Nasopharyngeal (Upper Throat) Cancer Symptoms, Stages and Treatment
In this article
What Is Nasopharyngeal (Upper Throat) Cancer?
Nasopharyngeal cancer originates in the nasopharynx (upper throat), behind the nasal cavity just below the skull base. Its profile differs markedly from other head and neck cancers: although rare worldwide, it has strikingly high incidence in Southern China, Hong Kong, Southeast Asia and parts of North Africa; almost all cases have a strong association with Epstein-Barr virus (EBV); and treatment relies largely on radiotherapy (particularly IMRT) — unlike most other head and neck cancers, surgery is not a primary treatment option. Important advances have also occurred recently with the EBV DNA biomarker and new immunotherapy approvals. This guide discusses every detail from causes and diagnosis to staging and the most current treatment options.
Three main concepts matter in understanding nasopharyngeal cancer: geographical/ethnic distribution (a cancer type with few parallels worldwide, combining EBV, genetic susceptibility and environmental factors), anatomical location (proximity to the skull base, brainstem, optic nerves and salivary glands directly determines treatment technique) and the EBV DNA biomarker (central to diagnosis, prognosis, treatment response monitoring and recurrence screening). This guide is structured around these three axes.
Nasopharyngeal Anatomy
The nasopharynx is a small, approximately cubical cavity beginning behind the nasal cavity and ending at the upper edge of the soft palate. Above are skull base bones (sphenoid and occipital); laterally are walls where the Eustachian (auditory) tube opens, adjacent to the parapharyngeal space. Because of this close anatomical neighborhood, nasopharyngeal tumors can spread to skull base bones, cranial nerves or the parapharyngeal space even relatively early — directly affecting staging and treatment planning. Immediately around the nasopharynx are the brainstem, optic nerves/chiasm, temporal lobes and parotid salivary glands; proximity to these critical structures requires extremely precise dose distribution in radiotherapy planning and explains why IMRT (intensity-modulated radiotherapy) has become indispensable in this disease.
How Common Is It? (Current Statistics)
According to the International Agency for Research on Cancer's (IARC) "Global cancer statistics 2024" report (Sung H, et al., CA: A Cancer Journal for Clinicians, published July 8, 2026, DOI: 10.3322/caac.70090), worldwide data for 2024 reported approximately 119.750 new nasopharyngeal cancer cases (ranking 23. in incidence among all cancers) and 62.060 deaths (ranking 21. in mortality) were reported — a rare cancer accounting for only %0,6 of all cancer cases. Of cases, %81 occur in Asia and %10,3 in Africa; the countries with the highest age-standardized incidence are Brunei (5,7 per 100.000) and Malaysia (3,2 per 100.000). This very pronounced geographical distribution is one of the most striking features distinguishing nasopharyngeal cancer from other cancers.
According to the American Cancer Society's current nasopharyngeal cancer page (cancer.org, March 3, 2026 update, based on SEER data), nasopharyngeal cancer is rare in the USA, occurring in fewer than 1 per 100.000 annually, and is not a separate row in the main ACS "Cancer Statistics" report (it is covered under oral cavity-pharyngeal cancers). The male/female ratio is 2-3/1. Notably, the US age distribution is bimodal — a smaller peak at ages 15-24 and the main peak at 65-79; this differs from Southern China's single peak (45-59). Stage-specific 5-year relative survival (SEER, 2015-2021 diagnosis cohort): %86 in localized disease, %79 in regional spread and %40 in distant metastasis.
According to the GLOBOCAN 2024 Türkiye country profile, Türkiye reports annually approximately 973 new nasopharyngeal cancer cases (ranking 24. among all cancers, %0,41 of cases) and 436 deaths . Unlike highly endemic regions such as Southern China, Türkiye is classified as an intermediate-risk region — part of a broader intermediate-risk belt encompassing the Mediterranean basin, North Africa and the Middle East. According to a Türkiye-specific epidemiological study (Türkoz FP, et al., Asian Pacific Journal of Cancer Prevention, 2011 — no more recent Türkiye-specific study was found), a cohort of 183 patients had a male/female ratio of 2/1 and median age of 44,9; %69,6 had WHO Type III (undifferentiated), %29,4 Type II and only %1 Type I (keratinizing) histology — showing a histological pattern in Türkiye similar to endemic regions.
