Archives: Cancer Types

Childhood Thyroid Cancer (PDQ®)–Patient Version

Childhood Thyroid Cancer (PDQ®)–Patient Version

What is childhood thyroid cancer?

Thyroid cancer in children is a rare cancer that forms in the thyroid, a butterfly-shaped gland at the base of the throat near the windpipe (also called the trachea). The thyroid gland has a right lobe and a left lobe that is connected by a thin piece of tissue called the isthmus. Although thyroid cancer can affect children of all ages, it’s more common in adolescents and girls. It also occurs more often in White people than in Black people.

Children can also have thyroid nodules. A thyroid nodule is an abnormal growth of thyroid cells in the thyroid. The nodules may be solid or fluid-filled. Thyroid nodules usually don’t cause symptoms or need treatment unless they become large enough that it is hard to swallow or breathe. Only one in five thyroid nodules become cancer.

EnlargeAnatomy of the thyroid and parathyroid glands; drawing shows the thyroid gland at the base of the throat near the trachea. An inset shows the front and back views. The front view shows that the thyroid is shaped like a butterfly, with the right lobe and left lobe connected by a thin piece of tissue called the isthmus. The back view shows the four pea-sized parathyroid glands. The larynx is also shown.
Anatomy of the thyroid and parathyroid glands. The thyroid gland lies at the base of the throat near the trachea. It is shaped like a butterfly, with the right lobe and left lobe connected by a thin piece of tissue called the isthmus. The parathyroid glands are four pea-sized organs found in the neck near the thyroid. The thyroid and parathyroid glands make hormones.

The thyroid uses iodine, a mineral found in some foods and in iodized salt, to help make several hormones. Thyroid hormones:

  • control heart rate, body temperature, and how quickly food is changed into energy (metabolism)
  • control the amount of calcium in the blood

Types of childhood thyroid cancer

There are four types of thyroid cancers:

Papillary and follicular thyroid cancer are sometimes called differentiated thyroid cancer. Medullary and anaplastic thyroid cancer are sometimes called poorly differentiated or undifferentiated thyroid cancer.

Adenomas are a type of thyroid nodule that can grow very large and sometimes make hormones. Adenomas are not cancer but may rarely become cancer and spread to the lungs or lymph nodes in the neck.

Causes and risk factors for childhood thyroid cancer

Thyroid cancer in children is caused by certain changes to the way thyroid cells function, especially how they grow and divide into new cells. Often, the exact cause of these cell changes is unknown. Learn more about how cancer develops at What Is Cancer?

A risk factor is anything that increases the chance of getting a disease. Not every child with one or more of these risk factors will develop thyroid cancer. And it will develop in some children who don’t have a known risk factor.

Risk factors for childhood thyroid cancer include:

Talk with your child’s doctor if you think your child may be at risk for thyroid cancer.

Genetic counseling for children with thyroid cancer

It is not always clear from the family medical history whether a condition is inherited. Genetic counseling can assess the likelihood that your child’s cancer is inherited and whether genetic testing is needed. Genetic testing may help explain why a child develops a rare cancer or a cancer that is usually seen in adults. Genetic counselors and other specially trained health professionals can discuss your child’s diagnosis and your family’s medical history to help you understand:

  • the options for testing for changes in the RET, DICER1, or APC gene
  • the risk of other cancers for your child
  • the risk of thyroid cancer or other cancers for your child’s siblings
  • the risks and benefits of learning genetic information

Genetic counselors can also help you cope with your child’s genetic testing results, including how to discuss the results with family members. They can advise you about whether other members of your family should receive genetic testing.

If your child has been found to have a change in the RET gene, other family members may also be tested to find out if they have an increased risk of medullary thyroid cancer. Family members, including young children, who have the changed gene may have a thyroidectomy (surgery to remove the thyroid). This can decrease the chance of developing medullary thyroid cancer.

Learn more about Genetic Testing for Inherited Cancer Risk.

Symptoms of childhood thyroid cancer

Often thyroid cancer is found when a physical exam or an imaging test is done for another health problem. Sometimes the cancer can cause symptoms. It’s important to check with your child’s doctor if your child has:

  • a lump in the neck
  • trouble breathing
  • trouble swallowing
  • hoarseness or a change in the voice

Children with changes to the RET gene may have symptoms that can lead to an early diagnosis of multiple endocrine neoplasia type 2A or 2B syndrome. It’s important to check with your child’s doctor if your child has:

  • bumps on the lips, tongue, or eyelids that do not hurt
  • trouble making tears
  • constipation
  • Marfan syndrome (being tall and thin, with long arms, legs, fingers, and toes)

These symptoms may be caused by problems other than thyroid cancer. The only way to know is to see your child’s doctor.

Tests to diagnose childhood thyroid cancer

If your child has symptoms that suggest thyroid cancer, the doctor will need to find out if these are due to cancer or to another problem. The doctor will ask when the symptoms started and how often your child has been having them. They will also ask about your child’s personal and family medical history and do a physical exam. Depending on these results, they may recommend other tests. If your child is diagnosed with thyroid cancer, the results of these tests will help you and your child’s doctor plan treatment.

The tests used to diagnose thyroid cancer may include:

Thyroid function test

A thyroid function test checks the blood for abnormal levels of thyroid-stimulating hormone (TSH). TSH is made by the pituitary gland in the brain. It stimulates the release of thyroid hormone and controls how fast follicular thyroid cells grow. The blood may also be checked for high levels of calcitonin (a hormone made by the thyroid that decreases the amount of calcium in the blood).

Thyroglobulin test

A thyroglobulin test checks the blood for the amount of thyroglobulin, a protein made by the thyroid gland. Thyroglobulin levels are low or absent with normal thyroid function but may be higher with thyroid cancer or other conditions.

RET, DICER1, or APC genetic testing

A RET, DICER1, or APC genetic test checks a sample of blood, saliva, or tissue for certain changes in the RET, DICER1, or APC genes.

Ultrasound exam

An ultrasound exam uses high-energy sound waves (ultrasound) that bounce off internal tissues or organs in the neck and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure can show the size of the mass and whether it is solid or a fluid-filled cyst. Ultrasound may be used to guide a fine-needle aspiration biopsy. A complete ultrasound exam of the neck is done before surgery.

Thyroid scan

A thyroid scan uses a small amount of a radioactive substance that is swallowed or injected. The radioactive material collects in thyroid gland cells. A special camera linked to a computer detects the radiation given off and makes pictures that show how the thyroid looks and functions and whether the cancer has spread beyond the thyroid gland. If the amount of TSH in the child’s blood is low, a scan to make images of the thyroid may be done before surgery.

CT scan (CAT scan)

A CT scan uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, and brain. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Learn more about Computed Tomography (CT) Scans and Cancer.

EnlargeComputed tomography (CT) scan of the head and neck; drawing shows a child lying on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of the inside of the head and neck.
Computed tomography (CT) scan of the head and neck. The child lies on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of the inside of the head and neck.

Magnetic resonance imaging (MRI) with gadolinium

MRI uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the neck and chest. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Chest x-ray

An x-ray is a type of radiation that can go through the body and make pictures. A chest x-ray makes pictures of the organs and bones inside the chest.

Biopsy

A biopsy is a procedure in which a sample of tissue is removed from the tumor so that a pathologist can view it under a microscope to check for signs of cancer.

  • Fine-needle aspiration biopsy is the removal of thyroid tissue using a thin needle. The needle is inserted through the skin into the thyroid. Several tissue samples are removed from different parts of the thyroid. A pathologist views the tissue samples under a microscope to look for cancer cells. If it is not clear whether cancer is present, a surgical biopsy may be done.
  • Surgical biopsy is the removal of the thyroid nodule or one lobe of the thyroid during surgery so the cells and tissues can be viewed under a microscope by a pathologist to check for signs of cancer.

Whole-body thyroid scan

A whole-body thyroid scan uses a small amount of radioactive substance that is swallowed or injected. The radioactive material collects in any thyroid tissue or cancer cells remaining after surgery. Radioactive iodine is used because only thyroid cells take up iodine. A special camera detects the radiation given off by the thyroid tissue or cancer cells. This procedure is also called radioactive iodine scan or RAI scan.

Getting a second opinion

You may want to get a second opinion to confirm your child’s cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the genetic test report, pathology report, slides, and scans. This doctor may agree with the first doctor, suggest changes to the treatment plan, or provide more information about your child’s cancer.

