The nasopharynx, basically is the deepest area of the nose, just before the entrance into back part of the mouth. When we break bad news to our patients- we will tell them- ‘kanser belakang hidung’ (cancer at the back part of the nose). Due to the location, this cancer usually has late presentation, as not visible from external view.
In 2007 National Cancer Registry, nasopharyngeal cancer (NPC) is the fourth most common cancer among population; after breast, colorectal and lung cancer. It is more common in male and patients of Chinese origin, comparatively to Malay, and very rarely in Indian population.
In the same registry, NPC was the most common cancer in Sarawak male and third most common cancer in Sabah male population. A previous study conducted in Sarawak, the incidence of NPC is comparatively as high as those from Southern Province of China, which happens to be the highest in the world. This is common among the Bidayuh, Iban, Kadazan, Dusun & other local pribumi in East Malaysia. In my current hospital in Kota Kinabalu, we see an average 3 new cases per week, which is comparatively high comparing to West Malaysian hospitals.
The cancer has a strong genetic link, which makes it more common to occur within the same race. It also tends to run in families, among siblings. The Ebstein Barr Virus (EBV) has a common occurrence among NPC patients, but then again, it is also endemic amongst our population, and so far the vaccination for EBV is still at research level.
You may ask, how does this cancer manifest itself? The cancer starts at a crease in the nasopharynx called the Fossa of Rossenmuller. This area is next to the Eustachian tube opening, which connects the ear to the nose. Once the tumour enlarges, it will grow forward into the nostril, downwards into the sides of the mouth and throat. Also, it extends upwards through the crevices at the base of skull and ultimately into the floor of the brain. As with other carcinoma, this cancer will spread via lymphatic drainage into the cervical region. The cancer tends to metastasize or spread to distant organs- typically lungs, liver and bone.
The patient will initially complain of
- blocked ear, typically one sided, described as hearing loss similar when having a runny nose
- bleeding from the nose and if the tumour large, nasal blockage may occur.
Once the tumour extends into the skull base, the cranial nerves will be affected. An array of neurological symptoms may occur
- reduced vision
- squint
- numbness of face
- difficulty in swallowing
- hoarseness of voice are among the common ones.
- Excruciating headache is a late symptom once the tumour has filled up the floor of the brain making it into a space occupying lesion.
The symptoms however, do not come in any particular order. Some may not have all the mentioned features. Some will only have neck swelling, usually on the sides, and painless. We have seen patients coming in with huge neck masses as large as a bowling ball before seeking any treatment. If there is an area of dead tumour cells- the skin will break and an area of discharging pus will occur and will leave the patient with a foul smelling fungating tumour at the neck. In late cases, the patient will have metastatic symptoms at distant organs. In rare cases, this may be the only presentation.
This article is a summary of
https://www.mmgazette.com/nasopharyngeal-carcinoma-east-malaysian-perspective-dr-ahmad-nordin/
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