What is Nasopharyngeal Carcinoma?

Nasopharyngeal carcinoma is a cancer that originates in the nasopharynx.

Where is the nasopharnyx?

Located behind / at the back of your nose and above the back of your throat (refer picture).

Incidence of Nasopharyngeal Carcinoma

Report by the National Cancer Registry (2003-2005), NPC is the fourth among the ten most frequent cancers in Peninsular Malaysia.

Risk Factors

• Genetic predisposition: High incidence in Chinese, may occur in Malays but very rare in Indians
• Diet: consumption of large amont of preserved salted fish, meat or egg since young.
• Infection: by Ebstein Barr Virus (EBV)
• Occupation: Exposure to smoke and dust
• Drinking large amount of alcohol

Symptoms Of Nasopharyngeal Carcinoma

Patient may have one or more of these symptoms:

• Nose bleeding / bloody discharge from your nose
• Nose Block
• Nasal discharge
• Decreased hearing(usually unilateral)
• Tinnitus(buzzing sound in the ear)
• Blocked Ear
• Neck mass / neck swelling
• Headache
• Double vision
• Facial numbness
• Difficulty in mouth opening
• Ptosis(drooping of upper eyelid)
• Hoarseness of voice

* Very early stage may be asymptomatic. If you have any of the above symptoms please consult your doctor for further assessment

Diagnosis

Physical Examination by doctors shows

• Enlarged Lymph node / swelling in the neck
• Examination of the ear
  • Dull tympanic membrane
  • Conductive hearing loss
• Neurological Examination(Examination of the nerves):
  • Cranial nerve palsies(late stage)
  • Cranial nerves commonly involved in Nasopharyngeal carcinoma are cranial nerves No.5, 6, 12
  • Decreased sensation over the face – involvement of cranial nerve no.5
  • Double vision-involvement of cranial nerve no. 6
  • Deviated tongue-involvement of cranial nerve no.12

Enlarged neck Lymph Nodes	Deviated tongue
Normal tympanic membrane	Dull tympanic membrane

Nasendoscopy Examination:

A procedure to look inside the nose using nasendoscopy (as shown in the picture)
Doctor will be able to view the growth / cancer directly (as shown in the picture)

Nasendoscopy procedure

Nasendoscopic view of growth

Radiological Examination

• CT Scan(Computed Tomography Scan)
• MRI(Magnetic Resonance Imaging)

Able to show the growth(nasopharyngeal carcinoma) and the extent of the growth.(Refer Picture)

CT Scan

MRI

Biopsy

Removal of a small amount of tissue from the growth for the pathologist to examine under the microscope. This is a confirmatory test to detect the presence of cancer cells.(CONFIRMATORY TEST).

Treatment Options

• Radiotherapy
• Chemotherapy
• Combination Radiotherapy and Chemotherapy
• Surgery

* Treatment options depend on the stage of the disease

* Surgical option is for patient who fail to respond to radiotherapy

Complication

NPC can spread (metastasis) beyond the confine of nasopharynx. It can spread to the nearby area (regional metastasis) such as lymph nodes in the neck or can spread to the distant region ( distant metastasis) such as bones, lung and liver.

Prevention

1. Avoid consumption of large amount of preserved salted fish, egg or meat.
2. Proper protection from inhalation of smoke/ dust in those working in the industries.
3. Ebstein Barr Virus Serology Test (Screening Test)
4. Stop smoking
5. Stop drinking alcohol