To learn more about choosing a doctor and getting a second opinion, see Finding Cancer Care. You can contact NCI’s Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor or hospital that can provide a second opinion. For questions you might want to ask at your child’s appointments, see Questions to Ask Your Doctor about Cancer.

Types of treatment for childhood thyroid cancer

Who treats children with thyroid cancer?

A pediatric oncologist, a doctor who specializes in treating children with cancer, oversees treatment of thyroid cancer. The pediatric oncologist works with other health care providers who are experts in treating children with cancer and who specialize in certain areas of medicine. Other specialists may include:

There are different types of treatment for children and adolescents with thyroid cancer. You and your child’s cancer care team will work together to decide treatment. Many factors will be considered, such as your child’s overall health and whether the tumor is newly diagnosed or has come back.

Your child’s treatment plan will include information about the cancer, the goals of treatment, treatment options, and the possible side effects. It will be helpful to talk with your child’s cancer care team before treatment begins about what to expect. For help every step of the way, see our booklet, Children with Cancer: A Guide for Parents.

Treatment for thyroid cancer might include:

Surgery

Surgery is the most common treatment for thyroid cancer. One of the following procedures may be used:

  • Total thyroidectomy is the removal of the whole thyroid. Lymph nodes near the cancer may also be removed and checked under a microscope for signs of cancer.
  • Near-total thyroidectomy is the removal of all but a very small part of the thyroid. Lymph nodes near the cancer may also be removed and checked under a microscope for signs of cancer.

In children, a total thyroidectomy is usually done.

Learn more about Surgery to Treat Cancer.

Radioactive iodine therapy

Follicular and papillary thyroid cancers are sometimes treated with radioactive iodine (RAI) therapy. RAI therapy may be given to children after surgery to kill any thyroid cancer cells that were not removed or to children whose tumor cannot be removed by surgery. RAI is taken by mouth and collects in any remaining thyroid tissue, including thyroid cancer cells that have spread to other places in the body. Because only thyroid tissue takes up iodine, the RAI destroys thyroid tissue and thyroid cancer cells without harming other tissue. Before a full treatment dose of RAI is given, a small test dose is given to see if the tumor takes up the iodine.

Targeted therapy

Targeted therapy uses drugs or other substances to block the action of specific enzymes, proteins, and other molecules involved in the growth and spread of cancer cells. Targeted therapies used to treat thyroid cancer include:

Learn more about Targeted Therapy to Treat Cancer.

Clinical trials

Joining a clinical trial may be an option. There are different types of clinical trials for childhood cancer. For example, a treatment trial tests new treatments or new ways of using existing treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.

You can use the clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. The search allows you to filter trials based on the type of cancer, your child’s age, and where the trials are being done.

Learn more at Clinical Trials Information for Patients and Caregivers.

Treatment of newly diagnosed childhood papillary and follicular thyroid cancer

Treatment of papillary and follicular thyroid carcinoma in children may include:

  • Surgery to remove all or most of the thyroid gland and sometimes lymph nodes near the thyroid gland. Radioactive iodine therapy may also be given if any thyroid cancer cells remain after surgery. Hormone replacement therapy (HRT) is given to make up for the lost thyroid hormone.
  • Radioactive iodine therapy alone may be given to children whose tumor cannot be removed by surgery. HRT is given to make up for the lost thyroid hormone.

Treatment of newly diagnosed childhood medullary thyroid cancer

Treatment of medullary thyroid cancer in children may include:

  • surgery to remove the cancer
  • targeted therapy (selpercatinib or vandetanib) for cancer that has continued to grow during treatment or has spread to other parts of the body

Treatment of progressive or recurrent childhood thyroid cancer

Treatment of progressive or recurrent papillary and follicular thyroid carcinoma in children may include:

  • radioactive iodine therapy
  • targeted therapy (entrectinib, larotrectinib, or selpercatinib)

If the cancer comes back after treatment, your child’s doctor will talk with you about what to expect and possible next steps. There might be treatment options that may shrink the cancer or control its growth. If there are no treatments, your child can receive care to control symptoms from cancer so they can be as comfortable as possible.

Prognosis and prognostic factors for childhood thyroid cancer

If your child has been diagnosed with thyroid cancer, you likely have questions about how serious the cancer is and your child’s chances of survival. The likely outcome or course of a disease is called prognosis.

The prognosis depends on:

  • your child’s age at the time of diagnosis
  • the type of thyroid cancer
  • the size of the cancer
  • whether the tumor has spread to the lymph nodes or other parts of the body at the time of diagnosis
  • whether the cancer was completely removed by surgery

The prognosis for most children with papillary thyroid cancer and follicular thyroid cancer is very good.

No two people are alike, and responses to treatment vary greatly. Your child’s cancer care team is in the best position to talk with you about your child’s prognosis.

Side effects and late effects of treatment

Cancer treatments can cause side effects. Which side effects your child might have depends on the type of treatment they receive, the dose, and how their body reacts. Talk with your child’s treatment team about which side effects to look for and ways to manage them.

To learn more about side effects that begin during treatment for cancer, visit Side Effects.

Problems from cancer treatment that begin 6 months or later after treatment and continue for months or years are called late effects. Late effects of cancer treatment for childhood thyroid cancer may include:

  • changes in the salivary glands
  • increased risk of infection
  • trouble breathing
  • changes in mood, feelings, thinking, learning, or memory
  • second cancers (new types of cancer)

Some late effects may be treated or controlled. It is important to talk with your child’s doctors about the effects cancer treatment can have on your child. Learn more about Late Effects of Treatment for Childhood Cancer.

Follow-up care

It is common for thyroid cancer to recur (come back), especially in children younger than 10 years and those with cancer in the lymph nodes. Ultrasound, whole-body scan, and thyroglobulin tests may be done from time to time to check if the cancer has recurred. Lifelong follow-up of thyroid hormone levels in the blood is needed to make sure the right amount of hormone replacement therapy (HRT) is being given. Talk with your child’s doctor to find out how often these tests need to be done.

Coping with your child's cancer

When your child has cancer, every member of the family needs support. Taking care of yourself during this difficult time is important. Reach out to your child’s treatment team and to people in your family and community for support. To learn more, see Support for Families: Childhood Cancer and the booklet Children with Cancer: A Guide for Parents.

Related resources

For more childhood cancer information and other general cancer resources, see:

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of childhood thyroid cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (“Updated”) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI’s website. For more information, call the Cancer Information Service (CIS), NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Thyroid Cancer. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: /types/thyroid/patient/child-thyroid-treatment-pdq. Accessed <MM/DD/YYYY>.

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

Surgery to Treat Cancer

Surgery to Treat Cancer

Group of surgeons in caps and masks.

Surgery is used to treat many types of cancer. It works best for solid tumors that are contained in one area.

Credit: National Cancer Institute

Surgery, when used to treat cancer, is a procedure in which a surgeon removes cancer from your body. Surgeons are medical doctors with special training in surgery.

How surgery is performed

Surgeons often use small, thin knives, called scalpels, and other sharp tools to cut your body during surgery. Surgery often requires cuts through skin, muscles, and sometimes bone. After surgery, these cuts can be painful and take some time to heal.

Anesthesia keeps you from feeling pain during surgery. Anesthesia refers to drugs or other substances that cause you to lose feeling or awareness. There are three types of anesthesia.

  • Local anesthesia causes loss of feeling in one small area of the body.
  • Regional anesthesia causes loss of feeling in a part of the body, such as an arm or leg.
  • General anesthesia causes loss of feeling and a complete loss of awareness that seems like a very deep sleep.

There are other ways of performing surgery that do not involve cuts with scalpels. Some of these include:

  • Cryosurgery
    Cryosurgery is a type of treatment in which extreme cold produced by liquid nitrogen or argon gas is used to destroy abnormal tissue. Cryosurgery may be used to treat early-stage skin cancer, retinoblastoma, and precancerous growths on the skin and cervix. Cryosurgery is also called cryotherapy.

    For more information, see Cryosurgery to Treat Cancer.

  • Lasers
    This is a type of treatment in which powerful beams of light are used to cut through tissue. Lasers can focus very accurately on tiny areas, so they can be used for precise surgeries. Lasers can also be used to shrink or destroy tumors or growths that might turn into cancer.

    Lasers are most often used to treat tumors on the surface of the body or on the inside lining of internal organs. Examples include basal cell carcinoma, cervical changes that might turn into cancer, and cervical, vaginal, esophageal, and non-small cell lung cancer.

