Courtesy of THIS Quarterly magazine  
Nose Cancer  

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

Detection and diagnosis:

• EBV Serology: In recent years, EBV-serology screening has been introduced
  to help early detection.

• Endoscopic examination: Over the last 20-30 years, ENT (ear, nose and
  throat) specialists have routinely used endoscopes, inserted into the nose
  and pharynx, to detect NPC and other head and neck cancers. Most ENT
  clinics in Singapore are equipped to do such procedures.


• NBI – Narrow Band Illumination: This form of video endoscopy uses a
  special Narrow Band Illumination (NBI) function. NBI makes use of a
  specific wavelength of light to illuminate the area. This special light enhances
  the blood vessels of extremely early cancers which are not yet bulky enough
  to be seen under normal light. With the help of NBI, head and neck cancers
  can be detected earlier and more accurately.

Signs and symptoms of NPC:

  1. B lood-stained sputum, usually first thing in the morning. If there is bleeding from a tumour, the blood usually flows into the throat overnight. If the bleeding is excessive, there may also be bleeding from the nose.

  2. A “blocked” sensation in the ear, hearing loss or tinnitus (a ringing sound) for no apparent reason. The tumour is often situated where the Eustachian tube of the ear opens into the nose. This may affect the normal function of the Eustachian tube. The blocked sensation would be similar to the feeling you may have when landing in a plane or when you have a bad head cold.

  3. Abnormal lumps in the neck. NPC often spreads to the lymph nodes in the neck.

  4. Blocked nose, headache, problems with the nerves controlling eye movement, vision and other cranial nerves. These are possible symptoms of later-stage NPC. In later-stage NPC, the cancer may spread to the bones, lungs and liver.

If a person has a family history of NPC, he or she should be particularly vigilant about watching out for NPC symptoms and signs. If the family history of NPC is strong, it may be advisable to do an EBV-serology (cancermarker)
screening. If the results of this screening are high, it may be wise to have regular NPC check-ups. n

Dr Lau Chee Chong
Senior Consultant, Ear Nose Throat, Head & Neck Surgery

Ear Nose & Throat Centre CC Lau
3 Mount Elizabeth
#14-11 Mount Elizabeth Medical Centre
Singapore 228510
Tel : (65) 6235 9535
Fax : (65) 6738 4377
Website :