Courtesy of THIS Quarterly magazine  
Nose Cancer  

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs 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, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC
NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as:

  • Blood-stained sputum, usually first thing in the morning. Any bleeding from a tumour usually flows into the throat overnight. In rare cases, there may be bleeding from the nose.

  • A "blocked" sensation in the ear, hearing loss or tinnitus (a ringing sound) for no apparent reason. The tumour often occurs where the Eustachian tul›e of the ear opens into the nose and may affect the normal functions of the Eustachian tube. The blocked sensation would be similar to the sensation one might experience when landing in a plane.

  • Abnormal, persistent lumps in the upper neck. NPC often spreads to the lymph nodes in the neck.
Later-stage NPC symptoms include blocked nose, headache and problems with cranial nerves, eye-movement and vision. Eventually, the cancer may spread to the bones, lungs and liver.


Treatment – the good news
The good news is that early-stage NPC, if treated promptly and properly, enjoys an extremely high cure rate. Accordingly, early detection is incredibly important. 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: EBV-scrology (cancel-marker) screening, through a simple blood test, helps early detection.

  • Endoscopic examination: Over the last 20-30 years, ENT (ear, nose and throat) specialists have routinely used endoscopes (inserted into the nose or pharynx) to detect NPC and other head and neck cancels. This examination is done as an in-clinic procedure.

  • NBI - Narrow Band Illumination: Some clinics are equipped with video endoscopy with a special NBI function, which uses a specific wavelength of light to enhance blood vessels of extremely early cancers, which are not yet bulky enough to be seen under normal light. With NBI, head and neck cancers can be detected earlier and more accurately.

  • If you have a family history of NPC: You may want to do an EBV-serology screening. Depending on the results, regular NPC check-ups may also be advisable.

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 :