    For more information, see Lasers to Treat Cancer.

  • Hyperthermia
    Hyperthermia is a type of treatment in which small areas of body tissue are exposed to high temperatures. The high heat can damage and kill cancer cells or make them more sensitive to radiation and certain chemotherapy drugs. Radiofrequency ablation is one type of hyperthermia that uses high-energy radio waves to generate heat. Hyperthermia is not widely available and is being studied in clinical trials.

    For more information, see Hyperthermia to Treat Cancer.

  • Photodynamic Therapy
    Photodynamic therapy is a type of treatment that uses drugs which react to a certain type of light. When the tumor is exposed to this light, these drugs become active and kill nearby cancer cells. Photodynamic therapy is used most often to treat or relieve symptoms caused by skin cancer, mycosis fungoides, and non-small cell lung cancer.

    For more information, see Photodynamic Therapy for Cancer.

Types of surgery

There are many types of surgery. The types differ based on the purpose of the surgery, the part of the body that requires surgery, the amount of tissue to be removed, and, in some cases, what the patient prefers.

Surgery may be open or minimally invasive.

  • In open surgery, the surgeon makes one large cut to remove the tumor, some healthy tissue, and maybe some nearby lymph nodes.
  • In minimally invasive surgery, the surgeon makes a few small cuts instead of one large one. They insert a long, thin tube with a tiny camera into one of the small cuts. This tube is called a laparoscope. The camera projects images from the inside of the body onto a monitor, which allows the surgeon to see what they are doing. They use special surgery tools that are inserted through the other small cuts to remove the tumor and some healthy tissue.

Because minimally invasive surgery requires smaller cuts, it takes less time to recover from than open surgery.  

To learn about the type of surgery that may be used to treat your type of cancer, see the cancer treatment summaries for adult and childhood cancers.

Types of cancer treated with surgery

Many types of cancer are treated with surgery. Surgery works best for solid tumors that are contained in one area. It is a local treatment, meaning that it treats only the part of your body with the cancer. It is not used for leukemia (a type of blood cancer) or for cancers that have spread.

Sometimes surgery will be the only treatment you need. But most often, you will also have other cancer treatments.

How surgery works against cancer

Depending on your type of cancer and how advanced it is, surgery can be used to:

  • Remove the entire tumor
    Surgery removes cancer that is contained in one area.
  • Debulk a tumor
    Surgery removes some, but not all, of a cancer tumor. Debulking is used when removing an entire tumor might damage an organ or the body. Removing part of a tumor can help other treatments work better.
  • Ease cancer symptoms
    Surgery is used to remove tumors that are causing pain or pressure.

Risks of surgery

Surgeons are highly trained and will do everything they can to prevent problems during surgery. Even so, sometimes problems do occur. Common problems are:

  • Pain
    After surgery, most people will have pain in the part of the body that was operated on. How much pain you feel will depend on the extent of the surgery, the part of your body where you had surgery, and how you feel pain.

    Your doctor or nurse can help you manage pain after surgery. Talk with your doctor or nurse before surgery about ways to control pain. After surgery, tell them if your pain is not controlled.

    For more information, see Pain and Cancer Treatment.

  • Infection
    Infection is another problem that can happen after surgery. To help prevent infection, follow your nurse’s instructions about caring for the area where you had surgery. If you do develop an infection, your doctor can prescribe a medicine (called an antibiotic) to treat it.

    Other risks of surgery include bleeding, damage to nearby tissues, and reactions to the anesthesia. Talk to your doctor about possible risks for the type of surgery you will have.

How much surgery costs

The cost of surgery depends on many factors, including:

  • the type of surgery you have
  • how many specialists are involved in your surgery
  • if you need local, regional, or general anesthesia
  • where you have surgery—at an outpatient clinic, a doctor’s office, or the hospital
  • if you need to stay in the hospital, and for how long
  • the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for surgery to treat cancer. To learn more, talk with the business office of the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the NCI database, Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

Where you have surgery

Where you have surgery depends on:

  • the type of surgery
  • how extensive it is
  • where the surgeon practices
  • the type of facility your insurance will cover

You can have outpatient surgery in a doctor’s office, surgery center, or hospital. Outpatient means that you do not spend the night. Or, you may have surgery in the hospital and stay the night. How many nights you stay will depend on the type of surgery you have and how quickly you recover.

What to expect before, during, and after surgery

Before surgery

Before surgery, a nurse may call you to tell you how to prepare. They may tell you about tests and exams you need to have before the surgery. Common tests that you may need, if you have not had them lately, are:

You may not be able to eat or drink for a certain period of time before the surgery. It is important to follow the instructions about eating and drinking. If you don’t, your surgery may need to be rescheduled.

You may also be asked to have supplies on hand for taking care of your wounds after surgery. Supplies might include antiseptic ointment and bandages.

During surgery

Once you are under anesthesia, the surgeon removes the cancer, usually along with some healthy tissue around it. Removing this healthy tissue helps improve the chances that all the cancer has been removed.

Sometimes, the surgeon might also remove lymph nodes or other tissues near the tumor. These tissues will be checked under a microscope to see if the cancer has spread. Knowing if the nearby tissue contains cancer will help your doctors suggest the best treatment plan for you after surgery.

After surgery

Once you are ready to go home after surgery, the nurse will tell you how to take care of yourself. They will explain:

  • how to control pain
  • activities you should and should not do
  • how to take care of your wound
  • how to spot signs of infection and steps to take if you do
  • when you can return to work

You will have at least one more visit with the surgeon a week or two after you go home. For more complex surgeries, you may need to see the surgeon more often. You may have stitches removed, and the surgeon will check to make sure you are healing as you should.

Special diet needs before and after surgery

Surgery increases your need for good nutrition. If you are weak or underweight, you may need to eat a high-protein, high-calorie diet before surgery.

Some types of surgery may change how your body uses food. Surgery can also affect eating if you have surgery of the mouth, stomach, intestines, or throat. If you have trouble eating after surgery, you may be given nutrients through a feeding tube or IV (through a needle directly into a vein).

Talk with a dietitian for help with eating problems caused by surgery. For more information about coping with eating problems see Nutrition During Cancer Treatment.

Working after surgery

You will need to take time off from work to have and recover from surgery. You may need only 1 day or many weeks. How long you need to recover depends on many factors, such as:

  • The type of anesthesia you have. If you have local or regional anesthesia, you will probably return to work more quickly than if you have general anesthesia.
  • The type of surgery you have, and how extensive it is
  • The type of work you do. If you have an active job, you may need to take off more time than if you sit at a desk. If your job allows, you may want to see if you can work at home, or start back part time, to help you ease back into a full day.

Ask your doctor how long you will need to recover from your surgery. If you expect a longer recovery time, talk with your employer to find out if you can take medical leave. Check to make sure your health insurance will cover costs if you are on medical leave and not working for a time.

Thyroid Cancer—Patient Version

Thyroid Cancer—Patient Version

Overview

There are four main types of thyroid cancer. These are papillary, follicular, medullary, and anaplastic. Papillary is the most common type. The four types differ in how aggressive they are. Thyroid cancer that is found at an early stage can often be treated successfully. Explore the links on this page to learn more about thyroid cancer treatment, screening, statistics, research, and clinical trials.

Treatment

PDQ Treatment Information for Patients

More information

Causes & Prevention

NCI does not have PDQ evidence-based information about prevention of thyroid cancer.

More information

Screening

PDQ Screening Information for Patients

Research

Coping with Cancer

The information in this section is meant to help you cope with the many issues and concerns that occur when you have cancer.

Emotions and Cancer Adjusting to Cancer Support for Caregivers Survivorship Advanced Cancer Managing Cancer Care

Statistics

Chemotherapy to Treat Cancer

Chemotherapy to Treat Cancer

Seated female patient receives chemotherapy infusion from female nurse.

Chemotherapy works against cancer by killing fast-growing cancer cells.

Credit: National Cancer Institute

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to kill cancer cells.

How chemotherapy works against cancer

Chemotherapy works by killing or stopping the growth of cancer and other fast-growing cells. Chemotherapy is used for two reasons:

  • Treat cancer: Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth.
  • Ease cancer symptoms: Chemotherapy can be used to shrink tumors that are causing pain and other problems.

Which types of cancer does chemotherapy treat

Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy with other cancer treatments. The types of treatment that you need depend on the type of cancer you have, if it has spread and where, and if you have other health problems. To learn more about treatment for your cancer, see the PDQ® cancer treatment summaries for adult and childhood cancers.

