Understanding Nasopharyngeal Cancer (NPC)
12 March 2020
WHAT IS NPC?
Nasopharyngeal Cancer (NPC) is a malignant tumour arising from the mucosa of the nasopharynx or postnasal space. It is one of the commonest cancers affecting the Malaysian Chinese population, especially adult males. If diagnosed and treated early, it is highly curable.
EPIDEMIOLOGY OF NPC
NPC is unique in terms of racial and geographical distribution. It is particularly common among the Chinese of Southern China and South-East Asian countries, with a male to female ratio of approximately 3:1. Most of the patients present in the 40 to 60 age group. It is the third most common cancer among men in Peninsular Malaysia. Over 3,000 new cases of NPC are diagnosed in Malaysia each year out of a worldwide total of approximately 11,000 cases. The incidence of NPC in the Malaysian Chinese population ranks second-highest in the world after Hong Kong. The lifetime risk of contracting NPC for Malaysian Chinese males and females are 1 in 50 and1 in 42 respectively.
CT Scan post-nasal space showing NPC.
WHAT ARE THE RISK FACTORS ASSOCIATED WITH NPC?
Known risk factors associated with NPC include:
- Infection by the Epstein- Barr Virus (EBV)
- Individuals of Southern Chinese descent
- Individuals with a Family History of NPC
- Certain diets (fermented vegetables & fermented fish)
- Cigarette smoking.
Left neck lump from the metastatic lymph node.
WHAT ARE THE COMMON SIGNS AND SYMPTOMS OF NPC?
The most common signs and symptoms of NPC are:
- Painless neck lump(s)
- Bloodstained phlegm especially after waking up in the mornings
- Nasal obstruction
- Nose bleeds
- Unilateral ear pressure (‘blocked sensation’), hearing loss or tinnitus
- Double vision
- Unilateral facial numbness
- Unilateral headache.
Nasal endoscopy showing NPC in post-nasal space.
SCREENING TESTS FOR NPC
Individuals with any of the above-listed signs and symptoms should consult an ENT Specialist immediately for further examination and evaluation of the nasopharynx.
For individuals with a family history of NPC and Chinese males above 40 years of age and who do not have any of the above symptoms, a half-yearly screening blood test for EBV VCA IgA levels is advised. A raised blood level of EBV VCA IgA will raise the suspicion of NPC and a visit to an ENT specialist for further evaluation is strongly recommended.
Otitis media with effusion from Eustachian tube obstruction by NPC.
HOW IS NPC DIAGNOSED?
The presence or absence of NPC can usually initially be diagnosed by a Nasal Endoscopy carried out by an ENT Specialist in his/her clinic after a local anaesthetic spray. This procedure is usually painless and comfortable. If a Nasal Endoscopy reveals a normal nasopharynx, no further investigation is usually necessary. If a Nasal endoscopy reveals the presence or suspicion of a tumour, the ENT Specialist will usually carry out a biopsy of the tumour and arrange for a CT or MRI scanning of the nasopharynx and neck.
HOW IS NPC TREATED?
After the confirmation of NPC, an ENT Specialist would refer the patient for treatment by a Radiotherapy/Oncology Specialist in a specialised cancer treatment centre. The standard treatment for NPC is Radiotherapy alone for patients with early-stage disease. Patient with
advanced stages of NPC are usually treated with Radiotherapy in combination with Chemotherapy.
WHAT IS THE PROGNOSIS OF NPC?
With prompt treatment using the latest advanced treatment techniques, the prognosis for patients with early stages of NPC is excellent. For those patients with advanced stages of the disease, the new treatment technique also affords a very promising outcome.
Dr Koay Cheng Eng, Consultant, Ear, Nose & Throat - Head & Neck Surgery