Risk Factors
EBV, classified by IARC as a definite (Group 1) carcinogen, is associated with almost all nonkeratinizing nasopharyngeal cancers (WHO Type II/III) in endemic regions. Certain EBV sequence variants have been associated with very high risk ratios in some population studies (OR 8,69 and 6,14), with attributable risk calculated at approximately %83 (Chang ET, et al., review, Cancer Epidemiology, Biomarkers & Prevention, 2021). This strong association explains why EBV DNA has become such a central biomarker in both diagnosis and treatment monitoring (addressed separately below).
- Epstein-Barr virus (EBV) infection — particularly in nonkeratinizing histology
- Genetic susceptibility: HLA-A*0207 and HLA-B*5801 (increased risk), HLA-A*1101 (protective)
- HLA-A2/B46 haplotype in Southern Chinese populations (associated with both risk and poor prognosis)
- History of nasopharyngeal cancer in first-degree relatives
- Salted fish consumption in childhood (nitrosamine exposure)
- Smoking (OR ~1,34)
- Passive tobacco smoke exposure in childhood
- Rural residence (in some population studies)
Risk may increase 4-20-fold in first-degree relatives of nasopharyngeal cancer patients; one study calculated lifetime cumulative risk at %6,3 in brothers, %3,5 in sisters, %3,4 in fathers and %2,5 in mothers (Chang ET, et al., 2021). Patients carrying the HLA-A2-B46 haplotype have significantly lower 5-year distant metastasis-free survival than noncarriers (%66,4 versus %90,3; Wang RZ, et al., J Huazhong Univ Sci Technol, 2016) — this genetic profile may thus affect prognosis as well as risk.
Nasopharyngeal cancer's striking geographical distribution results from the coexistence of EBV infection, genetic susceptibility (particularly HLA loci) and environmental/dietary factors (such as childhood salted fish consumption), rather than one cause. Approximately twice the risk in the Cantonese-speaking Tanka ethnic group, historically boat-dwelling, compared with other language groups in the same region suggests that neither genetics nor environment alone adequately explains it, and that strong gene-environment interaction plays a role.
Histological Classification (WHO)
The World Health Organization (WHO) divides nasopharyngeal carcinoma into three histological types:
| WHO Type | Definition | EBV Association | Frequency in Endemic Regions |
|---|---|---|---|
| Type I | Keratinizing squamous cell carcinoma | Variable/relatively weaker | ~%2-5 |
| Type II | Nonkeratinizing, differentiated carcinoma | Strong | High |
| Type III | Nonkeratinizing, undifferentiated carcinoma (formerly "lymphoepithelioma") | Almost universal | Most common type (>%90 Type II+III combined) |
Low-incidence regions (such as Western Europe and North America) have a higher proportion of Type I histology than endemic regions (up to %25); intermediate-risk regions including Türkiye have a distribution closer to endemic regions (as seen in the Türkiye data above, Type III predominates). The WHO classification also separately describes basaloid squamous cell carcinoma, a rare, aggressive variant.
Symptoms
- Painless neck swelling/mass (enlarged lymph node — usually the first noticed symptom)
- One-sided nasal obstruction
- Recurrent nosebleeds (epistaxis)
- One-sided hearing loss or ear fullness
- Recurrent one-sided middle ear inflammation (serous otitis media)
- Headache
- In advanced stages: double vision, facial numbness, hoarseness (cranial nerve involvement)
The nasopharynx has rich lymphatic drainage, so tumors tend to metastasize early to cervical lymph nodes even while relatively small — many patients therefore consult a physician after noticing painless neck swelling before symptoms from the primary tumor become obvious. Similarly, proximity to the Eustachian tube opening means unilateral hearing loss or recurrent middle ear inflammation (particularly unexplained one-sided findings in adults) can be an important warning sign and requires nasopharyngeal examination.
How Is It Diagnosed?
Nasopharyngoscopy and Biopsy
Diagnosis involves direct nasopharyngeal visualization with a thin, flexible camera (fiberoptic or rigid endoscope) (nasopharyngoscopy) and obtaining a biopsy from the suspicious area. In patients presenting with a neck mass, EBV-related histology and clinical context may strongly suggest the nasopharynx even when the primary tumor source is not clearly visible.