How chemotherapy is used with other cancer treatments

When used with other treatments, chemotherapy can

  • make a tumor smaller before surgery or radiation therapy (called neoadjuvant chemotherapy)
  • destroy cancer cells that may remain after surgery or radiation therapy (called adjuvant chemotherapy)
  • help other treatments work better
  • kill cancer cells that have returned or spread to other parts of your body

Chemotherapy can cause side effects

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.

The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by

  • asking someone to drive you to and from chemotherapy
  • planning time to rest on the day of and day after chemotherapy
  • asking for help with meals and childcare on the day of and at least one day after chemotherapy

There are many ways you can help manage chemotherapy side effects. For more information, see the section on side effects.

How much chemotherapy costs

The cost of chemotherapy depends on

  • the types and doses of chemotherapy used
  • how long and how often chemotherapy is given
  • whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
  • the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for chemotherapy. To learn more, talk with the business office where you go for treatment.

If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

What to expect when receiving chemotherapy

How chemotherapy is given

Chemotherapy may be given in many ways. Some common ways include

  • oral: comes in pills, capsules, or liquids that you swallow
  • intravenous (IV): goes directly into a vein
  • injection: given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly
  • intrathecal: injected into the space between the layers of tissue that cover the brain and spinal cord
  • intraperitoneal (IP): goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver
  • intra-arterial (IA): injected directly into the artery that leads to the cancer
  • topical: comes in a cream that you rub onto your skin

Of all the methods mentioned above, chemotherapy is most often given with an IV, through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. IV chemotherapy may also be given through catheters or ports, sometimes with the help of a pump.

  • Catheter: A catheter is a thin, soft tube. A doctor or nurse places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until you have finished your chemotherapy treatments. Catheters can also be used to give you other drugs and to draw blood. Be sure to watch for signs of infection around your catheter. See the section about infection for more information.
  • Port: A port is a small, round disc that is placed under your skin during minor surgery. A surgeon puts it in place before you begin your course of treatment, and it remains there until you have finished. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for longer than one day. Be sure to watch for signs of infection around your port. See the section about infection for more information.
  • Pump: Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port, allowing you to receive your chemotherapy outside of the hospital. Pumps can be internal or external. External pumps remain outside your body. Internal pumps are placed under your skin during surgery.

How your doctor decides which chemotherapy drugs to give you

There are many different chemotherapy drugs. Which ones are included in your treatment plan depends mostly on

  • the type of cancer you have and how advanced it is
  • whether you have had chemotherapy before
  • whether you have other health problems, such as diabetes or heart disease

Where you go for chemotherapy

You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor’s office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them. For more information on side effects and how to manage them, see the section on side effects.

How often you receive chemotherapy

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on

  • your type of cancer and how advanced it is
  • whether chemotherapy is used to
    • cure your cancer
    • control cancer’s growth
    • ease symptoms
  • the type of chemotherapy you are getting
  • how your body responds to the chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.

Missing a chemotherapy treatment

It is best not to skip a chemotherapy treatment. But, sometimes your doctor may change your chemotherapy schedule if you are having certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

How chemotherapy may affect you

Chemotherapy affects people in different ways. How you feel depends on

  • the type of chemotherapy you are getting
  • the dose of chemotherapy you are getting
  • your type of cancer
  • how advanced your cancer is
  • how healthy you are before treatment

Since everyone is different and people respond to chemotherapy in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.

How will I know if chemotherapy is working?

You will see your doctor often. During these visits, they will ask you how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests. Scans might include MRI, CT, or PET scans.

You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

Special diet needs while on chemotherapy

Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating while you are receiving chemotherapy. You might also find it helpful to speak with a dietitian. For more information about coping with eating problems see the booklet Eating Hints or the section on side effects.  

Working during chemotherapy

Many people can work during chemotherapy, as long as they match their work schedule to how they feel. Whether or not you can work may depend on what kind of job you have. If your job allows, you may want to see if you can work part-time or from home on days you do not feel well.

Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.

External Beam Radiation Therapy for Cancer

External Beam Radiation Therapy for Cancer

External beam radiation therapy comes from a machine that aims radiation at your cancer.

Credit: National Cancer Institute

External beam radiation therapy comes from a machine that aims radiation at your cancer. It is a local treatment, which means it treats a specific part of your body. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.

External beam radiation therapy is used to treat many types of cancer.

Types of beams used in radiation therapy

Radiation beams used in external radiation therapy come from three types of particles:

  • photons
  • protons
  • electrons

Photons

Most radiation therapy machines use photon beams. Photons are also used in x-rays, but x-rays use lower doses. Photon beams can reach tumors deep in the body. As they travel through the body, photon beams scatter little bits of radiation along their path. These beams do not stop once they reach the tumor but go into normal tissue past it.

Scans of the chest after traditional radiation therapy and after proton therapy, which show how much surrounding tissue is affected by each type of therapy.

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Learn the results of a study comparing the two types of radiation therapy.

Protons

Protons are particles with a positive charge. Like photon beams, proton beams can also reach tumors deep in the body. However, proton beams do not scatter radiation on their path through the body and they stop once they reach the tumor. Doctors think that proton beams might reduce the amount of normal tissue that is exposed to radiation. Clinical trials are underway to compare radiation therapy using proton beams with that using photons beams. Some cancer centers are using proton beams in radiation therapy, but the high cost and size of the machines are limiting their use.

Electrons

Electrons are particles with a negative charge. Electron beams cannot travel very far through body tissues. Therefore, their use is limited to tumors on the skin or near the surface of the body.

Types of external beam radiation therapy

There are many types of external beam radiation therapy, all of which share the goal of delivering the highest prescribed dose of radiation to the tumor while sparing the normal tissue around it. Each type relies on a computer to analyze images of the tumor in order to calculate the most precise dose and treatment path possible.

Types of external beam radiation therapy include:

3-D conformal radiation therapy

What it is

3-D conformal radiation therapy is a common type of external beam radiation therapy. It uses images from CT, MRI, and PET scans to precisely plan the treatment area, a process called simulation. A computer program is used to analyze the images and to design radiation beams that conform to the shape of the tumor.

How it works

3-D conformal radiation conforms to the shape of the tumor by delivering beams from many directions. The precise shaping makes it possible to use higher doses of radiation to the tumor while sparing normal tissue.

Treatment schedule

Most people have treatment once a day, Monday through Friday. The number of treatments vary from person to person based on details about your cancer, such as the type and stage of the cancer and the size and location of the tumor.

Intensity-modulated radiation therapy (IMRT)

What it is

IMRT is a type of 3-D conformal radiation therapy.

How it works

Like 3-D conformal radiation, radiation beams are aimed at the tumor from several directions.

IMRT uses many more smaller beams than 3-D conformal and the strength of the beams in some areas can be changed to give higher doses to certain parts of the tumor.

Treatment schedule

Most people have treatment once a day, Monday through Friday. The number of treatments varies from person to person based on details about your cancer, such as the type and stage of the cancer and the size and location of the tumor.

Image-guided radiation therapy (IGRT)

What it is

IGRT is a type of IMRT. However, it uses imaging scans not only for treatment planning before radiation therapy sessions but also during radiation therapy sessions.

How it works

During treatment, you will have repeated scans, such as CT, MRI, or PET scans. These scans are processed by computers to detect changes in the tumor’s size and location. The repeated imaging allows for your position or the radiation dose to be adjusted during treatment if needed. These adjustments can improve the accuracy of treatment and help spare normal tissue.

Treatment schedule

Most people have treatment once a day, Monday through Friday. The number of treatments varies from person to person based on details about your cancer, such as the type and stage of the cancer and the size and location of the tumor.

Tomotherapy®

What it is

Tomotherapy® is a type of IMRT that uses a machine that is a combination of a CT scanner and an external-beam radiation machine.

How it works

Tomotherapy® machines take images of the tumor right before treatment sessions to allow for very precise tumor targeting and sparing of normal tissues. It rotates around you during treatment, delivering radiation in a spiral pattern, slice by slice. Tomotherapy® might be better at sparing normal tissue than 3-D conformal radiation therapy, but it has not been tested in clinical trials to be sure.

Treatment schedule

Most people have treatment once a day, Monday through Friday. The number of treatments varies from person to person based on details about your cancer, such as the type and stage of the cancer and the size and location of the tumor.

