Nasopharyngeal Cancer (Nose Cancer)

Nasopharyngeal Cancer (Nose Cancer) - What it is

What is nasopharyngeal cancer (nose cancer)?

Nasopharyngeal cancer (NPC), also known as nose cancer, is a disease in which cancer cells develop from the tissues of the nasopharynx.

The nasopharynx is the passageway located behind the nose, just above the throat (oropharynx) which connects the nose to the respiratory system. The nasopharynx is also connected to the ear via the Eustachian tubes which open into the middle ear.

Anatomy of the nose that is being affected by nasopharyngeal cancer or nose cancer

How common is nasopharyngeal cancer (nose cancer)?

NPC affects more men than women. In Singapore, NPC is the 10th most common cause of cancer death in males and one of the most common cancers in males aged between 30 and 49 years old. This cancer also tends to run in the family i.e. patients with relatives with NPC are at a higher risk of developing the cancer.

Nasopharyngeal Cancer (Nose Cancer) - Symptoms

What are the symptoms of nasopharyngeal cancer (nose cancer)?

In the early stages of NPC, there are often no or mild symptoms. When the cancer progresses, some symptoms may show.

Symptoms of NPC may include:

A painless neck lump
Persistent blood stained saliva/sputum
Bleeding/bloody discharge from the nose or in nasal secretions
Nasal blockage that does not go away
Hearing loss or ringing in the ears (often one sided)
Persistent sensation of blocked ear/ears
Unusual face pain or numbness
Headache
Double vision
In advanced NPC, where the cancer has spread to other parts of the body such as the lung, bone or liver, symptoms such as breathlessness, cough or pain may surface

When should you see a doctor?

Make an appointment with your doctor if you have any signs or symptoms that worry you. If you have a strong family history of NPC (two or more first degree relatives with NPC), you may also wish to see a doctor to be screened for NPC.

Nasopharyngeal Cancer (Nose Cancer) - How to prevent?

How is nasopharyngeal cancer (nose cancer) prevented?

There are several ways to lower the risk of NPC:

Reduce consumption of salted and preserved foods
Adopt a healthy diet with fruits, vegetables and whole grains
Avoid smoking or inhaling second-hand smoke
Exercise regularly and maintain a healthy weight

Nasopharyngeal Cancer (Nose Cancer) - Causes and Risk Factors

What are the risk factors for nasopharyngeal cancer (nose cancer)?

While the exact cause of NPC is unknown, several factors have been found to contribute to its development. These risk factors include:

Gender – NPC is more common in men than in women
A diet high in salted or preserved (cured/smoked/pickled) foods
Epstein-Barr virus (EBV) infection
Ethnicity – NPC more commonly affects people in parts of China and Southeast Asia. In Singapore, people of Southern Chinese heritage have higher incidence of NPC
Family history of NPC
Smoking

Nasopharyngeal Cancer (Nose Cancer) - Diagnosis

How is nasopharyngeal cancer (nose cancer) diagnosed?

Tests and procedures used to diagnose NPC include:

Nasoendoscopy
A thin, flexible camera tube called a nasoscope, is inserted through the nostril to check for any abnormalities such as bleeding or growths within the nasopharynx and the rest of the head and neck structures.
Biopsy
If any abnormalities are seen during nasoendoscopy, a tissue sample may be collected (under local anaesthesia) for further examination in the lab.
Imaging tests
Imaging tests (e.g. Computer Tomography (CT) scan or Magnetic Resonance Imaging (MRI) scans) may be ordered by the doctor to examine the head and neck region, nearby organs and lymph nodes for signs of cancer.

If NPC is diagnosed, further tests may be required to determine if the cancer has spread and to determine the stage of the cancer. Tests may include:

Blood tests
Blood tests to check for general health and infection, including how well the liver, kidney and other organs are functioning.
Staging scans
Positron Emission Tomography (PET) scan may be ordered. In this scan, a low-level radioactive substance is injected to determine if there is spread of cancer to the rest of the body. A CT scan of the chest and abdomen, and bone scan may also be used.

Nasopharyngeal Cancer (Nose Cancer) - Treatments

How is nasopharyngeal cancer (nose cancer) treated?

Treatment for NPC depends on the following factors:

Size, type and location of the tumour
Stage of the disease
The patient’s general state of health

The main treatment for NPC is radiation therapy. Some patients may also require radiation therapy in combination with chemotherapy. Surgery may be required in some patients with persistent or relapsed disease after initial radiation treatment.

An individual with cancer should be assessed by a specialist to determine which treatment is best suited for them.

Radiotherapy/Radiation therapy

Radiotherapy, also known as radiation therapy, uses powerful and targeted x-ray beams to kill cancer cells, and can be given to the region that covers the nasopharynx, the neck and down to the collarbone to treat NPC. A new modality of radiotherapy known as Proton Therapy, allows radiation to be delivered to the tumour, yet sparing the normal tissues better than the conventional x-ray radiotherapy.

Receiving radiation treatment is a painless process, though radiation therapy to the head and neck can cause some cumulative side effects over the entire course of treatment; such as sores in the throat or mouth, hearing loss and dry mouth. Your doctor will discuss with you how to manage these side effects while undergoing treatment.

Chemotherapy

Chemotherapy uses chemicals to kill cancer cells in the body. In patients with localised NPC, chemotherapy may be offered before the start of radiotherapy, during the radiation treatment and after the completion of radiotherapy. When combined with radiation, chemotherapy can improve the effectiveness of radiotherapy. In patients with advanced NPC, chemotherapy may be recommended to help control the growth of the cancer.

Surgery

Surgery is not a common treatment for NPC and is usually reserved for cases where the cancer recurs after initial treatment. In cases where there is a small cancer recurrence at the nasopharynx or in the lymph nodes of the neck, surgery may be considered to treat the recurrence. This may be performed either through open surgery or endoscopic (keyhole) surgery through the nose. However, suitability for these procedures is best determined after appropriate scans and consultation with your surgical oncologist.

For more information on NPC, please click here.