Imaging
Magnetic resonance imaging (MRI) is preferred over CT for assessing parapharyngeal spread, skull base invasion and cranial nerve involvement in nasopharyngeal cancer because of its superior soft-tissue resolution. PET-CT contributes to distant metastasis screening, particularly in locally advanced disease, and to post-treatment response assessment.
EBV DNA: A Central Biomarker
Plasma EBV DNA (circulating tumor-derived EBV particles) is a versatile nasopharyngeal cancer biomarker to a degree seen in few cancers worldwide — used for screening, prognosis, treatment response monitoring and recurrence screening.
According to a groundbreaking study screening 20.174 asymptomatic adults in Hong Kong (Chan KCA, et al., New England Journal of Medicine, 2017), EBV DNA was detected on the initial test in %5,5 (1.112 people); 309 with persistent positivity underwent further assessment, confirming 34 nasopharyngeal cancer cases. Of screen-detected cases, %71 were early-stage (I/II) versus only %20 in an unscreened historical cohort (p<0,001); reported 3-year progression-free survival was %97 in screened patients versus %70 in the historical cohort (HR 0,10). Test sensitivity was %97,1 and negative predictive value %99,995. Thus, current guidelines recommend EBV DNA screening only in high-risk individuals in endemic regions (for example, men aged 40-62) — evidence is insufficient for routine population screening in low-incidence regions (including Türkiye).
High pretreatment EBV DNA (≥4.000 copies/mL) is associated with poor prognosis and may indicate additional imaging (PET-CT) for occult distant metastases. Persistently detectable EBV DNA after treatment (radiotherapy/chemoradiotherapy) is also a strong adverse prognostic sign: in a cohort of 931 patients (Oncotarget, 2016), those with persistent post-treatment EBV DNA positivity (%13,4) had a recurrence rate of %64,8 and 5-year overall survival of %49,5; 5-year survival was only %20,5 with high viral load (≥100 copies/mL) versus %62,9 with low load (<100 copies/mL) (p<0,0001). The same study showed that adding adjuvant chemotherapy in high-risk patients with persistent EBV DNA positivity increased 5-year survival from %33,2 to %69,4 (HR 0,38) — demonstrating a biomarker that may guide treatment intensity decisions as well as prognosis. This concept is formally being investigated in NRG-HN001 (a phase II/III study testing whether observation can replace adjuvant chemotherapy in post-treatment EBV DNA-negative patients).
EBV DNA PCR is technically available at major private laboratories in Türkiye; however, how established its nasopharyngeal cancer prognostic/monitoring use is in Turkish clinical protocols, and the clarity of SGK reimbursement for this specific use, remain uncertain. It is important to distinguish test availability from routine clinical/reimbursement status for this specific oncological indication.
Staging: The TNM System
Unlike many other head and neck cancers, nasopharyngeal cancer staging was updated to AJCC/UICC Version 9. in 2024 (JAMA Oncology, published online October 10, 2024) — making it one of the first cancers to move to AJCC 9, currently its official updated staging system. However, most clinical literature, guidelines and existing records still reference AJCC 8. edition (2017), and transition continues; therefore, AJCC 8. edition is detailed below, followed by the main differences in Version 9.
T Category (AJCC 8. Edition)
| T Category | Definition |
|---|---|
| T1 | Tumor confined to the nasopharynx or extending to the oropharynx/nasal cavity, without parapharyngeal spread |
| T2 | Spread to the parapharyngeal space and/or adjacent soft tissues (medial/lateral pterygoid muscles, prevertebral muscles) |
| T3 | Bony infiltration of the skull base, cervical vertebrae, pterygoid structures and/or paranasal sinuses |
| T4 | Intracranial spread, cranial nerve involvement, hypopharynx, orbit, parotid gland and/or extensive soft-tissue infiltration beyond the outer surface of the lateral pterygoid muscle |
N Category: A Different System from Other Head and Neck Cancers
Unlike most head and neck cancers, nasopharyngeal N staging depends on unilateral/bilateral involvement, the presence of retropharyngeal lymph nodes and location relative to the lower border of the cricoid cartilage rather than lymph node number or size:
| N Category | Definition |
|---|---|
| N0 | No regional lymph node metastases |
| N1 | Unilateral cervical and/or unilateral/bilateral retropharyngeal lymph node(s), ≤6 cm, above the lower border of the cricoid cartilage |
| N2 | Bilateral cervical lymph node(s), ≤6 cm, above the lower border of the cricoid cartilage |
| N3 | Unilateral/bilateral cervical lymph node(s), >6 cm and/or extending below the lower border of the cricoid cartilage |
Note: The "supraclavicular fossa" definition in AJCC 7. edition was replaced in AJCC 8 by the more precise anatomical reference, "lower border of the cricoid cartilage," and the former N3a (>6cm)/N3b (supraclavicular fossa) distinction was merged into a single N3 category.