Stereotactic radiosurgery

What it is

Stereotactic radiosurgery is the use of focused, high-energy beams to treat small tumors with well-defined edges in the brain and central nervous system. It may be an option if surgery is too risky due to your age or other health problems or if the tumor cannot safely be reached with surgery. GammaKnife is a type of stereotactic radiosurgery.

How it works

You will be placed in a head frame or some other device to make sure you do not move during treatment. In stereotactic radiosurgery, many small beams of radiation are aimed at the tumor from different directions. Each beam has very little effect on the tissue it passes through, but a precisely targeted dose of radiation is delivered to the site where all the beams come together.

Treatment schedule

Treatment schedules can vary, but treatment is usually given in one dose. In some cases, you may receive up to five doses, given once per day.

Stereotactic body radiation therapy

An imaging scan of the prostate and surrounding area depicting an SBRT treatment plan.

Study Supports SBRT as a Standard Option for Prostate Cancer

The radiation option, which requires fewer sessions, compared well with other standard radiation approaches.

What it is

Stereotactic body radiation therapy is similar to stereotactic radiosurgery, but it is used for small, isolated tumors outside the brain and spinal cord, often in the liver or lung. It may be an option when you cannot have surgery due to age, health problems, or the location of the tumor.

How it works

As in stereotactic radiosurgery, stereotactic body radiation therapy uses special equipment to hold you still during treatment. It delivers a highly precise beam to a limited area.

Treatment schedule

Tumors outside of the brain are more likely to move with the normal motion of the body, such as with breathing or digesting. Therefore, the radiation beams cannot be targeted as precisely as they are in stereotactic radiosurgery. For this reason, stereotactic body radiation is usually given in more than one dose. You may have up to five doses, given once per day.

What to expect when having external beam radiation therapy

How often you will have external beam radiation therapy

Most people have external beam radiation therapy once a day, five days a week, Monday through Friday. Radiation is given in a series of treatments to allow healthy cells to recover and to make radiation more effective. How many weeks you have treatment depends on the type of cancer you have, the goal of your treatment, the radiation dose, and the radiation schedule.

The span of time from your first radiation treatment to the last is called a course of treatment.

Researchers are looking at different ways to adjust the radiation dose or schedule in order to reach the total dose of radiation more quickly or to limit damage to healthy cells. Different ways of delivering the total radiation dose include:

  • Accelerated fractionation, which is treatment given in larger daily or weekly doses to reduce the number of weeks of treatment.
  • Hyperfractionation, which is a smaller dose than the usual daily dose of radiation given more than once a day.
  • Hypofractionation, which is larger doses given once a day or less often to reduce the number of treatments.

Researchers hope these different schedules for delivering radiation may be more effective and cause fewer side effects than the usual way of doing it or be as effective but more convenient.

Where you go for external beam radiation therapy

Most of the time, you will get external beam radiation therapy as an outpatient. This means that you will have treatment at a clinic or radiation therapy center and will not stay the night in the hospital.

What happens before your first external beam radiation therapy treatment

You will have a 1- to 2-hour meeting with your doctor or nurse before you begin radiation therapy. At this time, you will have a physical exam, talk about your medical history, and maybe have imaging tests. Your doctor or nurse will discuss external beam radiation therapy, its benefits and side effects, and ways you can care for yourself during and after treatment. You can then choose whether to have external beam radiation therapy.

If you decide to have external beam radiation therapy, you will be scheduled for a treatment planning session called a simulation. At this time:

  • A radiation oncologist (a doctor who specializes in using radiation to treat cancer) and radiation therapist will figure out your treatment area. You may also hear the treatment area referred to as the treatment port or treatment field. These terms refer to the places in your body that will get radiation. You will be asked to lie very still while x-rays or scans are taken.
  • The radiation therapist will tattoo or draw small dots of colored ink on your skin to mark the treatment area. These dots will be needed throughout your course of radiation therapy. The radiation therapist will use them to make sure you are in exactly the same position for every treatment. The dots are about the size of a freckle. If the dots are tattooed, they will remain on your skin for the rest of your life. Ink markings will fade over time. Be careful not to remove them and tell the radiation therapist if they fade or lose color.
  • A body mold may be made of the part of the body that is being treated. This is a plastic or plaster form that keeps you from moving during treatment. It also helps make sure that you are in exactly the same position for each treatment

A mask fitted to your face helps make sure that you are in exactly the same position for each treatment.

Credit: National Cancer Institute

  • If you are getting radiation to the head and neck area you may be fitted for a mask. The mask has many air holes. It attaches to the table where you will lie for your treatments. The mask helps keep your head from moving so that you are in exactly the same position for each treatment.

What to wear for your treatments

Wear clothes that are comfortable and made of soft fabric, such as fleece or cotton. Choose clothes that are easy to take off, since you may need to expose the treatment area or change into a hospital gown. Do not wear clothes that are tight, such as close-fitting collars or waistbands, near your treatment area. Also, do not wear jewelry, adhesive bandages, or powder in the treatment area.

What happens during a treatment session

  • You may be asked to change into a hospital gown or robe.
  • You will go to the treatment room where you will receive radiation. The temperature in this room will be very cool.
  • Depending on where your cancer is, you will either lie down on a treatment table or sit in a special chair. The radiation therapist will use the dots on your skin and body mold or face mask, if you have one, to help place you in the right position.
  • You may see colored lights pointed at your skin marks. These lights are harmless and help the therapist position you for treatment.
  • You will need to stay very still so the radiation goes to the exact same place each time. You will get radiation for 1 to 5 minutes. During this time, you can breathe normally.

The radiation therapist will leave the room just before your treatment begins. He or she will go to a nearby room to control the radiation machine. The therapist watches you on a TV screen or through a window and talks with you through a speaker in the treatment room. Make sure to tell the therapist if you feel sick or are uncomfortable. He or she can stop the radiation machine at any time. You will hear the radiation machine and see it moving around, but you won’t be able to feel, hear, see, or smell the radiation.

Most visits last from 30 minutes to an hour, with most of that time spent placing you in the correct position.

How to relax for treatment sessions

Keep yourself busy while you wait.

  • Read a book or magazine.
  • Work on crossword puzzles or needlework.
  • Use headphones to listen to music or recorded books.
  • Meditate, breathe deeply, pray, use imagery, or find other ways to relax.

See Learning to Relax for exercises and other ideas on how to relax.

External beam radiation therapy will not make you radioactive

People often wonder if they will be radioactive when they are having treatment with radiation. External beam radiation therapy will not make you radioactive. You may safely be around other people, even pregnant women, babies, and young children.

 

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What To Know About External Beam Radiation Therapy
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Radiation Therapy Side Effects

Radiation Therapy Side Effects

Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.

Many people who get radiation therapy have fatigue. Fatigue is feeling exhausted and worn out. It can happen all at once or come on slowly. People feel fatigue in different ways and you may feel more or less fatigue than someone else who is getting the same amount of radiation therapy to the same part of the body.

See Fatigue and Cancer Treatment to learn more.

Other radiation therapy side effects you may have depend on the part of the body that is treated. To see which side effects you might expect, find the part of your body being treated in the following chart. Many of the side effects in the list link to more information in the Side Effects section.

Discuss this chart with your doctor or nurse. Ask them about the side effects that you might expect.

Treatment areas and possible side effects

Part of the body being treated Possible side effects
Brain
Breast
Chest
Head and Neck
Pelvis
Rectum
Stomach and Abdomen

Healthy cells that are damaged during radiation treatment usually recover within a few months after treatment is over. But sometimes people may have side effects that do not improve. Other side effects may show up months or years after radiation therapy is over. These are called late effects. Whether you might have late effects, and what they might be, depends on the part of your body that was treated, other cancer treatments you’ve had, genetics, and other factors, such as smoking.

Ask your doctor or nurse which late effects you should watch for. See the section on Late Effects to learn more.

Childhood Esthesioneuroblastoma (PDQ®)–Patient Version

Childhood Esthesioneuroblastoma (PDQ®)–Patient Version

What is esthesioneuroblastoma?

Go to Health Professional Version

Childhood esthesioneuroblastoma is a rare type of cancer that forms in the olfactory nerve endings in the upper part of the nasal cavity. The olfactory nerves (sense of smell) pass through the many tiny holes in the bone at the base of the brain to the olfactory bulb. Esthesioneuroblastoma is also called olfactory neuroblastoma.

