usually vaginal, oral, and anal sex. Most people’s immune systems destroy HPV after it’s contracted, but in some people it may cause cell changes that lead to cancer.

Vaccines are available to protect against HPV, but whether they prevent nasopharyngeal cancer is not yet known. Avoiding sex with multiple partners and using condoms or other barrier methods when having vaginal, anal, or oral sex may help to prevent HPV infection.

Genetic factors may also play a role in a person’s risk of nasopharyngeal cancer. People who have a first-degree relative, meaning a parent or sibling, with nasopharyngeal cancer have higher odds of developing the cancer. This form of cancer is more common in men than in women.

To diagnose nasopharyngeal cancer, the doctor performs a physical exam, in which he or she looks for any abnormal growths in the head and neck area. He or she also asks about your medical history, including whether you’ve had an HPV infection, an EBV infection, or have lived in a country in which there is a higher risk of developing nasopharyngeal cancer.

Your doctor may also conduct several tests.

Nasal Endoscopy

To examine the nasopharynx, the doctor may use an endoscope—a thin, lighted tube with a lens at the tip that transmits images to a monitor. After numbing the nasal cavity with anesthetic spray, he or she inserts the scope through the nose and into the nasopharynx to look for tumors.

Nasal endoscopy can be performed in the doctor’s office.

Biopsy

If a doctor identifies a suspicious growth in the nasopharynx during an endoscopy, he or she performs a biopsy either in the office or in the hospital. The doctor passes surgical tools through or next to the scope and removes a small amount of tissue. You are given local anesthesia before the test.

A pathologist then examines the tissue under a microscope to determine if it contains cancer cells. The pathologist can also test biopsy samples to determine whether nasopharyngeal cancer is associated with an EBV or HPV infection.

You can go home the same day of a biopsy. You may experience a sore throat or mild bleeding for several days afterward. Over-the-counter pain relievers, throat lozenges, and drinking plenty of fluids can help manage discomfort.

Fine Needle Aspiration

Sometimes nasopharyngeal cancer spreads to nearby lymph nodes, causing swelling and one or more neck masses. NYU Langone doctors often use fine needle aspiration, in which they insert a small needle into the mass to withdraw a sample of cells for examination under a microscope.

During the procedure, the doctor may use ultrasound, in which sound waves are used to create images of the structures in the neck, to guide the needle with precision.

Doctors can use fine needle aspiration of the lymph nodes to diagnose nasopharyngeal cancer or to determine whether the cancer has spread.

PET/CT Scan

Nasopharyngeal cancer can sometimes be hidden in the tissue underneath the lining of the nasopharynx, making it difficult to detect with an endoscopy. For this reason, doctors may use a PET/CT scan—a combination of two imaging techniques—to help diagnose the condition. This scan can also help determine if the cancer has spread to nearby lymph nodes, bones, or other parts of the body.

The CT portion of the scan uses X-rays and a computer to create two- or three-dimensional, cross-sectional images of the body. Your doctor may inject a special dye into a vein to enhance the CT image. The PET portion of the scan, which creates images of the entire body, requires an intravenous (IV) infusion of radioactive glucose, or sugar, into a vein. This substance collects in cancer cells, making them easier to detect during the scan.

The information from both the PET and CT scans are combined to determine whether cancer is present and where it is located.

PET/MRI Scan

A PET/MRI scan combines PET and MRI technology in one machine. An MRI scan uses a magnetic field to create images. It is especially useful for examining the brain, nerves, and soft tissue. Because nasopharyngeal cancer can grow into the skull base, along nerves, and into nearby lymph nodes, doctors may use this test to map exactly how far the tumor has spread.

Doctors combine MRI images with information gathered from a PET scan, increasing their ability to detect cancer.

PET/MRI scans to detect nasopharyngeal cancer are available at NYU Langone in a clinical trial setting.