Nasopharyngeal (Nose) Cancer 101: Symptoms, Causes, Stages & Treatment

Roughly 1 out of 4 Singaporeans end up developing cancer over their lifetime. Out of the different types of head and neck cancers, nasopharyngeal cancer is one of the most common.

What is Nasopharyngeal Cancer?

Nasopharyngeal carcinoma (or NPC for short) is a kind of cancer that occurs in the tissues at the area behind the nose and just above the back of the throat. 

Out of the different types of cancer cells that may develop in the nasopharynx, cancer developing in the squamous cells (surface lining cells) is the most common. Cancer of the white blood cells (lymphoepithelioma) is also common since many types of NPC involve white blood cells.

Nasopharyngeal Cancer Causes and Risk Factors

Listed below are the main risk factors associated with NPC. 

Ancestry/Ethnicity

According to research, NPC is more prevalent in Southeast Asia as compared to the rest of the world — with 15-50 cases per 100,000 people versus less than 1 case per 100,000 people. 

Hence, people of Southeast Asian ethnicity (including Singaporeans) are at greater risk of NPC as compared to other ethnicities. 

Gender and Age

NPC is the 8th most common cancer among Singaporean men. It affects men more frequently than women, and NPC usually occurs between the ages of 35 to 55 years. One’s risk of NPC increases with age.

Epstein-Barr Virus

The Epstein-Bar Virus (EBV) is one of the most common human viruses around. It’s also known as the virus that causes mononucleosis, or “mono”.

Exposure to EBV is closely associated with NPC — meaning that those infected by EBV may be at higher risk of developing NPC.

Lifestyle Factors

Tobacco and alcohol are two substances that greatly increase the risk of developing NPC.

Smoking cigarettes and cigars is the greatest risk factor for head and neck cancer, including NPC — about 85% of head and neck cancer is linked to tobacco use. 

Frequent and heavy consumption of alcohol is another risk factor for NPC. Smoking and heavy consumption of alcohol together increases this risk even more. 

Other lifestyle factors that increase the risk of NPC include high exposure to pollutants such as dust and smoke, as well as a diet heavy on salt-cured fish and meats.

Symptoms of Nose Cancer

One of the most common symptoms of NPC, as well as other head and neck cancers, is a lump in the neck. Other possible signs or symptoms include: 

• Nasal obstruction or “stuffiness”
• Sore throat
• Trouble breathing or speaking
• Frequent nosebleeds
• Trouble hearing or loss of hearing
• Pain, ringing or the feeling of blockage in the ear
• Headaches
• Unexplained weight loss

If you are concerned by any of the above symptoms, contact your doctor for a review. 

That said, these symptoms may be an indicator of another medical condition rather than NPC, and some people with NPC may not experience any of these symptoms. 

Detecting NPC is one of the biggest challenges when it comes to dealing with this cancer, according to Dr Ranjit Magherra, an ENT at JurongHealth.  “Because it grows in a ‘hidden’ area at the back of the nose called the nasopharynx, it is not easy to detect.” He added that there may not even be any obvious signs during the early stages of NPC. 

As such, going for a regular health screening is critical in helping to detect early stages of NPC — particularly if you fall into any of the above lifestyle risk factors — as well as other cancers and diseases.

Diagnosing Nasopharyngeal Cancer

The sooner NPC and other cancers are detected, the better one’s chances for a full recovery are. Your doctor may run through one or more of the following procedures to determine your diagnosis: 

Physical Examination and Blood Tests

Checks for NPC are usually done during your general regular health and dental screenings. The doctor will look into your nose, mouth and throat for abnormalities, as well as feel for any unusual lumps in the neck region. 

A blood test for EBV virus antibodies may be ordered at the same time, in order to check for current or previous EBV exposure, which may increase risks of developing NPC. 

Endoscopy and/or Biopsy

An endoscopy may be conducted so that the doctor can examine the inside of the nasopharynx area for any abnormalities. This is often done by inserting a thin flexible tube into the mouth or nose as the patient is being sedated.

In order for a doctor to confirm a cancer diagnosis in a particular area of the body, a biopsy is usually conducted. This involves taking a small sample of the tissue to be sent for examination and testing, which may be taken during the endoscopy procedure. 

Neurological Tests

The doctor may conduct an examination that tests a person’s nerve function, particularly related to the amount of sensitivity in their face, as well as the function of certain nerves in the head and neck area.