EnlargeDrawing shows areas of the body where esthesioneuroblastoma tumors may form, including the olfactory nerve endings, olfactory bulb, nasal cavity, nasal sinuses, and brain.
Esthesioneuroblastomas form in the olfactory nerve endings in the upper part of the nasal cavity. The olfactory nerves (sense of smell) pass through the many tiny holes in the bone at the base of the brain to the olfactory bulb. Esthesioneuroblastomas may spread from the nasal cavity to the nasal sinuses or to nearby tissue. They may also spread to the brain or to other parts of the body (not shown).

Esthesioneuroblastoma affects adults and children. Even though it is very rare, esthesioneuroblastoma is the most common nasal cavity cancer in children and teens.

Causes and risk factors for childhood esthesioneuroblastoma

Childhood esthesioneuroblastoma is caused by certain changes to the way the cells in the olfactory nerve endings function, especially how they grow and divide into new cells. Often, the exact cause of these cell changes is unknown. Learn more about how cancer develops at What Is Cancer?

A risk factor is anything that increases the chance of getting a disease. There are no known risk factors for childhood esthesioneuroblastoma.

Symptoms of childhood esthesioneuroblastoma

Children may not have symptoms of esthesioneuroblastoma until the tumor has grown bigger. It’s important to check with your child’s doctor if your child has:

  • a mass in the nose
  • trouble breathing through the nose
  • a change in or loss of the sense of smell
  • nosebleeds
  • a headache
  • bulging of the eye
  • trouble seeing
  • eye pain

These symptoms may be caused by problems other than esthesioneuroblastoma. The only way to know is to see your child’s doctor.

Tests to diagnose childhood esthesioneuroblastoma

If your child has symptoms that suggest esthesioneuroblastoma, their doctor will need to find out if these are due to cancer or to another condition. The doctor will ask when the symptoms started and how often your child has been having them. The doctor will also ask about your child’s personal and family health history and do a physical exam. Depending on these results, they may recommend other tests. If your child is diagnosed with esthesioneuroblastoma, the results of these tests will help you and your child’s doctor plan treatment.

Diagnostic tests

The following tests may be used to diagnose esthesioneuroblastoma:

Nasal endoscopy

Nasal endoscopy is a procedure to look at organs and tissues inside the body to check for abnormal areas. A flexible or rigid endoscope is inserted through the nose. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which a pathologist checks under a microscope for signs of disease.

Magnetic resonance imaging (MRI)

MRI uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas of the body, such as the head and neck. This procedure is also called nuclear MRI (NMRI).

EnlargeMagnetic resonance imaging (MRI) scan; drawing shows a child lying on a table that slides into the MRI machine, which takes a series of detailed pictures of areas inside the body.
Magnetic resonance imaging (MRI) scan. The child lies on a table that slides into the MRI machine, which takes a series of detailed pictures of areas inside the body. The positioning of the child on the table depends on the part of the body being imaged.

CT scan (CAT scan)

CT scan uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body, such as the head and neck or lymph nodes. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Learn more about Computed Tomography (CT) Scans and Cancer.

EnlargeComputed tomography (CT) scan of the head and neck; drawing shows a child lying on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of the inside of the head and neck.
Computed tomography (CT) scan of the head and neck. The child lies on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of the inside of the head and neck.

PET scan (positron emission tomography scan)

PET scan uses a small amount of radioactive sugar (radioactive glucose) that is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Biopsy

Biopsy is a procedure in which a sample of tissue is removed from the tumor so that a pathologist can view it under a microscope to check for signs of cancer.

The following tests may be done on the sample of cells or tissues that were removed:

  • Immunohistochemistry uses antibodies to check for certain antigens (markers) in a sample of a patient’s tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.
  • Genetic analysis is a laboratory test in which cells or tissue are analyzed to look for changes in genes or chromosomes. These changes may be a sign that a person has or is at risk of having a specific disease or condition. Children with esthesioneuroblastoma may be eligible for genetic analysis and other types of molecular testing through the Molecular Characterization Initiative.

    The Molecular Characterization Initiative offers free molecular testing to children, adolescents, and young adults with certain types of newly diagnosed cancer. The program is offered through NCI’s Childhood Cancer Data Initiative. To learn more, visit About the Molecular Characterization Initiative.

  • Electron microscopy is a laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.

Tests to stage childhood esthesioneuroblastoma

If your child is diagnosed with esthesioneuroblastoma, they will be referred to a pediatric oncologist. This is a doctor who specializes in staging and treating esthesioneuroblastoma and other cancers. They will recommend tests to determine the extent (stage) of cancer. Sometimes the cancer is only in the olfactory nerve ending in the upper nasal cavity. Or, it may have spread from the nasal cavity to other parts of the body. The process of learning the extent of cancer in the body is called staging. It is important to know the stage of esthesioneuroblastoma to plan treatment.

Most children with esthesioneuroblastoma are at an advanced stage at the time of diagnosis. Esthesioneuroblastoma spreads most often to nearby tissue, including the olfactory bulb, nasal sinuses, or brain. It can also spread to the lymph nodes, lungs, liver, bone or bone marrow.

Learn more about a specific stage of esthesioneuroblastoma at Stages of childhood esthesioneuroblastoma.

The following tests may be used to determine the esthesioneuroblastoma stage:

Chest x-ray

An x-ray is a type of radiation that can go through the body and make pictures. A chest x-ray is one that makes pictures of the organs and bones inside the chest.

PET-CT scan

PET-CT scan combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself. If there is any cancer, this increases the chance that it will be found.

  • For the PET scan, a small amount of radioactive glucose (sugar) is injected into a vein. The scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
  • For the CT scan, a series of detailed pictures of areas inside the body, such as the chest or abdomen, is taken from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.

Fine-needle aspiration (FNA) biopsy

Fine-needle aspiration biopsy uses a thin needle to remove tissue or fluid from an enlarged lymph node. A pathologist views the tissue or fluid under a microscope to look for cancer cells.

Getting a second opinion

You may want to get a second opinion to confirm your child’s cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. This doctor may agree with the first doctor, suggest changes to the treatment plan, or provide more information about your child’s cancer.

To learn more about choosing a doctor and getting a second opinion, see Finding Cancer Care. You can contact NCI’s Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor or hospital that can provide a second opinion. For questions you might want to ask at your child’s appointments, see Questions to Ask Your Doctor About Cancer. 

Stages of childhood esthesioneuroblastoma

The cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. It is important to know the stage of esthesioneuroblastoma to plan the best treatment.

There are several different staging systems for cancer. The Kadish staging system is used for esthesioneuroblastoma. Based on the diagnostic and staging test results, a Kadish stage is assigned to your child’s esthesioneuroblastoma, such as stage A, stage B, stage C, or stage D. When talking with you about your child’s cancer, your child’s doctor may describe it as one of these stages.

Stage A esthesioneuroblastoma

In stage A, cancer is found in the nasal cavity only.

Stage B esthesioneuroblastoma

In stage B, cancer has spread from the nasal cavity to the nasal sinuses.

Stage C esthesioneuroblastoma

In stage C, cancer has spread through the nasal sinuses to nearby tissue.

Stage D esthesioneuroblastoma

In stage D, cancer has spread to distant parts of the body, such as the lymph nodes in the neck, or to the brain, bone marrow, or lung.

Types of treatment for childhood esthesioneuroblastoma

Who treats children with esthesioneuroblastoma?

A pediatric oncologist, a doctor who specializes in treating children with cancer, oversees treatment of esthesioneuroblastoma. The pediatric oncologist works with other health care providers who are experts in treating children with cancer and who specialize in certain areas of medicine. Other specialists may include:

There are different types of treatment for children and adolescents with esthesioneuroblastoma. You and your child’s care team will work together to decide treatment. Many factors will be considered, such as your child’s overall health and whether the cancer is newly diagnosed or has come back.

Your child’s treatment plan will include information about the cancer, the goals of treatment, treatment options, and the possible side effects. It will be helpful to talk with your child’s care team before treatment begins about what to expect. For help every step of the way, see our downloadable booklet, Children with Cancer: A Guide for Parents.

Surgery

Surgery to remove the tumor is one of the main treatments for esthesioneuroblastoma.

After the doctor removes all the cancer that can be seen at the time of the surgery, your child may be given chemotherapy or radiation therapy to kill any cancer cells that are left. Treatment given after surgery to lower the risk that the cancer will come back is called adjuvant therapy.

Radiation therapy

Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Esthesioneuroblastoma may be treated with external beam radiation therapy. This type of radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Radiation therapy may be given alone or with other treatments, such as chemotherapy.

