Nasopharyngeal cancer

Nasopharyngeal cancer (NPC) most commonly presents with a neck mass. Epistaxis, nasal obstruction, unilateral otitis media with effusion (serous otitis media), tinnitus, or impaired hearing in one ear should raise suspicion of NPC, particularly in an Asian patient.

Risk factors for NPC include a history of Epstein-Barr virus (EBV) infection, diet rich in salted fish, smoking or other tobacco use, and a family history of NPC in a first-degree relative.

Confirm the diagnosis with endoscopic biopsy of the primary tumour and/or fine-needle aspiration/core biopsy of neck nodal metastasis.

Radiotherapy is the main treatment modality for non-metastatic NPC. Some patients with early-stage NPC can be treated with radiotherapy alone. Concurrent chemotherapy is added for locally advanced disease. Surgery, re-radiation, and chemotherapy are options for locoregional nasopharyngeal/neck nodal recurrence and metastatic disease. Documentation of remission after completion of treatment is important and can be done with clinical and radiographic assessments.

Plasma EBV after treatment can provide prognostic information and it can also be used for early detection of recurrences.

​NPC most often refers to squamous cell carcinoma (SCC) of the nasopharynx. It is a head and neck cancer arising from epithelial cells with three histopathological subtypes: non-keratinising SCC, keratinising SCC, and basaloid SCC.[1]Chen YP, Ismaila N, Chua MLK, et al. Chemotherapy in combination with radiotherapy for definitive-intent treatment of stage II-IVA nasopharyngeal carcinoma: CSCO and ASCO guideline. J Clin Oncol. 2021 Mar 1;39(7):840-59. https://ascopubs.org/doi/10.1200/JCO.20.03237?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed http://www.ncbi.nlm.nih.gov/pubmed/33405943?tool=bestpractice.com ​ Other malignant tumours of the nasopharynx (e.g., adenocarcinoma, adenoid cystic carcinoma, lymphoma, melanoma, and sarcoma) are extremely rare in comparison and are not covered in this topic.