Other Tests

Other tests that may be conducted to aid in NPC diagnosis include MRI scans, CAT scans, ultrasounds and bone scans — these enable the radiologist to examine the images taken of the inside of the body and detect abnormalities. 

Nose Cancer Stages

After nasopharyngeal cancer has been diagnosed, the next step would be to determine what stage the cancer is at, and whether the cancer has spread to other parts of the body. 

The stages of NPC are: 

Stage 0 (very early stage)

Cancer cells detected in the nasopharynx, with no spread to the lymph nodes or other parts of the body. 

Stage I

Small tumor detected in the nasopharynx, with no spread to the lymph nodes or other parts of the body.

Stage II

Tumor detected in the nasopharynx that has extended beyond the area — may or may not have spread to the lymph nodes.

Stage III

A tumor that has spread to lymph nodes on both sides of the neck, but has not spread to further parts of the body, or a large tumor that extends into the area behind the nose and may or may not have spread to the lymph nodes, but not beyond.

Stage IVA

Any invasive tumors that spread to the inside of the head (brain or the lower part of throat) with more significant lymph node involvement and no distant spread, or any tumor over 6cm found in the lymph nodes. 

Stage IVB

Any tumor that has evidence of distant spread in the body. 

Nose Cancer Treatment

Many types of NPC can be cured, especially if they are discovered early. The more advanced the cancer, the more invasive the treatments typically are. 

Take the time to discuss all your treatment options with your doctor to find out which one is best for you, and so that you will know what to expect while undergoing treatment. Find out what you should eat when undergoing a cancer treatment regime, and check out more cancer care resources and services here. 

Here are some of the common treatments used for NPC: 

Radiation Therapy and Chemotherapy

Radiation therapy is one of the main treatments for NPC. This involves the use of high-energy e-rays to destroy cancer cells, with a number of treatments administered over a set period of time. 

Some side effects of radiation therapy may include irritation and swelling near the treated area, damage to salivary glands, difficulty swallowing, hearing loss and appetite loss. 

Radiation therapy is often combined with chemotherapy during treatment — this is known as chemoradiotherapy or concurrent chemotherapy. Chemotherapy is treatment involving the use of drugs to destroy cancer cells, by preventing existing cancer cells from growing and dividing. 

Some side effects of chemotherapy may include fatigue, nausea, vomiting, hair loss, dry mouth, diarrhea, constipation, and loss of appetite. Side effects may vary depending on the drugs used —  do consult your doctor on the potential side effects of each treatment route. 

Surgery

Surgery for NPC is sometimes used, though it is not a common treatment route as the nasopharynx area is hard to get to and lies quite close to cranial nerves and blood vessels. If this treatment option is exercised, it is usually to remove lymph nodes after chemoradiotherapy, or to treat recurring NPC. 

If you are opting for this treatment, do speak to your surgeon on what to expect post-surgery and if there might be any need for further reconstructive surgery.

Nose Cancer Prevention

One of the most important steps to take in mitigating one’s risk of NPC is to stop smoking, as well as to avoid second-hand smoke as much as possible. 

If you consume large amounts of alcohol frequently, reduce your alcohol intake to at most one glass for women and two glasses for men daily. 

A healthy diet that helps you maintain a healthy weight will help to reduce your risk of cancers and other diseases — here are some anti-cancer foods to incorporate into your daily diet for overall health. Regular exercise and staying active also play a part in reducing your risk of cancer and disease. 

Nose Cancer Support Group and Resources in Singapore

For patients and caregivers, joining a support group provides opportunities to get in touch with NPC survivors, as well as current patients and caregivers. 

One such support group is the NPC Support Group formed under the National Cancer Centre Singapore, which was formed by nose cancer survivors looking to share knowledge and provide emotional support to current patients and caregivers. 

Another NPC support group is the oneHeart Support Group under the National University Cancer Institute Singapore, which strives to be a community for patients and caregivers to learn more about navigating NPC, as well as conduct programmes for survivors, patients and caregivers to share their experiences.

For those taking care of loved ones, we have a list of caregiver support groups to assist you through this journey. 

Navigating a cancer diagnosis is never easy. For this journey, we have services for cancer caregivers to support you or your loved ones through the different stages, along with more caregiver resources and articles to help keep your loved ones safe and healthy.

Also, Homage has trained care professionals that are able to provide companionship, nursing care, night caregiving, home therapy and more, to keep your loved ones active and engaged. 

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