“Standard to care” refers to the best-known treatment. In cancer care, different doctors work together to bring out an overall treatment plan for the patient. This is a multidisciplinary team.
Treatments recommendations depend on many factors:
- The size, grade and type of tumour
- If the tumour has increased to other parts of the body
- Possible side effects
- The patient’s preferences and overall health
Radiation Therapy
Radiation therapy uses high-energy X-rays to destroy cancer cells. A radiation therapy schedule consists typically of a specific number of treatments offered over a set period.
A doctor can combine radiation therapy with chemotherapy during treatment. When a doctor does this, it is concurrent chemotherapy or chemoradiotherapy.
External-beam radiation therapy –
The most common type of radiation therapy used to treat NPC is external-beam radiation therapy, which aims for radiation from a machine outside the body at the tumour. A method of external-beam radiation therapy, called intensity-modulated radiation therapy, allows effective doses of radiation therapy to be delivered while reducing damage to normal healthy cells and causing fewer side effects. ASCO suggested IMRT for all people with stage II to stage IVA NPC.
Proton therapy –
Proton therapy is an external-beam radiation therapy that uses protons rather than x-rays. Protons can destroy cancer cells at high energy. Proton therapy can be used as part of the treatment for some tumours at the skull base to lower the radiation dose to nearby structures, like the optic nerves in the eye and the brainstem. Proton therapy can also be an option for later-stage NPC located close to parts of the central nervous system, including the brain and spinal cord.
Stereotactic radiosurgery –
Stereotactic radiosurgery delivers radiation therapy precisely to the tumour. Doctors use this to treat a tumour that has grown into the base of the skull or a tumour that has recurred at the base of the brain or skull.
Brachytherapy –
When the doctors give radiation treatment using implants, it is internal radiation therapy or brachytherapy. A doctor surgically implants a rod or tiny pellets that contain radioactive materials in or near the cancer location to treat NPC with internal radiation therapy. The doctor keeps the implant in place for several days while the person stays in the hospital. This approach is often used to treat NPC that has returned after the first treatment, but it may also treat the original tumour.
Before starting radiation treatment for any head and neck cancer, people should receive an examination from an oncologic dentist. Since radiation therapy can lead to tooth decay, damaged teeth may need to be removed. One can mostly prevent tooth decays with proper treatment from a dentist before cancer treatment starts. After radiation therapy for NPC, dental care should be continued to help prevent any dental problems. People may receive a fluoride treatment to prevent dental cavities.
Side effects of radiation therapy to the head and neck can include irritation or redness of the skin in the treated area, bone pain, dry mouth or thickened saliva from damage to salivary glands, mouth sores, sore throat, nausea, fatigue, pain or difficulty swallowing, swelling known as lymphedema, hearing loss because of a buildup of fluid in the middle ear, appetite loss because of changes in a person’s sense of taste, and earwax buildup that dries out because of the radiation therapy’s effect on the ear canal.
Radiation therapy can also cause hypothyroidism, in which the thyroid gland slows down. Hypothyroidism causes people to feel sluggish and tired and gain weight. As a result, the person who receives radiation therapy to the neck area should regularly check their thyroid.
Chemotherapy
Chemotherapy uses medicine to kill or stop the growth of cancerous cells. Doctors give chemotherapy depending upon the stage. The point that makes a difference is how the chemotherapy enters the body and which cells it affects.
A chemotherapy schedule usually consists of a certain number of cycles over a fixed period. A doctor may give a patient one drug at a time or a combination of different drugs simultaneously.
ASCO recommends chemotherapy for people with stage II to stage IVA NPC in the following situations.
- Doctors may recommend chemoradiotherapy for a stage II tumour that has spread to the lymph nodes. Chemoradiotherapy is when doctor gives radiation therapy and chemotherapy during the same period.
- For a stage II tumour that has not spread to the lymph nodes, doctors may still offer chemotherapy if there are signs that cancer may spread.
- Doctors suggest Induction chemotherapy plus chemoradiotherapy or adjuvant chemotherapy for stage III to stage IVA NPC. It is the first treatment doctors give to cure cancer. They give Induction chemotherapy before chemoradiotherapy. And, adjuvant chemotherapy after chemoradiotherapy.
