• Epstein-Barr virus (EBV infection); 
• chronic nasopharyngitis. 

Among the histological types, non-keratinizing undifferentiated carcinoma is more common. Meanwhile, non-keratinizing differentiated carcinoma and keratinizing squamous cell carcinoma are less common. The treatment is the same regardless of histological type. Types without keratinization have a better prognosis.

Rare nasopharyngeal tumors are: 

• adenocarcinoma,
• adenoid cystic carcinoma,
• lymphoma. 

In most cases, symptoms manifest themselves after the spread of metastasis to lymph nodes. Patients go to the doctor with complaints of neck swelling and swollen lymph nodes, which is usually a painless process.

Other possible symptoms associated with the local spread of the tumor are as follows:

• tinnitus,
• hearing loss, usually unilateral,
• runny nose,
• difficulty nasal breathing, 
• nosebleed,
• headache,
• facial pain,
• impaired sensitivity of the facial skin,
• pain when opening the mouth,
• blurred vision,
• difficulty breathing,
• difficulty speaking. 

To diagnose the disease, the specialists use anterior and posterior rhinoscopy, nasopharyngoscopy. These methods allow examining the nose and nasopharynx to visually detect the tumor. To confirm the diagnosis, the doctor takes an imprint smear or makes a biopsy. After the histological examination of the material in the laboratory, the type of tumor is specified.

• Principles of treatment

 Surgery is the main treatment for most oncological diseases. However, nasopharyngeal cancer is an exception. Surgical interventions for this disease are rare, and they are aimed mainly at removing metastases in the lymph nodes of the neck.

The initial treatment of the disease involves the use of one of the following approaches:

• Chemotherapy is followed by chemoradiotherapy (simultaneous irradiation of the tumor and chemotherapy).
• Chemoradiotherapy is followed by chemotherapy. This option is more common. In comparative studies, it has proved better patient survival rates.

Situations when chemotherapy is prescribed for nasopharyngeal cancer, are as follows: 

• before chemoradiotherapy (such chemotherapy is called induction);
• in combination with radiation therapy, as part of chemoradiotherapy (the main treatment for nasopharyngeal cancer),
• after chemoradiotherapy, to destroy the remaining cancer cells to avoid recurrent nasopharyngeal cancer,
• at the metastatic stage of nasopharyngeal cancer, if radiation therapy is not planned (chemotherapy is used as an independent method of controlling nasopharyngeal cancer).

Targeted therapy is used at the advanced stage, with nasopharyngeal cancer recurrence, with insufficient effectiveness of chemotherapy. This is a second-line treatment. Doctors use drugs from the group of EGFR (epidermal growth factor receptor) inhibitors. 

Immunotherapy is carried out using immune checkpoint inhibitors. These drugs are PD-1 inhibitors. , It is highly effective, so it can even be used as first-line therapy.

After the initial treatment, the response is assessed. If nasopharyngeal cancer has completely regressed, all metastases have disappeared, then the patient is monitored. He does not need any other treatment, at least until a nasopharyngeal cancer recurrence occurs.

In some cases, metastases in the lymph nodes do not disappear after initial treatment. Then they have to be removed using surgical techniques.

• selective – this option involves the removal of only the swollen lymph nodes closest to the tumor.
• modified – this is the most commonly used option, which involves the removal of tissues between the lower jaw and collarbone, while maintaining the brachial plexus.
• radical – this is the most traumatic operation, involving the removal of almost all the lymph nodes of the neck, many muscles, nerves, and blood vessels.

 

Radiation therapy for nasopharyngeal cancer is considered the main treatment option. It is combined with chemotherapy often.

IMRT (Intensity-modulated radiation therapy). The variant of three-dimensional irradiation is one of the safest. IMRT is used in cases of anatomical proximity of functionally important organs and irregular tumor configuration. With its help, even cancer that is around an organ at risk can be safely irradiated: for example, if it surrounds a large artery. The dose of radiation corresponds to the three-dimensional shape of the tumor by controlling or modulating the intensity of the radiation beam. The radiation dose intensity increases near the total tumor volume. It is reduced or absent for adjacent normal tissues. As a result, IMRT provides better tumor targeting, reduces the risk of side effects, and improves treatment outcomes. In studies, IMRT has proved most advantages in irradiating head and neck tumors compared to other types of cancer. The main advantage is treatment toxicity reduction.

VMAT (Volumetric modulated arc therapy). This is a new and improved version of IMRT. Nasopharyngeal cancer is irradiated using a rotating gantry along one or more arcs. The speed and shape of the beam changes. The main benefit is reduced delivery time for the required dose of radiation. VMAT is characterized by a sparing effect on organs at risk. Most of the benefits have been demonstrated in studies for the treatment of nasopharyngeal, oropharyngeal, and laryngopharyngeal cancers.

____________________________________________________________________________________

• Diagnosis:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• biochemical analysis of blood
• tumor markers
• inflammation indicators (CRP, ESR)
• indicators of blood coagulation
• CT, MRI scan (on indication)
• general otolaryngological examination
• laryngoscopy with biopsy (on indication)
• histological and cytological examination (on indication)
• nursing services
• tumor board involving oncologist, radiologist, surgeon
• consultation of the chief physician and all leading experts
• development of individual treatment plan

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: On request

Type of program: Outpatient

Expected duration of the program: 5 days

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• Chemo-radiotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT /MRI (if indicated clinically) 
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• tumor markers (If indicated clinically)
• indicators of inflammation (CRP, ESR)
• indicators of blood coagulation
• CT simulation and planning of radiation therapy
• Physics calculation
• full course of radiation therapy with different modalities (3D, IMRT, VMAT) according to your treatment plan.
• individual plan of the chemotherapy, the cost of medicines is included
• symptomatic treatment (for side effects of chemo and radiotherapy that may developed).
• cost of essential medicines and materials
• nursing services
• control examinations
• consultations of related specialists
• explanation of future recommendation

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will elaborate the chemotherapy regimen, conduct radiotherapy CT or MRI SIMULATION then planning, make the permanent tattoo marks on the skin to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy and radiation therapy are carried out as the day hospital procedure, without mandatory admission to the hospital. At each visit, the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded linear accelerator radiation therapy room.

Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will visit the hospital from 1 to 3-5 times a week.

Chemotherapy may be through intravenous route according to your treatment plan, during the chemotherapy session, after the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

During radiotherapy, you are under close follow-up daily from doctors and nurses.

After the completion of the chemotherapy and radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 days

_______________________________________________________________________________

• Chemotherapy and immunotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• analysis of medical records
• physical examination
• laboratory tests:

• complete blood count
• biochemical analysis of blood
• tumor markers
• inflammation indicators
• indicators of blood coagulation
• ultrasound scan, CT / MRI scan (if indicated).
• 1 course of chemotherapy
• consultations of related specialists
• symptomatic and specific treatment
• the cost of essential medicines and materials
• nursing services
• control examinations
• full hospital accommodation
• recommendations for further treatment

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as outpatient according to chemotherapy protocol type. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course and control examinations you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• Colonoscopy data, MRI/CT scan (not older than 3 months)
• Biopsy results
• Any recent laboratory results.

Price from: On request (regarding chemotherapy protocol)

Type of program: outpatient

Expected duration of the program: from 1 to 4 days per cycle (regarding chemotherapy protocol)