M Category and Stage Groups
M0: no distant metastases. M1: distant metastases present.
| Stage | TNM |
|---|---|
| 0 | Tis, N0, M0 |
| I | T1, N0, M0 |
| II | T1, N1, M0; or T2, N0-N1, M0 |
| III | T1-T2, N2, M0; or T3, N0-N2, M0 |
| IVA | T4, any N, M0; or any T, N3, M0 |
| IVB | Any T, any N, M1 |
Note: In nasopharyngeal cancer, AJCC 8 distinguishes Stages IVA and IVB but does not define a separate Stage IVC, unlike most other head and neck cancers; Stage IVB here represents distant metastases (M1).
AJCC 9 added "substantial extranodal extension" (spread to muscles/skin/neurovascular structures around the lymph node) as a new N3 criterion; split M1 into M1a (≤3 metastatic lesions) and M1b (>3 lesions) ; and compressed stage groups because AJCC 8 showed no significant survival difference between Stages I and II (former I/II merged, former III/IVA shifted down one stage). It is important to clarify with the patient which system current clinical practice uses.
Treatment Planning: A Radiotherapy-Centered Approach
Unlike most head and neck cancers, nasopharyngeal cancer treatment is centered on radiotherapy — surgery for the primary tumor is generally infeasible because of its anatomical location (proximity to the skull base and major vessels/nerves). Instead, treatment is planned by stage across a spectrum from radiotherapy alone (early-stage) to chemoradiotherapy and immunotherapy combinations (advanced/metastatic); the multidisciplinary team includes radiation oncologists, medical oncologists, ear-nose-throat surgeons and pathologists.
Early-Stage (Stage I) Treatment: IMRT Alone
The nasopharynx's proximity to the brainstem, optic nerves/chiasm, temporal lobes and parotid glands requires very precise dose distribution. Phase III randomized studies (Kam MK, et al., Journal of Clinical Oncology, 2007; Pow EH, et al., International Journal of Radiation Oncology Biology Physics, 2006, confirmed with 15-year follow-up by Poon EH, et al., Head & Neck, 2021) showed that IMRT significantly better preserves the parotid gland and reduces chronic dry mouth (xerostomia) compared with traditional 2-dimensional radiotherapy — without compromising tumor control. This evidence made IMRT standard radiotherapy at all nasopharyngeal cancer stages (including curative treatment alone in early stages).
Locally Advanced (Stage II-IVA) Treatment
Standard treatment in locally advanced nasopharyngeal cancer is cisplatin-based concurrent chemoradiotherapy (cisplatin weekly or every 3 weeks with radiotherapy).
According to the study by Sun Y et al. (NEJM, 2019), adding 3 cycles of gemcitabine+cisplatin induction chemotherapy before CCRT significantly improved results over CCRT alone: 3-year recurrence/failure-free survival %85,3 versus %76,5 (HR 0,51; p=0,001); 3-year overall survival %94,6 versus %90,3 (HR 0,43); 3-year distant recurrence-free survival %91,1 versus %84,4 (HR 0,43). However, acute grade 3-4 toxicity (neutropenia %28,0 versus %10,5) was significantly higher in the induction arm; serious late toxicity was similar. These results made induction chemotherapy before CCRT standard in locally advanced disease.
According to the joint ASCO and Chinese Society of Clinical Oncology (CSCO) guideline (Journal of Clinical Oncology, 2021), induction chemotherapy is now considered an "accepted new standard," while adjuvant (after surgery/radiotherapy) chemotherapy may also be offered as an alternative. However, no randomized trial directly compares these approaches — induction is more frequently preferred in clinical practice because it has stronger, more recent phase III evidence (such as NEJM 2019 above), while adjuvant evidence is relatively older and weaker.
