Can Nasopharyngeal Cancer Recur? Risks and Diagnosis

Is it possible for nasopharyngeal carcinoma to recur?

Hello Doctor, I would like to ask about my family member.
Two and a half years ago, they were diagnosed with nasopharyngeal carcinoma T1N1 and underwent 33 sessions of proton therapy and 5 cycles of chemotherapy.
Subsequent examinations have been normal.
However, in early May, blood tests showed that the EB virus levels increased from 0 to 288.
An MRI and nasal endoscopy were normal.
After another blood test, the EB virus levels rose to around 1000.
The doctor arranged for a PET scan, which revealed bright spots in the nasal cavity and lymph nodes, raising high suspicion of recurrence.
However, the doctor is puzzled as to why the MRI and nasal endoscopy did not show any abnormalities.
We are now waiting for the biopsy report.
I would like to ask, should we primarily rely on the biopsy report? Is it possible that the bright spots on the PET scan are just inflammatory cells? If it is indeed an unfortunate recurrence, is surgical resection an option? I am really worried and don't know what to do.
Thank you for your response.

Ms. Li, 40~49 year old female. Ask Date: 2024/06/03

Dr. Chen Sirong reply Oncology

Ms.
Li / 40 years old / Female
Hello~~
1.
I would like to ask the doctor~~ Is the diagnosis primarily based on the biopsy report?
A: Yes, the diagnosis is primarily based on the biopsy report.
However, if there are suspicions and the biopsy is inconclusive, we may repeat the biopsy or even proceed with treatment in the absence of biopsy evidence for recurrence.
2.
Is it possible that the PET scan highlights are just inflammatory cells?
A: The report indicates that the experts believe: recurrence >>> inflammation.
3.
If recurrence unfortunately occurs, is surgical resection possible?
A: In the past, there were professors at National Taiwan University Hospital who would perform surgery, but this is generally not a surgery-dominant condition.

3.1 You need to find a surgeon who is willing to operate.

3.2 Case evaluation: Surgery? Radiation therapy? Which is better?
Wishing you good health,
Taoyuan Hospital, Chen Si-Rong

Reply Date: 2024/06/03

More Info

Nasopharyngeal cancer (NPC) is known for its potential to recur after initial treatment, and understanding the risks and diagnostic processes involved is crucial for managing the condition effectively. Your family member's case, with a history of T1N1 NPC treated with proton therapy and chemotherapy, highlights several important aspects regarding recurrence and monitoring.

Firstly, it is essential to recognize that NPC can indeed recur, particularly within the first few years following treatment. The risk of recurrence is influenced by various factors, including the initial stage of the cancer, the completeness of the treatment, and the patient's overall health. In your family member's case, the rise in Epstein-Barr virus (EBV) levels is concerning, as elevated EBV DNA levels in the blood can be associated with NPC recurrence. This is particularly relevant since NPC is closely linked to EBV, and monitoring EBV levels is a common practice in follow-up care.

The fact that MRI and nasal endoscopy did not reveal abnormalities, despite the elevated EBV levels and the findings from the PET scan, raises important questions. PET scans are sensitive to metabolic activity, which means they can detect areas of increased glucose uptake that may indicate cancer or inflammation. Therefore, the "hot spots" observed in the PET scan could potentially represent inflammatory processes rather than cancerous lesions. However, given the context of elevated EBV levels and the history of NPC, the possibility of recurrence cannot be ruled out without further investigation.

The biopsy results will be critical in determining the nature of the findings observed in the PET scan. A biopsy is the gold standard for diagnosing cancer, as it allows for histological examination of the tissue. If the biopsy confirms recurrence, treatment options may include surgery, radiation therapy, or chemotherapy, depending on the extent of the disease and the patient's overall condition. Surgical resection may be feasible if the cancer is localized and has not spread extensively, but this decision will depend on the specific circumstances and the expertise of the treating oncologist.

In terms of managing anxiety and uncertainty during this waiting period, it is important to maintain open communication with the healthcare team. They can provide guidance on what to expect from the biopsy results and the next steps in treatment, should recurrence be confirmed. Additionally, support from family, friends, or counseling services can be beneficial in coping with the emotional aspects of this situation.

In summary, while NPC can recur, the presence of elevated EBV levels and PET scan findings necessitates careful evaluation through biopsy to confirm or rule out recurrence. The management plan will be tailored based on the biopsy results, and it is essential to stay engaged with the healthcare team for ongoing monitoring and support.

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