Nasopharyngeal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up.

NPC is clinically staged according to the International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC) staging system (Table 1). Routine staging procedures include history, physical examination including cranial nerve examination, complete blood cell count, serum biochemistry (including liver function test), chest X-ray, nasopharyngoscopy, computed tomography (CT) scan or magnetic resonance imaging (MRI) of nasopharynx and base of skull and neck. MRI is preferred if available [III, B]. Imaging for distant metastases including isotope bone scan and CT scan of chest and upper abdomen could be considered for at-risk subsets (node positive, especially N3 stage) and for those patients with clinical or biochemical abnormalities detected [III, B]. The use of positron emission tomography is under investigation and findings seem promising. Both the pre-treatment and post-treatment plasma/serum load of Epstein–Barr viral DNA has been shown to be of prognostic value [III, B].