Pediatric Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is a rare type of cancer that occurs in the nasal cavity and the pharynx, the upper part of the throat behind the nose. This cancer is called a carcinoma because it begins in the cells that line the throat and nose.

Childhood nasopharyngeal carcinoma is more common in adolescents than in younger children. Because this cancer is rare and has no distinguishing symptoms, it may take time to detect and diagnose a tumor. If left untreated, nasopharyngeal cancer can spread (metastasize) to other parts of the body and lead to death.

Scientists and physicians do not yet know the exact causes of nasopharyngeal carcinoma. However, the Epstein-Barr virus (EBV), a common virus that’s part of the herpes family, has been associated with this type of cancer.

There are three types of nasopharyngeal carcinoma, characterized by how the cancer cells look under a microscope. Classified by the World Health Organization (WHO), they are WHO-1, WHO-2, and WHO-3, which is most common in children.

Children with nasopharyngeal carcinoma often have these symptoms:

• Nosebleeds
• Nasal congestion, discharge and blockage
• Frequent ear infections 
• Enlarged or swollen lymph nodes in the neck and throat
• Sore throat

Because these symptoms also occur in common childhood infections, they don’t point specifically to nasopharyngeal carcinoma. Your pediatrician will further evaluate your child to confirm or rule out this condition.

If your child has any of these symptoms and has taken antibiotics without improvement, your pediatrician may recommend one or more of the following tests:

• Blood tests, including Epstein-Barr virus titers to measure the EBV antibody levels in the blood
• Nasal endoscopy to evaluate the nasopharynx with a tiny camera on a small, flexible tube
• Diagnostic imaging, including CT, PET and MRI scans, to check for a tumor
• Biopsy, a tissue sample of the tumor that a lab pathologist can study to determine whether or not the growth is cancerous

The most effective treatment is a combination of chemotherapy and radiation therapy. Depending on the stage of cancer and your child’s overall health, he or she may respond best to one of the following treatment options:

• Radiation therapy, including:
  • External beam using a machine to focus high-powered X-rays on the tumor
  • Brachytherapy (internal radiation) using tiny implants to deliver radiation directly into or very near the tumor
• Chemotherapy with drugs that are delivered by mouth or vein
• Targeted therapy with drugs that focus on cell changes
• Cancer surgery, usually to remove cancerous lymph nodes

Learn more about our comprehensive Solid Tumor Program at Children’s National Hospital.