Where is the “nasopharynx” in your body ? : Nasopharynx is the small area located behind your nose and above the back of your throat. What is nasopharyngeal cancer (NPC) ?: NPC is cancer that occurs in the nasopharynx, an area located behind your nose and above the back of your throat. NPC is difficult to detect early, probably because the nasopharynx isn't easy to examine (it is impossible to see unless an endoscope is used in an ENT clinic) and symptoms of NPC mimic those of many other conditions. In its early stages, NPC may not even cause any symptoms !Possible noticeable symptoms of NPC include:•A lump in your neck caused by a swollen lymph node •Bloody discharge from your nose•Nasal congestion/blockage on one side of your nose•Hearing loss in one ear -otitis media wth effusion•Frequent ear infections•Headaches•Double vision•Face and neck pain
Nasopharyngeal cancer (NPC) 3-fold pamplet (English language)
(PDF files will open in a new window)
Nasopharyngeal cancer (NPC) 3-fold pamplet (Bahasa Malaysia/Malay language)
Nasopharyngeal cancer (NPC) 3-fold pamplet (Chinese language)
This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
What are the complications ?NPC frequently spreads (metastasizes) beyond the nasopharynx. Many people with NPC have regional metastases, meaning cancer cells from the initial tumor have migrated to nearby areas, such as lymph nodes in the neck, causing the lymph nodes to be swollen. Cancer cells that spread beyond the head and neck (distant metastases) most commonly travel to the bones and bone marrow, lungs and liver. Just like any cancers, death is inevitable in advanced disease.What are the risk factors ?Researchers have identified some risk factors that appear to increase your risk of developing NPC, including:•Gender. Men have about double the risk of developing cancer of the nasopharnyx as women do. •Race & Genetics. This type of cancer more commonly affects people in Asia and northern Africa. In Malaysia, the Chinese in particular has a higher risk of NPC and in Sarawak, the Bidayuhs and Ibans.•Age. Most cases of NPC occur in people between the ages of 30 and 55. However, it can still occur outside this age group.•Salt-cured food. Chemicals released in steam when cooking salt-cured foods, such as fish, preserved vegetables and Chinese herbs, may enter the nasal cavity, increasing the risk of NPC. In China, NPC has been linked to high consumption of salted fish, and as people in Southeast China are adopting a more Western diet, their rates of NPC have been declining.•Preserved meats. Preserved meats contain high levels of nitrates, contributing to the production of carcinogenic agent nitrosamine, which may increase the risk of NPC.•Infection by Epstein-Barr virus (EBV)-virus particles of EBV has been found in many cases of NPC. It is believed that EBV infection contributes to the early cancer transformation changes •Family history.Having a family member with NPC increases your risk of the disease, This could be due to genetic or environmental factors.How is NPC diagnosis made ?Diagnosing NPC usually begins with a general examination by the ENT doctor. Your doctor will ask questions about your symptoms. He or she may press on your neck to feel for swelling in your lymph nodes.Because early signs and symptoms of NPC are not specific to the disease, the initial symptoms may be ignored or diagnosis may be elusive. Your doctor will also use the endoscope (an endoscope is a thin, tube-like instrument with a light and a camera lens for viewing) to examine your nose and nasopharynx. Narrow Band Imaging (NBI) endoscopy also offers an extra advantage in the early detection of cancer lesion. Once a suspicious lesion is seen,another instrument to take a small tissue sample (biopsy) to be tested for cancer. Biopsy refers to the removal of cells or tissues so they can be viewed under a microscope in a laboratory by a pathologist to check for signs of cancer. A biopsy is the only sure way to diagnose NPC beyond doubt ! Once the diagnosis is confirmed, your doctor orders other tests to determine the extent (stage) of the cancer. This may include chest X-ray, CT scan of the neck and ultrasound of the liver. Many people are not diagnosed with NPC until it has spread, probably because the nasopharynx is not easy to examine and symptoms of this cancer mimic those of many other conditions. Even a nasal polyp can sometimes mimic NPC. However, as NPC becomes more advanced, it also becomes more difficult to treat successfully.So what is the treatment and chances of cure?Your main treatment options for NPC are radiation therapy/radiotherapy, chemotherapy or a combination of the two. Radiotherapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from multiplying. Prognosis (chance of recovery) and treatment options depend on the following:•The stage of the cancer (whether it affects part of the nasopharynx, involves the whole nasopharynx, or has spread to other places in the body).