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STAGE 3 NASOPHARYNGEAL CANCER: SYMPTOMS, DIAGNOSIS AND TREATMENT

What is stage 3 nasopharyngeal cancer?

Nasopharyngeal cancer is staged from stage 0 to stage 4, where stage 3 nasopharyngeal cancer is said to be locally advanced – locally, when tumor cells have invaded the muscles. surrounding organs (such as: skull base, cervical spine, nasal sinuses, etc.), lymph node metastasis on both sides of the neck without signs of distant metastasis.Decoding T, N, M segments in stage 3 nasopharyngeal cancer
In the staging system for nasopharyngeal cancer stage 3 has the following characteristics:Case 1: Tumor spread to surrounding structures and nasal sinuses, invaded the base of the skull, invaded the cervical spine (T3), with or without cervical lymph node metastasis. The lymph nodes are ≤6cm in size. No distant metastases to other parts of the body have been reported (M0).
The second case: The primary tumor cannot be detected in the nasopharynx, or the tumor is confined to the nasopharynx or may also have grown into the oropharynx, nasal cavity or parapharyngeal space (T0, T1, T2). Cancer cells may invade lymph node masses in the neck region with lymph node size ≤6cm (N2, M0).
Symptoms of throat cancer stage 3
MSc Luu Thao Ngoc – Oncologist at Tam Anh General Hospital, Hanoi, said that compared to the unclear symptoms of early stage nasopharyngeal cancer, the symptoms of stage 3 nasopharyngeal cancer became clear. clearer and louder. This is also the stage when many people are diagnosed with the disease because of the frequent occurrence of severe pain. Typical signs of stage 3 nasopharyngeal cancer include:Systemic manifestations of malignancy: such as fatigue, weight loss, poor eating, anorexia, etc.
Headache, sometimes the pain comes on suddenly, intensely; pain deep in the eye socket.
Swallowing problems due to tumor growth pressing on the mouth and throat.
Coughing up blood, spitting up bloody sputum, stuffy nose, frequent nosebleeds. If the amount of blood loss is large, the patient may experience weakness, fatigue, dizziness, headache, dizziness, etc.
Tinnitus, hearing loss, ear discharge with pus and blood… due to the large tumor size affecting the tympanic tube as well as parts related to the ear.
Swollen lymph nodes in the neck. If the lymph node ruptures, the patient can become infected, causing pain.

Prognosis of survival rate of nasopharyngeal cancer stage 3

Stage 3 nasopharyngeal cancer causes serious disease symptoms, leading to other complications by affecting other structures in the oropharynx, sinuses, bones… This stage is recorded when the tumor grows locally – in the region.Regarding the prognosis, to answer the question ” how long do patients with stage 3 nasopharyngeal cancer live “, doctors will rely on clinical examination and evaluation of the EBV viral DNA load test index (Epstein- Barr Virus). According to the Journal of Clinical Oncology ( JCO) , for a low EBV viral load (less than 400 copies/mL), there is a 66% chance of a patient surviving to more than 5 years from the time of diagnosis. If the test shows a viral load higher than 400 copies/mL, the rate drops to just 54%.In fact, viral load index only partially reflects disease progression. Many cases have recorded that people with stage 3 nasopharyngeal cancer can live up to 5-6 years after detecting the disease, there are also cases of only 6 months – 1 year. Therefore, the survival prognosis for cancer patients is only relative and will depend on the individual disease, general health status, response to treatment and tolerance of each patient.How to diagnose stage 3 nasopharyngeal cancer
To diagnose stage 3 nasopharyngeal cancer, doctors will take the following approaches:

Clinical examination

The doctor conducts a clinical examination, assesses the patient’s nutritional status, symptoms, examines the cervical lymph nodes, cranial nerves, observes the oral cavity and pharynx, and distant metastases.

Endoscopy otorhinolaryngology

If you show signs of disease, your doctor will prescribe an ENT endoscopy to detect abnormal lesions. Otolaryngoscopy helps doctors clearly see the area inside the nasopharynx thanks to the image received by the camera, giving images 10-30 times magnified. The camera is attached to the end of a flexible tube, threaded through the patient’s nose, ears and throat.

If abnormal areas are suspected, the doctor will conduct a biopsy of the specimen from the lesion to send for pathology, determining whether the lesion is malignant or benign.

EBV DNA analysis and imaging tests – Nuclear medicine
Blood tests such as peripheral blood cytology and plasma EBV DNA load testing may be ordered.

When there are clinical signs and histopathological evidence indicating that the patient has had nasopharyngeal cancer, the doctor will give some indications for imaging – nuclear medicine to diagnose the stage. diseases such as computed tomography (CT), PET-CT, magnetic resonance imaging (MRI)… to assess the size and extent of tumor invasion, lymph node metastasis and distant metastasis, if any. From there, the doctor will develop a treatment plan suitable for the patient.

Treatment of nasopharyngeal cancer stage 3
The question often asked is “Can stage 3 nasopharyngeal cancer be curable?”. With the advancement of modern medicine, timely treatment allows to prolong the life of many patients, even if they detect the disease at stage 3.

According to MSc.BS Luu Thao Ngoc, a number of factors are involved in developing a treatment regimen for stage 3 nasopharyngeal cancer such as:

Year old

General condition of the patient
Accompanying medical disease
Treatment goals
Response and tolerability to radiotherapy and chemotherapy
In general, a multimodal treatment regimen (including radiation and chemotherapy) will be indicated when treating stage 3 nasopharyngeal cancer. Patients usually receive radical concurrent chemoradiotherapy. to destroy tumor and lymph node metastasis. Some patients may receive chemotherapy first, then radical chemo-radiotherapy later (such as patients with large tumors who receive chemotherapy first to shrink the tumor and metastasize to support cancer treatment). facilitate radiotherapy with fewer complications).