Treatment in Recurrent or Metastatic Disease
According to GEM20110714 (Zhang L, et al., Lancet, 2016; final overall survival analysis Zhang L, et al., Journal of Clinical Oncology, 2021), first-line gemcitabine+cisplatin (GP) was superior to 5-fluorouracil+cisplatin (PF) in recurrent/metastatic nasopharyngeal cancer: progression-free survival HR 0,55 (p<0,001); median overall survival 22,1 versus 18,6 months (HR 0,72; p=0,004); 5-year overall survival %19,2 versus %7,8 (p<0,001). This made GP the chemotherapy backbone in recurrent/metastatic disease and the foundation of immunotherapy combinations described below.
Based on JUPITER-02, toripalimab received FDA approval on October 27, 2023 — the first FDA immunotherapy approved specifically for nasopharyngeal cancer. It has two indications: (1) first-line with gemcitabine+cisplatin in recurrent/metastatic disease; (2) as a single agent (monotherapy) after progression on platinum-based chemotherapy. In JUPITER-02, toripalimab+GP increased median progression-free survival to 11,7 months versus 8,0 months with placebo+GP (HR 0,52; p=0,0003); median overall survival was not reached, versus 33,7 months in the control arm (HR 0,63; p=0,0083). The monotherapy indication is based on POLARIS-02 (ORR %21). In December 2023, NCCN updated toripalimab+GP as the only "preferred, Category 1" first-line regimen.
Penpulimab-kcqx received FDA approval on April 23, 2025 — with two indications specifically in nonkeratinizing nasopharyngeal cancer: (1) first-line with cisplatin (or carboplatin) + gemcitabine; (2) as a single agent in metastatic disease progressing after platinum-based chemotherapy and at least one additional treatment line. In AK105-304 (n=291), penpulimab+chemotherapy increased median progression-free survival to 9,6 months versus 7,0 months (HR 0,45; p<0,0001); although overall survival data were immature at approval, no adverse trend was seen. The monotherapy indication is based on AK105-202 (ORR %28). This approval means a second FDA-approved anti-PD-1 option is now available in nasopharyngeal cancer.
Camrelizumab was approved in China (NMPA, June 17, 2021) based on CAPTAIN-1st (median PFS 9,7 versus 6,9 months; HR 0,54) but has no FDA approval. Tislelizumab was also approved in China (NMPA, June 10, 2022) based on RATIONALE-309, but has no FDA approval. Both drugs are mainly on the Chinese market and are unlicensed in Türkiye.
An interesting approach for patients metastatic at diagnosis (de novo Stage IVB) with low tumor burden is adding to the primary tumor consolidation (locoregional) radiotherapy . According to You R et al. (JAMA Oncology, published August 25, 2020), 126 patients responding to 3 induction chemotherapy cycles (cisplatin+5-FU) were randomized to continued chemotherapy or added locoregional IMRT to the nasopharynx/neck; 24-month overall survival was %76,4 versus %54,5 (HR 0,42; p=0,004), and 24-month progression-free survival %35,0 versus %3,6 (HR 0,36). The Chinese Society of Clinical Oncology (CSCO) recommends this with evidence level 1A; NCCN permits consideration after a good systemic response but does not mandate it. A known limitation is that the study used cisplatin+5-FU induction, requiring confirmatory studies in the current gemcitabine+cisplatin/immunotherapy era.
Treatment of Local/Regional Recurrence: Surgery or Reirradiation?
According to a multicenter randomized phase III study comparing endoscopic nasopharyngectomy with repeat IMRT in surgically resectable local recurrent nasopharyngeal cancer (Lancet Oncology, 2021), overall survival was significantly higher in the surgery arm: %85,8 versus %68,0 at 3 years and %73,8 versus %57,2 at 5 years (HR 0,47; p=0,0015). Serious (grade ≥3) late radiation-related toxicity was also much lower with surgery (%13 versus %37), and deaths from late toxicity were %5 versus %20. These results support endoscopic nasopharyngectomy as preferred for surgically accessible recurrences; reirradiation (including stereotactic techniques) remains mainly for unresectable recurrences (such as deep skull base invasion or cavernous sinus/carotid involvement).
Treatment-Related Side Effects and Their Management
Radiotherapy (IMRT)
Radiotherapy to the nasopharynx can cause dry mouth (xerostomia — markedly reduced with IMRT but not eliminated), taste changes, jaw restriction (trismus), unilateral/bilateral hearing loss, hypothyroidism (due to thyroid proximity to the radiation field) and rarely temporal lobe necrosis. Regular thyroid function testing, dental care and jaw exercises (to prevent trismus) are important parts of treatment.
