Chemotherapy for nasopharyngeal cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs go around your body in the bloodstream.

When do you have chemotherapy?

You might have:

• chemotherapy together with radiotherapy (chemoradiotherapy)
• chemotherapy on its own

The treatment you have depends on several things including the size of your cancer and whether it has spread (the stage).

If you have chemotherapy on its own, you usually have 2 or more chemotherapy drugs together. Using a combination of drugs can work better than using one drug on its own. But you may have more side effects.

Chemotherapy with radiotherapy

You might have radiotherapy and chemotherapy. This is called chemoradiotherapy. You usually have chemoradiotherapy for:

• nasopharyngeal cancers that have a higher risk of coming back after treatment 
• cancer that has grown into your lymph nodes or tissues around your nasopharynx (locally advanced cancer)

Some chemotherapy drugs make cancer cells more sensitive to radiotherapy, so doctors use them together. 

Chemoradiotherapy can be a tough treatment to get through. The side effects are the same as for chemotherapy and radiotherapy on their own. But some are likely to be more severe. You will have some tests to make sure you are fit enough to have it.

You usually have radiotherapy daily Monday to Friday. Chemotherapy is usually given once every 3 weeks or once every week.

Chemotherapy on its own

You might have chemotherapy on its own if:

• the cancer has spread to another part of your body (advanced cancer)
• the cancer has come back after treatment (recurrence)

You might have a combination of chemotherapy drugs. This may shrink the cancer and help to control any symptoms the cancer is causing.

You might have chemotherapy on its own before you start chemoradiotherapy. This is usually for larger nasopharyngeal cancers, generally stage 3 or 4A. This is called induction or neo adjuvant chemotherapy.  

Some people might have chemotherapy after chemoradiotherapy. This is called adjuvant treatment. 

Having chemotherapy over a longer period does cause added side effects and may only be suitable for some people.

Which chemotherapy drugs do you have?

With chemoradiotherapy, you have a chemotherapy drug called cisplatin alongside the radiotherapy. You may have the cisplatin once a week or once every 3 weeks. If you can’t have cisplatin, for example due to the side effects, you may have carboplatin instead.

If you have chemotherapy on its own before starting chemoradiotherapy, you usually have cisplatin and another chemotherapy drug called gemcitabine. You have chemotherapy as cycles of treatment. This means you have the drugs and then a rest period to allow your body to recover. Each cycle is 3 weeks. You usually have 3 cycles of chemotherapy before starting chemoradiotherapy.

You usually have up to 6 cycles of cisplatin (or carboplatin) and gemcitabine for nasopharyngeal cancer that has spread to other parts of the body. Other chemotherapy drugs that doctors may use include:

• fluorouracil (5FU) and cisplatin
• docetaxel
• paclitaxel, usually with cisplatin

How do you have chemotherapy?

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Where do you have chemotherapy?

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test. 

Side effects

Common chemotherapy side effects include:

• feeling sick
• loss of appetite
• losing weight
• feeling very tired
• an increased risk of infection
• bleeding and bruising easily
• diarrhoea or constipation
• hair loss

Side effects depend on:

• which drug or drugs you have
• how much of each drug you have (the dose)
• if you have it with other treatment such as radiotherapy
• how your body reacts

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

• take any supplements
• have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

When you go home

Chemotherapy can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.