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Below, week by week, is what OnCo's record of Locoregionally advanced nasopharyngeal carcinoma (stage III to IVA) says about the first two months: the order is typical, the timing is yours to ask about. Locoregionally advanced nasopharyngeal carcinoma is nasopharyngeal cancer, the Epstein-Barr-virus-driven cancer behind the nose, that has grown into nearby structures or neck lymph nodes but not further. It is treated without surgery, by precise radiotherapy with cisplatin, usually after gemcitabine and cisplatin chemotherapy and in recent trials with PD-1 immunotherapy; most patients are cured. Sections appear only where the record has something to say. Orientation, not medical advice.
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
MRI of the nasopharynx and neck, PET-CT or CT of chest and abdomen with bone scan, plasma EBV DNA, dental and audiological assessment.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Induction gemcitabine and cisplatin for three cycles followed by intensity-modulated radiotherapy (70 Gy) with concurrent cisplatin; TPF induction as an alternative.
Metronomic capecitabine for one year in high-risk patients; EBV DNA-directed adjuvant therapy in trials (NRG-HN001).
PD-1 antibody (sintilimab in CONTINUUM; toripalimab and camrelizumab in trials) added to induction and chemoradiotherapy in high-risk disease, adopted in China.
Plasma EBV DNA, MRI and nasopharyngoscopy; management of xerostomia, hearing loss, hypothyroidism and hypopituitarism.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
Every term links to the glossary.