Can Nasopharyngeal Cancer Spread To The Brain?

Nasopharyngeal cancer is the cancer of the head and neck region. It originates in the nasopharyngeal part of the pharynx. The pharynx is divided into three parts namely nasopharynx, oropharynx and hypopharynx. The nasopharyngeal part is located behind the nose, the oropharynx is located behind the oral cavity and hypopharynx is the part that is present where the trachea and the esophagus start. Nasopharyngeal cancer is not a common type of cancer, it quite rare the incidence rate is one or less amongst 1,00,000 people. The survival rate of this cancer depends on the stage at which the cancer is diagnosed.

Can Nasopharyngeal Cancer Spread To The Brain?

Yes, there are cases reported where nasopharyngeal cancer has spread or metastasized to the brain. A study was conducted where 352 cases diagnosed with nasopharyngeal carcinoma were included and among them, 3 of the cases showed brain metastases. Brain metastasis from a nasopharyngeal carcinoma is not very commonly seen. When the brain metastasis is present, the patient suffers from neurological deficits. Cancer spreads to the brain either through the blood (hematogenous spread) or via cerebrospinal fluid (CSF). Along with metastasis in the brain, other organs like bones, lungs, and liver might also be involved. The most common site for metastasis of nasopharyngeal cancer is bone followed by lungs and then liver. When cancer has metastasized, it can be managed by giving supportive care, palliative chemoradiotherapy and by using surgical interventions. When surgical intervention and radiotherapy are used together, the survival period of the patient prolongs a little. Although, the patients with brain metastasis have a very poor prognosis and very less survival rate.

Nasopharyngeal cancer can have a direct extension into the brain through the skull base. This is more common than the cancer being metastasized.

When the cancer is metastasized to the brain the patient might show up with symptoms like the blurring of vision, complete loss of vision, etc. On radiological examination, there might be the presence of cerebral edema and the appearance of a mass lesion in the brain.

Nasopharyngeal cancer can spread to the spinal cord too. In order to confirm the CNS (Central Nervous System) spread, investigations like CT scan and MRI are to be done to find out the exact location of the tumor metastasis. After the diagnosis has been made, the usual treatment given is surgical with or without chemotherapy and radiotherapy. In the surgical intervention, the tumor mass present in a particular part of the brain is totally excised out. This can increase the patient survival rate and reduce the symptoms due to brain metastasis. (1), (2), (3)

Radiation Therapy Or Radiotherapy In Nasopharyngeal Carcinoma

Radiation therapy is the modality of treatment where high power X-rays are used to decrease the speed of multiplication of the cancer cells or even to kills the cancerous cells. Usually, nasopharyngeal cancers are sensitive to radiation and hence it is very useful in treating this cancer. Along with radiation therapy, chemotherapy is also given. Both modalities of treatment when used together are called chemoradiation.

The radiation is given to nasopharyngeal cancer as well as to the lymph nodes that are present nearby. Two types of radiation therapies are used, one is EBRT (External Beam Radiation Therapy) and the second one is Brachytherapy also known as internal radiation.

In EBRT, the X-rays are aimed towards the tumor mass. This is the commonest type of radiation therapy used.

In brachytherapy, very thin implants made of metal are inserted in the tumor mass or near the tumor mass. This is a very rarely used method of delivering radiation therapy.
Side effects of radiation therapy are:

  • Nausea
  • Vomiting
  • Redness of the skin exposed to radiation
  • Blistering of the skin exposed to X-rays or radiation
  • Loss of taste sensation
  • Easy fatigability
  • Hoarseness of the voice
  • Oral ulcers or sores
  • Ulcers and sores in the throat that causes difficulty in swallowing
  • Weight loss due to decreased appetite

These side effects go away as soon as the radiation therapy is discontinued. There are other certain side effects like hearing loss, the problem with vision, etc. that don’t reverse on stopping radiation therapy. (4)

Conclusion

Yes, there are a few cases reported with brain metastasis of nasopharyngeal cancer. Brain metastasis is not very commonly seen, as it is quite rare. When there is metastasis in the brain, the symptoms usually present are blurring of vision or complete loss of vision, giddiness, etc. Radiological investigations like CT scan and MRI must be done to confirm the diagnosis. Treatment is given in the form of surgery with or without chemotherapy and radiotherapy.

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