- With or without induction or adjuvant chemotherapy, doctors suggest chemotherapy for large stage III tumours that do not involve the lymph nodes.
Regimens for induction chemotherapy may include:
- Combinations of gemcitabine (Gemzar) and cisplatin (Platinol).
- Docetaxel (Taxotere) with cisplatin and 5-fluorouracil (5-FU).
- Cisplatin and 5-fluorouracil.
- Docetaxel and cisplatin.
- Cisplatin and capecitabine (Xeloda).
Regimens for adjuvant chemotherapy include cisplatin, 5-fluorouracil, or carboplatin (Paraplatin).
When chemoradiotherapy is used to treat NPC, nedaplatin (Aqupla), cisplatin, carboplatin, or oxaliplatin (Eloxatin) should be used when possible.
Each drug or combination of drugs can cause particular side effects, and it is essential to talk to the doctor about which side effects to expect and if any may become permanent. Side effects of chemotherapy can include nausea, vomiting, fatigue, hair loss, dry mouth, diarrhoea, constipation, and loss of appetite, primarily due to a change in a person’s sense of taste.
Additionally, chemotherapy can weaken the immune system and cause open sores in the mouth, leading to infection. Generally, chemotherapy in combination with radiation therapy increases these side effects. Nutritional support can be necessary during treatment due to these side effects.
Surgery
Surgery is the removal of the tumour and some nearby healthy tissue during an operation. Doctors sometimes use it for NPC, but it is not a usual treatment choice because it is hard to reach and close to cranial nerves and blood vessels.
If the doctor suspects that cancer has spread to the lymph nodes, he or she may suggest a surgical removal of lymph nodes in the neck. This type of surgery is neck dissection. A patient may sometimes require neck dissection for undifferentiated carcinoma of the nasopharynx.
A neck dissection may cause weakness when raising the arm above the head, numbness of the ear, and weakness of the lower lip. Nerve damage in the area causes these side effects. Depending on the type of neck dissection, weakness of the lower lip and arm may go after a few months. However, weakness may be permanent if the doctor removes a nerve or if the nerve damages as part of a dissection. Swelling called lymphedema might also be possible. A patient may need a facial disfigurement using reconstructive/plastic surgery. Before your operation, talk to the surgeon in detail about what you can expect and if you might need another surgery for reconstruction. If there are changes in your appearance, talk to the health care team about ways to cope and find support services.
Palliative Care
Cancer and its treatment have side effects that can be mental, physical or financial and managing the effects are palliative or supportive care.
Palliative care includes medication, nutritional changes, emotional and spiritual support and other relaxation therapies.
Palliative care focuses on alleviating how you feel during treatment by managing symptoms and supporting patients and their families with other non-medical needs. Regardless of type and stage of Cancer age, any person may receive this type of care.
Metastatic NPC
When cancer starts spreading to other parts of the body, it is metastatic cancer. Doctors can have different opinions regarding the best standard treatment plan. Clinical trials might also be an option. For many people, the diagnosis of metastatic cancer is very stressful and challenging. It is usually helpful to talk with other patients through support groups or peer support programs. The treatment plan can include a combination of surgery, targeted therapy, radiation therapy, and immunotherapy, which is a treatment created to boost the body’s natural defences to fight the tumour.
Remission and the chance of recurrence
Remission is when a doctor cannot detect cancer in the body, and there are no symptoms. This may also be having ‘no evidence of disease’ or ‘NED.’
A remission can be temporary or permanent. Many people worry about the recurrence of cancer.
Recurrent NPC is usually treated with radiation therapy or chemotherapy and sometimes with surgery. Chemotherapy is used for NPC that has returned to distant sites and was previously treated with radiation therapy. Chemotherapy can also be used together with radiation therapy to improve the effectiveness of radiation therapy.
If treatment doesn’t work
If one cannot treat or control his or her cancer, it leads to advanced or terminal cancer. It is vital to have straightforward conversations with your health care team to express your feelings, preferences, and concerns. The health care team has unique skills, knowledge, and experience to assist patients and their families. Ensuring that a person is physically comfortable, free from pain, and emotionally supported is extremely important.
