Head and Neck Surgery

About Nasopharyngeal Cancer

Background

  • The nasopharynx is the uppermost part of the throat located at the back of the nose. Cancer of the nasopharynx is one of the 10 most common cancers in Singapore. It usually affects adults between the ages of 35 to 55, is more likely to occur in Chinese compared to other races, and in men more than women.
  • Increased detection of specific antibodies and DNA sequences of the Epstein-Barr virus are associated with increased risk of developing NPC.It is thought that a combination of genetic factors together with exposure to EBV contributes to the development of this cancer.

Symptoms and signs

  • The most common symptoms of NPC are blood stained nasal discharge or sputum, enlarged lymph nodes in the upper neck and blocked ear with decreased hearing.
  • Less commonly, tumours that have spread more extensively may cause dysfunction of the nerves with more sinister symptoms features including double vision, loss of vision, pain or numbness in the face.

Assessments

  • Nasopharyngoscopy allows the nasopharynx to be visualised
  • CT, MRI or PET scans provide information about the size and spread of tumour
  • A biopsy of the tumour is required for diagnosis to be made. This is performed under local anaesthesia through the nostrils and nasal passage with direct visualisation provided by an endoscope

Management

  • Early cancers of the nasopharynx are treated with radiotherapy. For larger tumours or tumours with spread beyond the nasopharynx, commonly to the lymph nodes of the neck, treatment with both chemotherapy and radiotherapy is recommended. 

Cancer screening

  • Screening tests are available for patients with a family history of NPC. These include nasopharyngoscopy and blood tests for levels of tumour markers.