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Nasopharyngeal carcinoma
Nasopharyngeal carcinoma is EBV-related, highly sensitive to radiation and chemotherapy, and treated without surgery: radiation alone in stage I, and induction chemotherapy followed by cisplatin chemoradiation in locally advanced stages.
Why it matters in the exam
Nasopharyngeal carcinoma appears in the exam in questions on planning the radiation field, standard treatment by stage and how it differs from other head and neck tumours. The typical scenario is an upper posterior neck mass, unilateral middle ear effusion, nosebleeds or cranial nerve palsies.
Remember that the tumour spreads early to the skull base and to nodes on both sides, so the radiation field includes the whole nasopharynx, the involved adjacent structures and nodes on both sides of the neck, including the retropharyngeal nodes. The blood EBV DNA level is a prognostic marker and is also used in follow-up.
Key points
- Nasopharyngeal carcinoma is EBV-related, mostly non-keratinising, and highly sensitive to radiation and chemotherapy.
- Typical presentation: upper neck mass, unilateral middle ear effusion, nosebleeds, nasal obstruction and cranial nerve palsies when the tumour reaches the skull base.
- In stage I radiation alone is enough, and in stages II to IVA induction is given followed by cisplatin chemoradiation.
- The radiation field includes the whole nasopharynx, the involved structures and nodes on both sides of the neck, and is built with IMRT to spare the salivary glands and the brainstem.
- Blood EBV DNA is an important prognostic marker: a high level before treatment or a level that stays detectable afterwards marks a high risk of relapse.
Summary table
| Issue | What to know | Exam detail |
|---|---|---|
| Epidemiology and biology | Common in southern China, South-East Asia and North Africa | Most tumours are non-keratinising and EBV-related |
| Presentation | Neck mass, unilateral middle ear effusion, nosebleeds, nasal obstruction | Cranial nerves: mainly V and VI because of skull base spread |
| Work-up | Endoscopy and biopsy, MRI of the nasopharynx and skull base, PET-CT, blood EBV DNA | MRI is better for the skull base and the pterygoid muscles |
| Stage I | Radiation alone | Very high local control |
| Stage II to IVA | Induction chemotherapy (gemcitabine with cisplatin) followed by cisplatin chemoradiation | Induction improved survival; surgery is not part of primary treatment |
| Radiation field | The whole nasopharynx, involved adjacent structures (for example the pterygoid muscles), and neck nodes on both sides including retropharyngeal | IMRT to spare the salivary glands, brainstem and spinal cord |
| Recurrence or metastases | Gemcitabine with cisplatin and a PD-1 inhibitor | Isolated local recurrence — re-irradiation or salvage surgery |
A free exam question
בהמשך לשאלה הקודמת , בן 35 , אובחן עם Nasopharyngeal carcinoma .הוגדר כ- T2N0M0 staging . מה אפשרויות הטיפול למטופל זה? (the question as examined, in Hebrew)
- א. קרינה בלבד
- ב. אינדוקציה של כימותרפיה ולאחריה קרינה בלבד
- ג. טיפול משולב בקרינה וכימותרפיה
- ד. טיפול קרינתי ולאחריו דיסקציה סלקטיבית של רמות 2-5
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Sources
- NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers, 2026 — Cancer of the nasopharynx
- ESMO-EURACAN Clinical Practice Guideline: Nasopharyngeal carcinoma, 2021 — Diagnosis, treatment and follow-up
- Gunderson and Tepper's Clinical Radiation Oncology, 5th ed. (2021) — Nasopharyngeal carcinoma
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.