Chemotherapy (Cisplatin, Gemcitabine)
Cisplatin-based regimens may cause renal toxicity, hearing loss, peripheral neuropathy and bone marrow suppression; gemcitabine is frequently associated with neutropenia and elevated liver enzymes. Pretreatment renal and hearing assessment, and regular blood counts during treatment, are important.
Immunotherapy (Toripalimab, Penpulimab)
Anti-PD-1 agents carry a risk of "immune-related adverse events" due to the immune system attacking its own tissues (colitis, hepatitis, pneumonitis, thyroid dysfunction, skin reactions). These side effects are generally manageable when recognized and treated early; any new symptom (diarrhea, jaundice, cough/shortness of breath, extreme fatigue) must be reported immediately.
Global Approval and Evidence History
Nasopharyngeal cancer drug development has largely been driven by China-centered research programs, with relatively few drugs receiving FDA approval. Therefore, this timeline presents international regulatory approvals and important evidence changing treatment standards (study results) together with FDA approvals; each item clearly identifies the type of development.
Prognostic Value of Plasma EBV DNA Evidence — Key Biomarker Study
Lin JC et al., in a study published in NEJM, showed the prognostic value of plasma EBV DNA before/during/after treatment.
Phase III Evidence for IMRT Evidence
Kam MK et al. (JCO) demonstrated IMRT's superior parotid preservation over conventional radiotherapy in a randomized study.
Gemcitabine+Cisplatin (GP) Chemotherapy Backbone
GEM20110714 (Lancet) established GP as standard first-line chemotherapy in recurrent/metastatic disease.
EBV DNA Screening Evidence — Screening Validation
Chan KCA et al. (NEJM) showed that plasma EBV DNA screening markedly increased early-stage detection in endemic regions.
Consolidation RT in De Novo Metastatic Disease
You R et al. (JAMA Oncology) showed that adding locoregional radiotherapy significantly prolonged survival in metastatic disease with low tumor burden.
Camrelizumab (Chinese NMPA Approval)
Approved only in China based on CAPTAIN-1st; no FDA approval.
Toripalimab (Loqtorzi) The First FDA-Approved Immunotherapy
Based on JUPITER-02, it became the first FDA-approved immunotherapy specific to nasopharyngeal cancer (first-line combination + platinum-refractory monotherapy).
Penpulimab The Second FDA-Approved Immunotherapy
Approved for nonkeratinizing nasopharyngeal cancer based on AK105-304 — two FDA-approved anti-PD-1 options are now available for this disease.
Diagnosis, Licensing and Reimbursement in Türkiye
Cisplatin and gemcitabine are longstanding standard generic chemotherapy agents licensed by TİTCK and covered by SGK in Türkiye. IMRT is also widely offered at Turkish university hospitals and private oncology centers as a standard SGK-covered radiotherapy technique — no access problem has been reported.
As of the date this guide was prepared, no records for toripalimab (Loqtorzi) or penpulimab were found in Turkish drug databases, and they are not licensed by TİTCK — consistent with toripalimab not yet having European Medicines Agency (EMA) approval either (application under review since December 2022). Camrelizumab and tislelizumab are also primarily Chinese-market drugs and are unlicensed in Türkiye. Therefore, standard access to these drugs in Türkiye is currently unavailable; direct confirmation of current status through TİTCK's official sources is recommended.
The SUT update dated July 10, 2025 expanded pembrolizumab reimbursement to "head and neck squamous cell cancer outside the nasopharynx" — meaning this update explicitly excludes nasopharyngeal cancer. This is an important distinction easily misunderstood: nasopharyngeal cancer is not among pembrolizumab indications covered by SGK under this update.
EBV DNA testing is technically available at major laboratories in Türkiye, but this research could not confirm clear SGK reimbursement for its nasopharyngeal cancer-specific prognostic/monitoring use. Because licensing and reimbursement status may change rapidly, direct checks of TİTCK and SGK's official sources are recommended before treatment decisions.
Frequently Asked Questions
- Why Is Nasopharyngeal Cancer Rare in Türkiye but Very Common in Some Countries?
- EBV infection, genetic susceptibility (particularly certain HLA gene types) and environmental/dietary factors (such as childhood salted fish consumption) must coexist; this combination is much more common in Southern China, Southeast Asia and parts of North Africa, while Türkiye is classified as intermediate-risk.
