Nasopharyngeal Cancer ("Nose" Cancer)

Nasopharyngeal or "nose" cancer (NPC) arises from the nasopharynx, a small anatomic space located directly behind the nasal cavity. This space is bordered on either side by the Eustachian tubes, narrow passages that connect the middle ear to the upper aero-digestive tract. Due to this unique spatial arrangement, a small tumor in the nasopharynx can obstruct the Eustachian tube and cause accumulation of fluid in the middle ear, resulting in hearing loss in that ear.

Risk factors for NPC include Ebstein Barr Virus (EBV) infection and excessive salted fish consumption. There is a strong genetic predispostion for NPC, and it is seen with highest frequency in Chinese males of Cantonese descent originating from the Quangdong province in Southern China.

The large majority of NPCs consist of poorly differentiated or undifferentiated carcinoma (descriptive terms for the appearance of the cancer under the microscope).

NPC is distinct from other squamous cancers of the upper aero-digestive tract in its epidemiology, biology, clinical behavior, and treatment.


Symptoms:

          Hard painless neck lumps on one or both sides of the neck
          Nasal congestion
          Blood tinged nasal discharge or sputum
          Hearing loss, especially if one-sided


*The most common presentation for NPC is a painless neck lump (representing an enlarged lymph node) in an otherwise well young or middle-aged Chinese man of Cantonese descent.

Patients suspected of, or at risk of developing NPC should have a blood assessment for EBV antibodies, a fibreoptic nasoendoscopy and tissue biopsies for diagnosis. CT, MRI and often PET scans are required for accurate staging of the disease, and for treatment planning.


Treatment

The primary treatment for NPC is external beam radiation therapy, usually given in combination with chemotherapy.

Surgery is usually only considered for patients with recurrent disease (cancer that relapses after the completion of primary radiation and chemotherapy. Surgery may be in the form of a


          NASOPAHRYNGECTOMY for recurrent disease in the nasopharynx,

                  or, more commonly a

          RADICAL NECK DISSECTION for recurrent disease in the lymph nodes of the neck.


Prognosis

The 5-year cure rates for Stages I & II NPC are 90 – 98%, and for Stage III & IV, 60 – 75%.

Unlike SCC, recurrent NPC, if detected early is very treatable, and can result in good long-term survival.

The Thyroid Head & Neck Surgery Centre