Nasopharyngeal cancer

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

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Последний просмотренный: 14 Feb 2026

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.

Определение

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.

Анамнез и осмотр

Ключевые диагностические факторы

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

Полная информация

Другие диагностические факторы

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

Полная информация

Факторы риска

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

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

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

Полная информация

Исследования, проведение которых нужно рассмотреть

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

Полная информация

Алгоритм лечения

Острый

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

ПРОДОЛЖЕНИЕ

locoregional nasopharyngeal and/or neck nodal recurrence

Составители

Авторы

Hyunseok Kang, MD, MPH

Professor

Department of Medicine

University of California

San Francisco

Раскрытие информации

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

Раскрытие информации

JC declares that he has no competing interests.

Рецензенты

Kevin J. Harrington, PhD, FRCP, FRCR

Head of Division of Radiotherapy and Imaging

The Institute of Cancer Research

London

Раскрытие информации

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

Раскрытие информации

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.

Список литературы

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.

Основные статьи

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.Полный текст Аннотация

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.Полный текст Аннотация

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

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.Полный текст Аннотация

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. Аннотация

Статьи, указанные как источники

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

Differentials
- Nasopharyngeal polyposis
- Nasopharyngeal angiofibroma
- Lymphoma
Больше Differentials
Guidelines
- 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
Больше Guidelines
Videos
How to examine the nasal cavity
More videos
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Nasopharyngeal cancer

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

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

Составители

Авторы

Hyunseok Kang, MD, MPH

Раскрытие информации

Jason Chan, MD

Раскрытие информации

Рецензенты

Kevin J. Harrington, PhD, FRCP, FRCR

Раскрытие информации

Lawrence R. Lustig, MD

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

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

Differentials

Guidelines

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice