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For some people with nasopharyngeal cancer (NPC), the end of treatment can be both stressful and exciting. You may be relieved to finish treatment, but it’s hard not to worry about cancer coming back (recurring). This is very common if you’ve had cancer.

For others, the cancer might never go away completely. Some people may get regular treatments to try and help control the cancer for as long as possible. Learning to live with cancer that does not go away can be difficult and very stressful. 

Ask your doctor for a survivorship care plan

Talk with your doctor about developing a survivorship care plan for you. This plan might include: 

• A suggested schedule for follow-up exams and tests
• A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
• A list of possible late- or long-term side effects from your treatment, including what to watch for and when and how you should contact your doctor
• Recommendations for things you could do to improve your health and even possibly lower the chance of your cancer coming back, such as diet and physical activity suggestions
• Reminders about your appointments with your primary care provider (PCP), who will monitor your general health care 

Follow-up care after nasopharyngeal cancer

People with cancer of the nasopharynx are at risk for the cancer coming back (a recurrence) and developing new cancers in other parts of the body, so they must be watched closely after treatment. Your cancer care team will discuss which tests should be done and how often based on the type and initial stage of your cancer, as well as the type of treatment you had, and your response to that treatment.

If you have completed treatment, your doctors will still want to watch you closely. You will probably have follow-up appointments with your doctor for many years and it's important to go to all of them. During these visits, you will be asked questions about any problems you may have and may undergo exams and lab tests or imaging tests (such as MRI or CT scans) to look for signs of cancer or treatment side effects. Your health care team will discuss which tests should be done and how often based on the stage of your cancer and the type of treatment you had.

Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others might last a long time. Some side effects might not even show up until years after you have finished treatment. Your doctor visits are a good time for you to ask questions and talk about any changes or problems you have noticed or concerns you have.

It's important to report any new symptoms or problems to the doctor right away. This might help your doctor help find recurrent cancer as early as possible, when cancer is small and easier to treat.

Doctor visits and tests

If there are no signs of cancer, many doctors will recommend you have a physical exam, endoscopy, and some of the other tests listed below about every 3 months for the first couple of years after treatment, then every 4 to 6 months for the next few years. People who were treated for early-stage cancers may have doctor visits less often, and people with more advanced disease might be followed more frequently.

Imaging: CT or PET scans and other imaging tests might be used to watch for recurrence or a new tumor, especially if you have new symptoms.

Blood tests: If you were treated with radiation, it might have damaged your thyroid gland. You will most likely need regular blood tests to check your thyroid function.

Dental exams: People treated with radiation may also have problems with dry mouth and tooth decay, so regular dental exams are often recommended.

Speech, hearing, and swallowing rehabilitation: Both radiation and surgery can lead to problems with speech, swallowing, and hearing. These are often checked and treated by a speech therapist after treatment (see below). You might also need to see an audiologist (a specialist in hearing loss) for devices, like a hearing aid, to improve your hearing if the treatment changed it.

Nutrition follow-up: Cancers of the nasopharynx and their treatments can sometimes cause problems such as trouble swallowing, dry mouth, or even loss of teeth. This can make it hard to eat, which can lead to weight loss and weakness from poor nutrition.

After treatment, you might not gain weight or replace your protein stores as well as you should. A team of doctors and nutritionists can work with you to provide nutrition supplements and information about your individual nutritional needs. This can help you maintain your weight and nutritional intake. Some may even need a feeding tube placed into the stomach for a short time after treatment.

Keeping health insurance and copies of your medical records

Even after treatment, it’s very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think about cancer coming back, this could happen.

At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know your medical history. It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.

Can I lower my risk of NPC progressing or coming back?

If you have (or have had) NPC, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements.

Quit smoking: Smoking during cancer treatment can reduce the benefit of treatment and increase the risk of cancer coming back (recurrence). Smoking after treatment can also increase the risk of getting a new smoking-related cancer (see Second Cancers ). Quitting smoking for good (before treatment starts, if possible) is the best way to improve your chances for survival. And it is never too late to quit. Your doctor may recommend counseling as well as medication to help you. See Stay Away from Tobacco and call 1-800-227-2345 for more information about quitting smoking.

Avoid alcohol intake: Heavy drinking of alcohol has been associated with NPC, especially in areas at low risk of NPC. Avoiding alcohol after treatment for NPC can benefit your overall health and might help lower your risk of the cancer recurring, but more studies are needed.

Adopting healthy behaviors such as  eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure. Still, we do know that these types of lifestyle changes can have positive effects on your health that might help lower your risk of NPC or other cancers.

About dietary supplements

So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of NPC progressing or coming back. This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.

Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do. If you’re thinking about taking any type of nutritional supplement, talk to your health care team first. They can help you decide which ones you can use safely while avoiding those that might be harmful.

If the cancer comes back

If the cancer does recur, your treatment options will depend on where the cancer is located, what treatments you’ve had before, and your overall health. For more information on how recurrent cancer is treated, see ?Treatment Options for Nasopharyngeal Cancer, by Stage.

For more general information on coping with a recurrence, you may also want to see Understanding Recurrence.

Getting emotional support

Some feelings of depression, anxiety, or worry are normal when cancer is a part of your life. Some people are affected more than others. But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others. Learn more in Life After Cancer.

Second cancers after nasopharyngeal cancer treatment

People who’ve had NPC can still get other cancers. In fact, NPC survivors are at higher risk for getting some other types of cancer.

Cancer survivors can be affected by a number of health problems, but often a major concern is facing cancer again. Cancer that comes back after treatment is called a recurrence. But some cancer survivors may develop a new, unrelated cancer later. This is called a second cancer.

Survivors of NPC can get any second cancer, but they have an increased risk of:

• Cancer of the tongue
• Cancer of the nose and nasal cavity
• Cancer of the esophagus
• Cancer of the bone and joints (mostly the jaw bone or mandible)

Staying healthy after treatment for nasopharyngeal cancer

After completing treatment for NPC, you should still see your doctor regularly. Your doctor may order tests to look for signs that the cancer has come back or spread. These tests are also useful in finding some second cancers. Experts don’t recommend any other tests to look for second cancers in patients who don’t have symptoms. Let your doctor know about any new symptoms or problems, because they could be caused by the cancer coming back, a new disease, or a second cancer.

Survivors of NPC should follow the American Cancer Society guidelines for the early detection of cancer, stay away from tobacco products, and avoid alcohol. Smoking increases the risk of getting certain second cancers as well as other health problems. Heavy drinking has been associated with some cases of NPC especially in areas where people are at low risk of NPC.

To help maintain good health, survivors should also:

• Get to and stay at a healthy weight
• Keep physically active and limit the time you spend sitting or lying down
• Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
• Not drink alcohol. If you do drink, have no more than 1 drink per day for women or 2 per day for men

These steps may also lower the risk of some other health problems.

See Second Cancers in Adults for more information about causes of second cancers.