Learn more about External Beam Radiation Therapy for Cancer and Radiation Therapy Side Effects.

Chemotherapy

Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells. Chemotherapy either kills the cells or stops them from dividing. Chemotherapy may be given alone or with other types of treatment, such as radiation therapy.

For esthesioneuroblastoma, the chemotherapy is injected into a vein. When given this way, the drugs enter the bloodstream and can reach cancer cells throughout the body.

Chemotherapy drugs used alone or in combination to treat esthesioneuroblastoma in children include:

Other chemotherapy drugs not listed here may also be used.

Learn more about Chemotherapy to Treat Cancer.

Clinical trials

For some children, joining a clinical trial may be an option. There are different types of clinical trials for childhood cancer. For example, a treatment trial tests new treatments or new ways of using current treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.

You can use the clinical trial search to find NCI-supported cancer clinical trials accepting participants. The search allows you to filter trials based on the type of cancer, your child’s age, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Learn more about clinical trials, including how to find and join one, at Clinical Trials Information for Patients and Caregivers.

Treatment of childhood esthesioneuroblastoma

Treatment of newly diagnosed stage A esthesioneuroblastoma may include:

  • surgery to remove the tumor followed by radiation therapy if visible tumor cells remain after surgery

Treatment of newly diagnosed stage B esthesioneuroblastoma may include:

  • surgery to remove the tumor followed by radiation therapy

Treatment of newly diagnosed stage C esthesioneuroblastoma may include:

  • chemotherapy followed by surgery to remove the tumor
  • radiation therapy followed by surgery to remove the tumor
  • chemotherapy and radiation therapy given at the same time followed by surgery to remove the tumor

Treatment of newly diagnosed stage D esthesioneuroblastoma may include:

  • chemotherapy given before or after surgery to remove the tumor
  • radiation therapy to the tumor and other places in the body where the cancer has spread

If the cancer comes back after treatment, your child’s doctor will talk with you about what to expect and possible next steps. There might be treatment options that may shrink the cancer or control its growth. If there are no treatments, your child can receive care to control symptoms from cancer so they can be as comfortable as possible.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Prognostic factors for esthesioneuroblastoma

If your child has been diagnosed with esthesioneuroblastoma, you likely have questions about how serious the cancer is and your child’s chances of survival. The likely outcome or course of a disease is called prognosis. The prognosis can be affected by whether the cancer is only in the nose or if it has spread to the nasal sinuses, lymph nodes, or other parts of the body and whether the tumor was completely removed by surgery. No two people are alike, and responses to treatment can vary greatly. Your child’s cancer care team is in the best position to talk with you about your child’s prognosis.

Side effects and late effects of treatment

Cancer treatments can cause side effects. Which side effects your child might have depends on the type of treatment they receive, the dose, and how their body reacts. Talk with your child’s treatment team about which side effects to look for and ways to manage them.

To learn more about side effects that begin during treatment for cancer, visit Side Effects.

Problems from cancer treatment that begin 6 months or later after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:

  • physical problems
  • changes in mood, feelings, thinking, learning, or memory
  • second cancers (new types of cancer) or other conditions

Some late effects may be treated or controlled. It is important to talk with your child’s doctors about the possible late effects caused by some treatments. Learn more about Late Effects of Treatment for Childhood Cancer.

Follow-up care

As your child goes through treatment, they will have follow-up tests or check-ups. Some of the tests that were done to diagnose the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of the these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child’s condition has changed or if the cancer has recurred (come back).

Coping with your child's cancer

When your child has cancer, every member of the family needs support. Taking care of yourself during this difficult time is important. Reach out to your child’s treatment team and to people in your family and community for support. To learn more, see Support for Families When a Child Has Cancer and the booklet Children with Cancer: A Guide for Parents.

Related resources

For more childhood cancer information and other general cancer resources:

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of childhood esthesioneuroblastoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (“Updated”) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI’s website. For more information, call the Cancer Information Service (CIS), NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Esthesioneuroblastoma. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: /types/head-and-neck/patient/child/esthesioneuroblastoma-treatment-pdq. Accessed <MM/DD/YYYY>.

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

Head and Neck Cancer—Patient Version

Head and Neck Cancer—Patient Version

Overview

Head and neck cancers include cancers in the larynx, throat, lips, mouth, nose, and salivary glands. Tobacco use, heavy alcohol use, and infection with human papillomavirus (HPV) increase the risk of head and neck cancers. Explore the links on this page to learn more about the different types of head and neck cancer and how they are treated. We also have information about prevention, screening, research, clinical trials, and more.

The Head and Neck Cancers fact sheet has additional basic information.

Adult Treatment

PDQ Treatment Information for Patients

More information

Childhood Treatment

PDQ Treatment Information for Patients

More information

Causes & Prevention

PDQ Prevention Information for Patients

More information

Screening

PDQ Screening Information for Patients

Research

Toripalimab Becomes First Immunotherapy Drug Approved for Nasopharyngeal Cancer

Study in India Could Make Immunotherapy More Affordable Worldwide

Treatments for Oropharyngeal Cancer Are Very Effective, But Are There Ways to Do Less Harm?

HPV Vaccine May Provide Men with “Herd Immunity” against Oral HPV Infections

View more research

Statistics

Coping with Cancer

The information in this section is meant to help you cope with the many issues and concerns that occur when you have cancer.

Emotions and Cancer Adjusting to Cancer Support for Caregivers Survivorship Advanced Cancer Managing Cancer Care

Immunotherapy to Treat Cancer

Immunotherapy to Treat Cancer

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.

Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer.

How does immunotherapy work against cancer?

As part of its normal function, the immune system detects and destroys abnormal cells and most likely prevents or curbs the growth of many cancers. For instance, immune cells are sometimes found in and around tumors. These cells, called tumor-infiltrating lymphocytes or TILs, are a sign that the immune system is responding to the tumor. People whose tumors contain TILs often do better than people whose tumors don’t contain them.

Even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system. For example, cancer cells may:

  • Have genetic changes that make them less visible to the immune system.
  • Have proteins on their surface that turn off immune cells.
  • Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells.

Immunotherapy helps the immune system to better act against cancer.

What are the types of immunotherapy?

Several types of immunotherapy are used to treat cancer. These include:

  • Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer.

    Learn more about immune checkpoint inhibitors.

  • T-cell transfer therapy, which is a treatment that boosts the natural ability of your T cells to fight cancer. In this treatment, immune cells are taken from your tumor. Those that are most active against your cancer are selected or changed in the lab to better attack your cancer cells, grown in large batches, and put back into your body through a needle in a vein.

    T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.

    Learn more about T-cell transfer therapy.

  • Monoclonal antibodies, which are immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Such monoclonal antibodies are a type of immunotherapy.

    Monoclonal antibodies may also be called therapeutic antibodies.

    Learn more about monoclonal antibodies.

  • Treatment vaccines, which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease.

    Learn more about cancer treatment vaccines.

  • Immune system modulators, which enhance the body’s immune response against cancer. Some of these agents affect specific parts of the immune system, whereas others affect the immune system in a more general way.

    Learn more about immune system modulators.

Which cancers are treated with immunotherapy?

Immunotherapy drugs have been approved to treat many types of cancer. However, immunotherapy is not yet as widely used as surgery, chemotherapy, or radiation therapy. To learn about whether immunotherapy may be used to treat your cancer, see the PDQ® adult cancer treatment summaries and childhood cancer treatment summaries.

What are the side effects of immunotherapy?

Immunotherapy can cause side effects, many of which happen when the immune system that has been revved-up to act against the cancer also acts against healthy cells and tissues in your body.

Learn more about immunotherapy side effects.

How is immunotherapy given?

Different forms of immunotherapy may be given in different ways. These include:

  • intravenous (IV)
    The immunotherapy goes directly into a vein.
  • oral
    The immunotherapy comes in pills or capsules that you swallow.
  • topical
    The immunotherapy comes in a cream that you rub onto your skin. This type of immunotherapy can be used for very early skin cancer.
  • intravesical
    The immunotherapy goes directly into the bladder.

Where do you go for immunotherapy?

You may receive immunotherapy in a doctor’s office, clinic, or outpatient unit in a hospital. Outpatient means you do not spend the night in the hospital.

How often do you receive immunotherapy?

