Nasopharyngeal Cancer: Stages, Symptoms, and Treatment

Nasopharyngeal cancer is a malignant transformation of the epithelial cells lining the nasopharynx. In its early stages, it often progresses silently, sometimes lasting for several months to over a year before obvious symptoms appear.

How many stages does nasopharyngeal cancer have?
According to the international TNM system, nasopharyngeal cancer typically progresses through the following stages:

• Stage 0 (Carcinoma in situ)

• Stage I

• Stage II

• Stage III

• Stage IV

Stage 0 – Precancerous Lesions (Carcinoma in situ)

At this stage, abnormal cells are confined to the nasopharyngeal mucosa without clear symptoms. If undetected, they may progress quickly to invasive cancer.

Possible early signs are vague and easily mistaken for common ENT problems, such as:

• Headaches: Usually dull, sometimes sharp, often mistaken for neurological or vascular issues.

• Tinnitus: Due to obstruction of the Eustachian tube, patients may hear buzzing or ringing in one ear.

• Nasal congestion: Gradually worsening, sometimes with nosebleeds or bloody mucus.

When detected and treated early, prognosis is favorable. However, because symptoms are subtle (e.g., cough, nasal blockage, throat discomfort), patients often miss this stage.

Stage I – Localized Cancer

The tumor has formed but remains confined to the nasopharynx or has only slightly spread to nearby areas such as the oropharynx or nasal cavity.

Symptoms become clearer, including:

• Persistent sore throat, often on one side, possibly radiating to the ear.

• Pain or difficulty swallowing, sensation of obstruction.

• Hoarseness or voice changes if the tumor affects the vocal cords.

• Coughing up blood or bleeding in the throat.

• Unexplained weight loss.

• Foul breath due to tissue necrosis.

• Swollen cervical lymph nodes, often firm, painless, and detected incidentally.

Stage II – Regional Spread

At this stage, cancer cells begin to extend beyond the nasopharynx but remain relatively localized. Common scenarios include:

• Spread to cervical or retropharyngeal lymph nodes: Usually one side, with nodes ≤6 cm.

• Primary tumor still in nasopharynx or extending to oropharynx/nasal cavity.

• Occult primary: Sometimes no tumor is visible in the nasopharynx, but malignant cells are found in cervical lymph nodes. The most common type is non-keratinizing undifferentiated carcinoma, strongly associated with Epstein–Barr Virus (EBV).

• Parapharyngeal space invasion: Tumor extends into adjacent muscles or soft tissue, with lymph node involvement on one side (≤6 cm).

Stage III – Bilateral Lymph Node Involvement or Deep Tissue Invasion

By this stage, cancer is more aggressive. Tumor growth may compress cranial nerves, invade the hypopharynx, salivary glands, skull base, bone, soft tissue, or orbit.

• Bilateral cervical lymph nodes: Cancer cells are detected in lymph nodes on both sides, ≤6 cm in size.

• Deep parapharyngeal or muscular invasion, with bilateral lymph node spread.

• Extension into skull base or paranasal sinuses (sphenoid, maxillary, ethmoid).

Stage IV – Advanced Disease (Metastasis)

Here, cancer has spread extensively, making treatment difficult and prognosis poor.

Stage IV is subdivided into:

• Stage IVA – Deep structural invasion or large lymph nodes:

  • Tumor invades critical structures such as the skull base, cervical vertebrae, jaw muscles, or paranasal sinuses.

  • Lymph nodes may exceed 6 cm or extend to the lowest part of the neck near the clavicle.

• Stage IVB – Distant Metastasis:

  • Cancer spreads to distant lymph nodes (mediastinal, supraclavicular, axillary, inguinal) or organs such as the lungs, liver, or bones.

  • Bone metastasis is the most common (up to 75%).

Can metastatic nasopharyngeal cancer be cured?

At stage IVB, complete cure is usually not possible. Treatment focuses on symptom control, prolonging survival, and improving quality of life. Stage IVA may still allow for aggressive therapy aimed at long-term control.

Survival rates vary by stage:

• Localized disease: up to 82% five-year survival.

• Spread to lymph nodes: about 50%.

• Distant metastasis (liver, lungs, bones): around 30%.

Importance of Early Detection

In Vietnam, nasopharyngeal cancer accounts for about 10–15% of head and neck cancers. Alarmingly, nearly 70% of patients are diagnosed only at advanced stages.

According to Dr. Luu Tu Anh (ENT specialist, Bernard Healthcare), people with chronic sinusitis, gastroesophageal reflux, or a family history of head and neck cancers should undergo regular ENT check-ups and endoscopy every 4–12 months. Endoscopy helps detect abnormalities, including early-stage cancer.

Comprehensive ENT Care at Bernard Healthcare

Bernard Healthcare’s ENT department provides complete diagnostic and treatment services with advanced equipment and experienced specialists, including:

• Screening for nasopharyngeal and laryngeal cancer.

• Diagnosis and treatment of ear diseases (tinnitus, ear pain, hearing loss, otitis media, mastoiditis).

• Diagnosis and treatment of nasal disorders (allergic rhinitis, sinusitis, nasal polyps).

• Management of throat and laryngeal conditions (laryngitis, hoarseness, vocal cord nodules/polyps, sleep apnea).

• Care for other ENT-related issues (hearing loss, dizziness, vestibular disorders, loss of smell).