How should I manage a patient with nasopharyngeal carcinoma who presents with significant weight loss and dysphagia?

Management of a patient with nasopharyngeal carcinoma presenting with significant weight loss and dysphagia involves:

• Assessment of nutritional status and early consideration of enteral nutrition support, including prophylactic feeding tube placement if needed, based on performance status, tumour stage, site, and pre-existing dysphagia. This is essential to address significant weight loss and swallowing difficulties.
• Offer intensity-modulated radiotherapy (IMRT) combined with concomitant chemotherapy for locally advanced (stage II and above) nasopharyngeal carcinoma. This is the standard curative treatment approach.
• Consider adjuvant or neoadjuvant chemotherapy in addition to chemoradiotherapy for locally advanced disease.
• Involve a multidisciplinary team including dietitians, speech and language therapists, and palliative care specialists to optimize nutritional support, swallowing rehabilitation, and symptom management.
• Consider swallowing-exercise programmes during radiotherapy to help maintain or improve swallowing function.
• Monitor and manage airway risks and breathing difficulties, involving palliative care and other specialists as appropriate.

These steps aim to manage the cancer effectively while addressing the critical issues of weight loss and dysphagia to improve quality of life and treatment tolerance.

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