•The type of NPC (WHO Type I, II or III).•The size of the neck lymph nodes.•The patient's age and general health.Surgery is not often used as a first-line treatment for NPC unless for:•Recurrence of cancer in the neck. oHere, neck disssection can be performed to remove the diseased lymph nodes.oPrior to this, FNAC and CT or preferably PET-CT scan can be performed to confirm that the disease has indeed spread to the lymphatic chain in the neck.•Recurrence of cancer in the nasopharynxoSurgical options are possible in the form of nasopharyngectomy, whether done endoscopically or via open approach.oThe option for treatment also include brachytherapy (a very precise form of radiation therapy localised to the nasopharynx only, limiting the radiation dose and damage to important neighbouring structures eg. eye, brain) or other forms of stereotactic radiosurgery•Other concurrent conditions associated with NPC oOtitis Media with Effusion i.e fluid behind the ear drum -usually a ventiilation/drainage tube (grommet) can be inserted onto the eardrumoVocal Cord Paralysis- if symptomatic of choking on fluid intake, corrective surgery can be performed to mobilise the vocal cords into a particular position to overcome this problem.How do I prevent NPC ?Unfortunately, NO sure way exists to prevent NPC. However, you can take steps to reduce your risk of the disease. For instance, cut back on the amount of salt-cured foods and preserved meats that you eat, or choose to avoid these foods altogether.Random IgE antibody tumour marker screening is not advisable and best done only after taking into consideration the family history and a complete physical and endoscopic examination.In those with strong family history (i.e parents, siblings had NPC before), regular surveillance examination and endoscopy is advised to detect early onset of disease.
This is how Epstein-Barr virus (EBV) looks like under the electron microscope.(image source: Wikipedia)
Best viewed with Google Chrome browser
The number 1 head and neck cancer in Malaysia is nasopharyngeal cancer (NPC). Other common cancers include oral cavity cancers (eg. tongue, floor of mouth, buccal region).Based on the 2006 Malaysian National Cancer Registry NCR (refer to graph on the right), the commonest Head & Neck Cancers (by frequency) were: 1.Nasopharyngeal Cancer (NPC) (981 cases)2.Thyroid Cancer (891)3.Oral Cancer (428) 4.Laryngeal Cancer (216)5.Salivary Gland Cancer (142)6.Pharyngeal Cancer (113)7.Sinonasal Cancer (113)In 2007, there were 900 NPC cases geal cancer diagnosed in 2007 and registered at NCR, comprising of 685 males and 255 females. Based on 2007 Malaysian NCR (the latest officially published registry report), NPC is the:•4th commonest cancer among Malaysian (behind cancers of the breast, colorectal and lung in that sequence )•commonest cancer in the Head & Neck region•3rd commonest cancer among males in Malaysia.The incidence was more than 2 folds higher among males when compared to females. Chinese were found to have higher incidence rate compared to Malay and Indian. The incidence of nasopharyngeal cancer increases with age. The peak of Age-specific Incidence Rate was at the 70-75 age groups. Unfortunately, the majority of NPC was detected at the late stages of III and IV. The percentage of the cancer detected at the early stages of I and II was only 34%
unfortunately, most NPC cases are diagnosed late !
Reference: 1. Malaysia Cancer Registry 2006 and 2007
Top 10 cancers in Malaysia ! (source: NCR2007)
Top Head & Neck cancers in Malaysia ! (source: NCR2006)
Left picture showing a suspicious mass (the white arrow) seen under conventional white light. The right picture showing similar site using Narrow-Band Imaging (NBI) where irregular blood vesssels pattern is clearly seen depsite the copius secretion and mucus over the local site. “Can you see the tumour ?”
DR. VINCENT TANConsultant Ear, Nose and Throat, Head and Neck Surgeon,MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Cert.in Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore)Fellowship in Head and Neck Oncology & Surgery (Amsterdam)