Overview
Nasopharyngeal cancer usually affects adults between 35 and 55 years of age and is 20 to 30 times more common in persons of Chinese (especially Cantonese) descent than in other races. It is more frequent in males than in females. If the cancer is detected early, it is curable.
In Singapore, it is the ninth most common cancer in men.*
* Source: Singapore Cancer Registry Annual Registry report, Trends in Cancer Incidence in Singapore 2015
Risk Factors
- Consumption of salted vegetables, fish, and meat is associated with nasopharyngeal cancer. Studies show that foods such as salted soy beans, canned pickled vegetables, Szechuan vegetables, and salted vegetables are high risk foods. The cooking of such foods releases toxic substances called nitrosamines into the fumes that are inhaled.
- The Epstein Barr virus has been found to be associated with nasopharyngeal cancer.
- Genetic factors may play an important role in nasopharyngeal cancer. Blood tests can identify certain people who are at risk.
- Nasopharyngeal cancer is found about 3 times as often in males as it is in females.
Screening
There are no simple non-invasive examinations or blood tests that can reliably detect nasopharyngeal cancer at an early stage.
Signs and Symptoms
Nasopharyngeal cancer often does not show any symptoms in the early stages. Some common symptoms may include:
- A painless lump in the neck is the most common symptom (80%). This could be a swollen lymph node infiltrated by cancer cells.
- Nose bleeding, blocked nostrils, excessive mucus secretion, and blood in saliva.
- Loss of hearing, ear pain, buzzing noises, and aural discharge.
These symptoms may be due to other medical conditions. However, if they persist, consult a doctor for further testing.
Diagnosis
Medical history and physical exam:
- Endoscopic Examination – A flexible fibro-optic tube with a light at its tip is introduced via the nose. The nasopharynx is visually examined and any suspicious lump is biopsied, i.e. a piece of tissue from the back of the nose is removed for examination under a microscope to confirm if cancer is present.
- CT Scan of Head and Neck – This is a special X-ray which can show the cancer and the extent of its spread. This test is used in planning treatment.
- Blood Tests – This determines the level of antibodies against the Epstein Barr virus. If the level is high, a diagnosis of nasopharyngeal cancer is suspected.
- Chest and Abdominal CT Scans, Bone Scans – These are performed to determine whether cancer has spread to other parts of the body.
- MRI Head and Neck and PET-CT scans have been increasingly used as alternatives to CT scans.
Treatment
Radiotherapy
Nasopharyngeal cancer responds well to radiotherapy. Hence, the use of radiotherapy or high energy x-rays forms the mainstay of treating nasopharyngeal cancer. Often this cancer requires a high dosage of x-rays to completely eradicate the cancer cells. If the cancer is detected early, radiotherapy may cure it. X-rays are delivered to the back of the throat and sometimes to the lymph glands in the neck. Temporary side effects of radiotherapy include redness of skin of the neck, reduced saliva production which causes dryness of the mouth and throat, mouth ulcers, and the loss of taste and appetite.
Surgery
The role of surgery is limited in nasopharyngeal cancer treatment because it is very difficult to surgically remove it without injuring vital neighbouring organs. If nasopharyngeal cancer recurs in an area which had received radiotherapy, surgery can be used to remove the recurrence.
Chemotherapy
Chemotherapy is the use of toxic drugs to kill cancer cells. Its role in nasopharyngeal cancer treatment is limited to 2 situations:
- Advanced nasopharyngeal cancer which has spread to the bones, liver, and lungs
- In combination with radiotherapy to improve the effectiveness of radiotherapy
Support Group
The New Voice Club consists of members who have undergone surgical treatment or laryngectomy. After surgery, patients lose their voices completely. Rehabilitation aims to help patients learn how to speak again, with or without speech devices. It also reaches out to new patients and renders emotional support to members and their families in coping with a ‘new voice’ after surgery. Speech practice sessions conducted by its members have enabled many to regain their ability to communicate with others.
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