How often and how long you receive immunotherapy depends on:

  • your type of cancer and how advanced it is
  • the type of immunotherapy you get
  • how your body reacts to treatment

You may have treatment every day, week, or month. Some types of immunotherapy given in cycles. A cycle is a period of treatment followed by a period of rest. The rest period gives your body a chance to recover, respond to immunotherapy, and build new healthy cells.

How can you tell if immunotherapy is working?

You will see your doctor often. He or she will give you physical exams and ask you how you feel. You will have medical tests, such as blood tests and different types of scans. These tests will measure the size of your tumor and look for changes in your blood work.

What is the current research in immunotherapy?

Researchers are focusing on several major areas to improve immunotherapy, including:

  • Finding solutions for resistance.
    Researchers are testing combinations of immune checkpoint inhibitors and other types of immunotherapy, targeted therapy, and radiation therapy to overcome resistance to immunotherapy.
  • Finding ways to predict responses to immunotherapy.
    Only a small portion of people who receive immunotherapy will respond to the treatment. Finding ways to predict which people will respond to treatment is a major area of research.
  • Learning more about how cancer cells evade or suppress immune responses against them.
    A better understanding of how cancer cells get around the immune system could lead to the development of new drugs that block those processes.
  • How to reduce the side effects of treatment with immunotherapy.

How do you find clinical trials that are testing immunotherapy?

To find clinical research studies that involve immunotherapy visit Find NCI-Supported Clinical Trials or call the Cancer Information Service, NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

NCI’s list of cancer clinical trials includes all NCI-supported clinical trials that are taking place across the United States and Canada, including the NIH Clinical Center in Bethesda, MD.

Childhood Nasopharyngeal Cancer Treatment (PDQ®)–Patient Version

Childhood Nasopharyngeal Cancer Treatment (PDQ®)–Patient Version

General Information About Childhood Nasopharyngeal Cancer

Go to Health Professional Version

Key Points

  • Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasal cavity and throat.
  • Being infected with the Epstein-Barr virus increases the risk of nasopharyngeal cancer.
  • Signs and symptoms of nasopharyngeal cancer include headache and blocked or stuffy nose.
  • Tests that examine the nasopharynx are used to help diagnose nasopharyngeal cancer.
  • Certain factors affect prognosis (chance of recovery).

Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasal cavity and throat.

Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the nasopharynx. The nasopharynx is made of the nasal cavity (inside of the nose) and top part of the throat.

Nasopharyngeal cancer is more common in teens than in children younger than 10 years of age.

EnlargeAnatomy of the nasopharynx; drawing shows the three parts of the pharynx (throat): the nasopharynx, oropharynx, and hypopharynx. Also shown are the nasal cavity, oral cavity, larynx, esophagus, and trachea.
Anatomy of the nasopharynx. The nasopharynx is in the upper part of the pharynx (throat) behind the nose. The nostrils lead into the nasopharynx. An opening on each side of the nasopharynx leads into the ear.

Being infected with the Epstein-Barr virus increases the risk of nasopharyngeal cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk.

Being infected with the Epstein-Barr virus (EBV) is strongly linked to having nasopharyngeal cancer.

Signs and symptoms of nasopharyngeal cancer include headache and blocked or stuffy nose.

These and other signs and symptoms may be caused by nasopharyngeal cancer or by other conditions.

Check with your child’s doctor if your child has any of the following:

  • Headache.
  • Blocked or stuffy nose.
  • Nosebleeds.
  • Earache.
  • Ear infection.
  • Hearing loss.
  • Problems moving the jaw.
  • Trouble speaking.
  • Trouble seeing or droopy eyelid.
  • Lumps in the neck that may be painful.

Tests that examine the nasopharynx are used to help diagnose nasopharyngeal cancer.

The following tests and procedures may be used:

  • Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas of the body, such as the head and neck. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Nasal endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. A flexible or rigid endoscope is inserted through the nose. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope by a pathologist for signs of disease.
  • Epstein-Barr virus (EBV) tests: Blood tests to check for antibodies to the Epstein-Barr virus and DNA markers of the Epstein-Barr virus. These are found in the blood of patients who have been infected with EBV.

Certain factors affect prognosis (chance of recovery).

Prognosis depends on:

Stages of Nasopharyngeal Cancer

Key Points

  • After nasopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the nasal cavity and throat or to other parts of the body.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • Sometimes childhood nasopharyngeal cancer does not respond to treatment or comes back after treatment.

After nasopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the nasal cavity and throat or to other parts of the body.

To plan treatment, it is important to know whether cancer cells have spread within the nasal cavity or to other parts of the body. The process used to find out if cancer has spread is called staging.

Most children with nasopharyngeal cancer are at an advanced stage at the time of diagnosis. Nasopharyngeal cancer spreads most often to the bone, lung, and liver.

The following tests and procedures may be used to find out if cancer has spread:

  • Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • PET-CT scan: A procedure that combines the pictures from a PET scan and a CT scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself.
    • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest or abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
    • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
    EnlargeBone scan; drawing shows a child lying on a table that slides under the scanner, a technician operating the scanner, and a computer monitor that will show images made during the scan.
    Bone scan. A small amount of radioactive material is injected into the child’s vein and travels through the blood. The radioactive material collects in the bones. As the child lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if nasopharyngeal cancer spreads to the lung, the cancer cells in the lung are actually nasopharyngeal cancer cells. The disease is metastatic nasopharyngeal cancer, not lung cancer.

Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.

Sometimes childhood nasopharyngeal cancer does not respond to treatment or comes back after treatment.

Refractory nasopharyngeal cancer is cancer that does not respond to treatment.

Recurrent nasopharyngeal cancer is cancer that has recurred (come back) in the nasopharynx or in other parts of the body such as the bone, lung, or liver.

Treatment Option Overview

Key Points

  • There are different types of treatment for children with nasopharyngeal cancer.
  • Children with nasopharyngeal cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.
  • Four types of standard treatment are used:
    • Chemotherapy
    • Radiation therapy
    • Surgery
    • Immunotherapy
  • New types of treatment are being tested in clinical trials.
  • Treatment for childhood nasopharyngeal cancer may cause side effects.
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up tests may be needed.

There are different types of treatment for children with nasopharyngeal cancer.

Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

Children with nasopharyngeal cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.

Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine. This may include the following specialists and others:

Four types of standard treatment are used:

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Surgery

Surgery to remove the tumor is done if the tumor has not spread throughout the nasal cavity and throat at the time of diagnosis.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This cancer treatment is a type of biologic therapy.

Several types of immunotherapy are being used or studied to treat children with nasopharyngeal cancer:

  • Interferon may stop cancer cells from growing and it may also help kill cancer cells.
  • EBV-specific cytotoxic T-lymphocytes are a type of immune cell that can kill certain cells, including foreign cells, cancer cells, and cells infected with the Epstein-Barr virus. Cytotoxic T-lymphocytes can be separated from other blood cells, grown in the laboratory, and then given to the patient to kill cancer cells. EBV-specific cytotoxic T-lymphocytes are being studied to treat refractory or recurrent nasopharyngeal cancer.
  • Immune checkpoint inhibitor therapy blocks certain proteins. PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. Pembrolizumab and nivolumab are types of PD-1 inhibitors that have been used to treat adults with refractory nasopharyngeal cancer and may be considered to treat children.
EnlargeImmune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T cells from killing tumor cells in the body. Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells.
Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).
Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.

New types of treatment are being tested in clinical trials.

Information about clinical trials is available from the NCI website.

Treatment for childhood nasopharyngeal cancer may cause side effects.

To learn more about side effects that begin during treatment for cancer, visit Side Effects.

Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:

Some late effects may be treated or controlled. It is important to talk with your child’s doctors about the possible late effects caused by some treatments. See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

As your child goes through treatment, they will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child’s condition has changed or if the cancer has recurred (come back).

Treatment of Childhood Nasopharyngeal Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of newly diagnosed nasopharyngeal cancer in children may include the following:

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Refractory or Recurrent Childhood Nasopharyngeal Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of refractory or recurrent nasopharyngeal cancer may include the following:

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

To Learn More About Childhood Nasopharyngeal Cancer

For more information from the National Cancer Institute about nasopharyngeal cancer, see the following:

For more childhood cancer information and other general cancer resources, visit:

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of childhood nasopharyngeal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (“Updated”) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI’s website. For more information, call the Cancer Information Service (CIS), NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Nasopharyngeal Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: /types/head-and-neck/patient/child/nasopharyngeal-treatment-pdq. Accessed <MM/DD/YYYY>.

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.