Nasopharyngeal cancer

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Evidence last reviewed: 15 Feb 2026

Topic last updated: 15 Apr 2025

Nasopharyngeal cancer (NPC) most commonly presents with a neck mass. Epistaxis, nasal obstruction, unilateral otitis media with effusion (serous otitis media), tinnitus, or impaired hearing in one ear should raise suspicion of NPC, particularly in an Asian patient.

Risk factors for NPC include a history of Epstein-Barr virus (EBV) infection, diet rich in salted fish, smoking or other tobacco use, and a family history of NPC in a first-degree relative.

Confirm the diagnosis with endoscopic biopsy of the primary tumor and/or fine-needle aspiration/core biopsy of neck nodal metastasis.

Radiation therapy is the main treatment modality for nonmetastatic NPC. Some patients with early-stage NPC can be treated with radiation therapy alone. Concurrent chemotherapy is added for locally advanced disease. Surgery, reradiation, and chemotherapy are options for locoregional nasopharyngeal/neck nodal recurrence and metastatic disease. Documentation of remission after completion of treatment is important and can be done with clinical and radiographic assessments.

Plasma EBV after treatment can provide prognostic information and it can also be used for early detection of recurrences.

定义

NPC most often refers to squamous cell carcinoma (SCC) of the nasopharynx. It is a head and neck cancer arising from epithelial cells with three histopathologic subtypes: nonkeratinizing SCC, keratinizing SCC, and basaloid SCC.[1] Other malignant tumors of the nasopharynx (e.g., adenocarcinoma, adenoid cystic carcinoma, lymphoma, melanoma, and sarcoma) are extremely rare in comparison and are not covered in this topic.

病史和体格检查

关键诊断因素

neck mass
epistaxis or bloody nasal discharge
nasal obstruction
tinnitus or impaired hearing
unilateral otitis media with effusion
cranial nerve palsy

完整详情

其他诊断因素

headaches
diplopia or strabismus
facial numbness
fever
night sweats
unintentional weight loss

完整详情

危险因素

Epstein-Barr virus (EBV) infection
diet high in salted fish
first-degree relative with nasopharyngeal cancer (NPC)
smoking
human papilloma virus (HPV) infection

完整详情

诊断性检查

首要检查

nasopharyngoscopy
tumor biopsy
MRI of the nasopharynx, skull base, and neck (to clavicles)
18F-FDG-PET/chest CT

完整详情

需考虑的检查

plasma Epstein-Barr virus (EBV) DNA
Epstein-Barr virus-encoded RNA in situ hybridization (EBER ISH)

完整详情

治疗流程

急症处理

stage 1 (T1, N0, M0)

stage 2 (T2, N0, M0)

stage 2 (T0 (EBV+)-T2, N1, M0)

stage 3 (T3, N0, M0)

stage 3-4A (T3, N1-3, M0; OR T4, N0-3, M0; OR T0 (EBV+)-2, N2-3, M0)

metastatic disease

持续性治疗

locoregional nasopharyngeal and/or neck nodal recurrence

撰稿人

作者

Hyunseok Kang, MD, MPH

Professor

Department of Medicine

University of California

San Francisco

利益声明

HK has been paid by Coherus Biosciences, and HLB Group for serving their scientific advisory board. HK is a paid consultant for PIN therapeutics and Bayer. HK has been paid by MitoImmune for serving the data safety monitoring board. HK's institution has been paid by PDS Biotechnology, NeoImmuneTech, Lilly, Remix Therapeutics, and Merus for contracted research. HK's institution has been paid by NRG Oncology's grant program. HK has been paid by Wiley, OncLive, Massachusetts Medical Association, and AXIS medical education for developing educational content.

Jason Chan, MD

Assistant Professor

Department of Radiation Oncology

University of California

San Francisco

利益声明

JC declares that he has no competing interests.

同行评议者

Kevin J. Harrington, PhD, FRCP, FRCR

Head of Division of Radiotherapy and Imaging

The Institute of Cancer Research

London

利益声明

KJH has received honoraria for Scientific Advisory Boards and/or Lectures/Symposia from Arch Oncology, AstraZeneca, BMS, Boehringer-Ingelheim, Codiak, F-Star, Inzen, Johnson and Johnson, Merck-Serono, MSD, Pfizer, and Replimune.

Lawrence R. Lustig, MD

BMJ Best Practice ENT expert panel member

Professor and Chair

Department of Otolaryngology

Columbia University Vagelos College of Physicians and Surgeons

New York

利益声明

LRL declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Chen YP, Ismaila N, Chua MLK, et al. Chemotherapy in combination with radiotherapy for definitive-intent treatment of stage II-IVA nasopharyngeal carcinoma: CSCO and ASCO guideline. J Clin Oncol. 2021 Mar 1;39(7):840-59.全文摘要

Bossi P, Chan AT, Licitra L, et al. Nasopharyngeal carcinoma: ESMO-EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021 Apr;32(4):452-65.全文摘要

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: head and neck cancers [internet publication].全文

Maghami E, Ismaila N, Alvarez A, et al. Diagnosis and management of squamous cell carcinoma of unknown primary in the head and neck: ASCO guideline. J Clin Oncol. 2020 Aug 1;38(22):2570-96.全文摘要

Lee AWM, Lee VHF, Ng WT, et al. A systematic review and recommendations on the use of plasma EBV DNA for nasopharyngeal carcinoma. Eur J Cancer. 2021 Aug;153:109-22. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Nasopharyngeal polyposis
- Nasopharyngeal angiofibroma
- Lymphoma
更多鉴别诊断
指南
- NCCN clinical practice guidelines in oncology: head and neck cancers
- Diagnosis and management of squamous cell carcinoma of unknown primary in the head and neck
更多指南
Videos
How to examine the nasal cavity
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Nasopharyngeal cancer

Summary

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

stage 1 (T1, N0, M0)

stage 2 (T2, N0, M0)

stage 2 (T0 (EBV+)-T2, N1, M0)

stage 3 (T3, N0, M0)

stage 3-4A (T3, N1-3, M0; OR T4, N0-3, M0; OR T0 (EBV+)-2, N2-3, M0)

metastatic disease

locoregional nasopharyngeal and/or neck nodal recurrence

撰稿人

作者

Hyunseok Kang, MD, MPH

利益声明

Jason Chan, MD

利益声明

同行评议者

Kevin J. Harrington, PhD, FRCP, FRCR

利益声明

Lawrence R. Lustig, MD

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

Videos

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