Radiotherapy method

Radiation therapy is the treatment of choice for nasopharyngeal cancer due to its difficult anatomical location to reach with surgery. Using high-energy ionizing radiation, such as X-rays or protons, kills cancer cells. For stage 3 nasopharyngeal cancer, external radiation therapy is usually indicated. Advanced radiotherapy techniques such as dose-modulated radiation therapy (IMRT) are effective in killing tumors and reducing side effects on surrounding healthy organs.

Side effects of radiation therapy may occur such as dermatitis, redness, dry mouth, difficulty swallowing, mucositis, etc. If chemotherapy and radiation are given at the same time, the side effects can be serious. More serious, causing discomfort, pain in the mouth and throat.

Chemotherapy method

Chemotherapy is the use of chemicals to kill cancer cells. Chemotherapy is usually given through an intravenous infusion, some by mouth. Chemotherapy in stage 3 nasopharyngeal cancer includes:

Simultaneous chemo-radiotherapy: applying chemotherapy and radiation at the same time.
Adjuvant chemotherapy: chemotherapy is given after the patient completes the concurrent chemo-radiotherapy course.
First-line chemotherapy: using intravenous chemotherapy drugs before radiation therapy or before chemo-radiotherapy.
Drugs for the treatment of stage 3 nasopharyngeal cancer with Platinum drug group including Cisplatin and Carboplatin are often used in concurrent chemo-radiotherapy regimens. The unwanted effects of chemotherapy drugs such as nausea, vomiting, electrolyte disturbances, toxicity on the hematopoietic system, hair loss… So depending on the patient’s condition, the doctor will adjust the appropriate dose. .

Multimodality combination in the treatment of stage 3 . nasopharyngeal cancer

For stage 3 nasopharyngeal cancer, doctors often use multimodality therapy, i.e. chemotherapy combined with radiation therapy, chemotherapy may be given first followed by concurrent chemoradiotherapy. or concurrent chemoradiotherapy followed by adjuvant chemotherapy. The application of any therapy is based on the treatment guidelines of the Ministry of Health of Vietnam, the American Society of Clinical Oncology (ASCO), the Chinese Society of Clinical Oncology (CSCO), the European Cancer Society, and the American Society of Clinical Oncology. European Union (ESMO), the US National Cancer Network (NCCN) and other reputable cancer organizations.

Treatment of nasopharyngeal cancer stage 3 (case T3N0M0): Concurrent chemo-radiotherapy is often indicated thanks to its superior effectiveness compared with radiotherapy alone. Cisplatin weekly or high-dose every 3 weeks is a commonly used chemotherapy drug. If the patient has a contraindication or intolerance to cisplatin, the doctor can replace it with carboplatin.
Treatment of nasopharyngeal cancer stage 3 (cases T0N2M0, T1N2M0, T2N2M0):
Chemotherapy may be used as a lead, followed by concurrent chemoradiotherapy. If the locality responds well, the tumor and metastatic lymph nodes can shrink, reduce significantly in size, making radiation therapy easier. This is the option often preferred by many treating doctors. First-line chemotherapy regimens (such as Gemcitabine and Cisplatin regimens), followed by concurrent chemo-radiotherapy with Cisplatin.
Another alternative for this group is concurrent chemoradiotherapy followed by adjuvant chemotherapy. This method helps to improve the success rate of the treatment course, increasing the survival time compared to radiotherapy alone. Cisplatin and Fluorouracil regimens are often indicated in adjuvant therapy.
MSc Luu Thao Ngoc emphasized, stage 3 nasopharyngeal cancer treatment requires great efforts from the patient as well as the family because this is the advanced stage of the disease, affecting many surrounding structures. around. However, thanks to scientific advances in cancer treatment, methods such as multimodality therapy contribute to increased survival rates for patients. It is essential from the patient’s side to coordinate and comply with the treatment regimen prescribed by the doctor, and at the same time avoid anxiety, panic, and negativity. Finally, the patient needs to organize his life scientifically and change bad habits.

Living with stage 3 nasopharyngeal cancer

Taking care of patients with stage 3 nasopharyngeal cancer has certain difficulties when at this time, the patient’s condition is severely reduced due to poor eating. At the same time, severe pain often occurs in combination with chemotherapy – radiotherapy with many side effects that make patients anxious and depressed. Therefore, in order for the treatment process to take place smoothly, it requires great efforts of the patient himself, his family as well as the medical team directly treating.

MSc Luu Thao Ngoc recommends that, when taking care of patients with stage 3 nasopharyngeal cancer, it should be noted:

Mentally encourage and accompany the patient throughout the treatment process;
Change the menu every day to create excitement for the patient when eating;
Use fresh, soft products, cooked in liquid and viscous form to make it easy for patients to eat. Do not process hard and dry foods that affect the patient’s chewing and swallowing process;

Combine exercise, gentle health exercises such as walking, nourishing exercises, yoga …
Patients with stage 3 nasopharyngeal cancer need to adhere to the treatment regimen prescribed by the doctor in combination with a scientific lifestyle to ensure effective treatment and prolong the patient’s life. The examination and screening for nasopharyngeal cancer to treat the disease at an early stage helps to reduce pain and costs for patients as well as their families.

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