- I Noticed Neck Swelling. Does This Definitely Mean Nasopharyngeal Cancer?
- No, neck swelling has many benign causes, including infection. However, a painless, enlarging, persistent neck mass must be assessed by a physician, as it may be the most common first symptom of nasopharyngeal cancer.
- Why Is Radiotherapy Emphasized over Surgery in This Cancer?
- The nasopharynx is difficult to access surgically, very close to the skull base, brainstem and major vessels/nerves. Thus, radiotherapy (IMRT) alone or with chemotherapy/immunotherapy is standard for the primary tumor at most stages; surgery mainly comes into play at recurrence.
- Should Everyone Have EBV DNA Testing?
- No. Population screening with EBV DNA is recommended only for at-risk individuals in highly endemic regions such as Southern China. Evidence is insufficient for routine population screening in intermediate/low-incidence regions such as Türkiye; however, it may be valuable for treatment response monitoring and recurrence screening in diagnosed patients.
- How Can New Drugs Such as Toripalimab or Penpulimab Be Accessed in Türkiye?
- These drugs are unlicensed in Türkiye as of the date this guide was prepared. You are advised to confirm the current situation directly with your physician or TİTCK's official sources, and ask about clinical trials you may qualify for.
- Sung H, et al. "Global cancer statistics 2024." CA: A Cancer Journal for Clinicians, 2026. DOI: 10.3322/caac.70090
- IARC Global Cancer Observatory (GLOBOCAN 2024) — Nasopharyngeal Cancer and Türkiye Country Fact Sheet. gco.iarc.who.int
- American Cancer Society. Nasopharyngeal Cancer — Key Statistics and Survival Rates (based on SEER data). cancer.org, March 3, 2026 update.
- Türkoz FP, et al. Nasopharyngeal cancer risk factors in Türkiye. Asian Pacific Journal of Cancer Prevention, 2011.
- Chang ET, Ye W, Zeng YX, Adami HO. The changing epidemiology of nasopharyngeal cancer. Cancer Epidemiology, Biomarkers & Prevention, 2021.
- Wang RZ, et al. HLA-A2-B46 haplotype and prognosis. Journal of Huazhong University of Science and Technology [Medical Sciences], 2016.
- Lin JC, et al. Quantification of plasma EBV DNA in advanced nasopharyngeal cancer. New England Journal of Medicine, 2004.
- Chan KCA, et al. Plasma EBV DNA analysis for nasopharyngeal cancer screening. New England Journal of Medicine, 2017.
- Persistent plasma EBV DNA after radiotherapy and long-term outcomes. Oncotarget, 2016.
- NRG-HN001 study protocol, EBV DNA-guided adjuvant treatment. NRG Oncology.
- Chen YP, et al. AJCC/UICC Version 9. nasopharyngeal cancer TNM staging classification. JAMA Oncology, 2024.
- Kam MK, et al. IMRT and parotid preservation, randomized study. Journal of Clinical Oncology, 2007.
- Poon EH, et al. Long-term parotid-preserving effect of IMRT, 15-year follow-up. Head & Neck, 2021.
- Sun Y, et al. Induction chemotherapy in locoregionally advanced nasopharyngeal cancer. New England Journal of Medicine, 2019.
- Joint CSCO and ASCO guideline, Stage II-IVA nasopharyngeal cancer treatment. Journal of Clinical Oncology, 2021.
- Zhang L, et al. GEM20110714, gemcitabine+cisplatin vs 5-FU+cisplatin. Lancet, 2016; final analysis JCO, 2021.
- FDA approval announcement: Toripalimab (Loqtorzi), JUPITER-02 study, October 27, 2023.
- FDA approval announcement: Penpulimab, AK105-304 study, April 23, 2025.
- CAPTAIN-1st study, camrelizumab. Lancet Oncology, 2021; Chinese NMPA approval June 17, 2021.
- RATIONALE-309 study, tislelizumab. Chinese NMPA approval June 10, 2022.
- You R, et al. Locoregional radiotherapy in de novo metastatic nasopharyngeal cancer. JAMA Oncology, 2020.
- Endoscopic nasopharyngectomy vs repeat IMRT, local recurrence, randomized phase III study. Lancet Oncology, 2021.
- Communiqué Amending the Health Implementation Communiqué, July 10, 2025 (SGK SUT update).
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