Vincent’s S.C.A.N.S
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)
Kanser nasofarinks/hidung
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.
Copyright Vincent Specialist Solutions Sdn Bhd 2016. All rights reserved
Last update: 1/5/13
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.
o
Here, neck disssection can be performed to remove the diseased lymph nodes.
o
Prior
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 nasopharynx
o
Surgical
options
are
possible
in
the
form
of
nasopharyngectomy,
whether
done
endoscopically or via open approach.
o
The
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
o
Otitis
Media
with
Effusion
i.e
fluid
behind
the
ear
drum
-usually
a
ventiilation/drainage tube (grommet) can be inserted onto the eardrum
o
Vocal
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.
© Vincent Tan ENT
A grommet in place (red arrow) on the ear drum.
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This is how Epstein-Barr virus (EBV) looks like
under the electron microscope.
(image source: Wikipedia)
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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 ?”
© Vincent Tan ENT
Footer Text: Lorem ipsum dolor
D
R.
V
INCENT
T
AN
Consultant 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)
+603-3377 7864
+6012-3760 728
ENTdrvincenttan@gmail.com
