Nasopharyngeal Cancer: Key Symptoms, Risk Factors, and Treatment Options

NPC is a rare form of head and neck cancer that starts in the nasopharynx. The nasopharynx refers to the area above the throat behind the nose and just above the oropharynx including the mouth and throat. This type of cancer occurs in the lining of the nasopharynx, where abnormal cells begin to grow uncontrollably, forming tumours of a malignant nature. These tumours can eventually metastasize to lymph nodes, the liver, lungs, and bones.

Although nasopharyngeal cancer is a rare disease overall, it is significantly more common in some parts of the world compared to others. This includes areas of Asia, northern Africa, and the Middle East. In the United States, about 1 in every 100,000 people is affected by nasopharyngeal cancer. The disease predominantly affects people between 15 to 24 years and 65 to 79.

Types of Nasopharyngeal Cancer

Nasopharyngeal cancer is classified based on the type of cells involved. The World Health Organization has classified NPC into three major subtypes, including:

• Keratinizing squamous cell carcinoma (WHO type 1): This type includes tumour cells on the surface of the nasopharynx with associated keratin, a protein also found in the hair, nails, and skin.
• Non-keratinizing Squamous cell carcinoma (WHO type 2): In this, the tumour cells in the nasopharyngeal tissue do not contain keratin.
• Undifferentiated or poorly differentiated Carcinoma (WHO type 3): This type consists of cells that appear extremely different from normal cells when examined through a microscope. Such cells multiply and spread in rapid manners hence being quite aggressive.

Symptoms of Nasopharyngeal Cancer

One symptom that could assist the doctor in diagnosing the sickness is a painless lump in the neck. This is brought about by the cancerous cells that have built up in lymph nodes in the neck, making them swell up. However, nasopharyngeal cancer also has other symptoms that may affect various other parts of the body:

• Tinnitus or ringing in the ears.
• Hearing impairment or ringing in the ears.
• Chronic ear infections resistant to treatment.
• Headache, ranging from mild to severe. Nosebleed and stuffiness of the nose or blockage.
• Shortness of breath or an inability to speak loudly without some hindrance in the back of the nasal passages.
• Pain and numbness in the face, especially in areas around the mouth or eyes.
• Problematic opening of the mouth and tenderness during chewing.
• A strange voice change or hoarseness.

Many of these symptoms can be shared with more benign conditions; an infection or allergy would render them hard to pick up when they are in their early stages. To have any one of these symptoms persist for more than two weeks, or to recur frequently requires being checked by a health professional.

Causes and Risk Factors

The exact cause of nasopharyngeal cancer is not known, but several risk factors have been identified. These can predispose a person to the condition:

• Tobacco use: Smoking or using any form of tobacco significantly raises the chances of acquiring nasopharyngeal cancer.
• Habitual alcohol use: Consuming large amounts of alcohol over a long period can help influence the development of nasopharyngeal cancer.
• Epstein-Barr virus (EBV): This virus has been associated with mononucleosis, but there is also an apparent strong association between the virus and nasopharyngeal cancer. Individuals who have a high level of EBV antibodies in their system may be at an increased risk.
• Dietary habits: Frequent ingestion of food preserved by salting, such as certain types of preserved fish and meats, appears to increase the risk for this type of cancer.
• Exposure to the environment: A person who is exposed to large amounts of smoke, dust, or fumes related to chemicals has a greater tendency in the development of the disease.
• Family medical history: Genetic influence is there makes people from a family where one of its members has been diagnosed with nasopharyngeal cancer at risk.
• Geographic and racial factors: People belonging to Southeast Asia, southern China, and northern Africa are commonly found to be affected by nasopharyngeal cancer.

In cases where nasopharyngeal cancer is suspected, a doctor will have a person undergo a full physical examination and obtain a medical history, especially regarding family history. Several tests will confirm the diagnosis, including the following:

• Epstein-Barr Virus Test: This is a blood test that measures the amount of EBV in the body, as this virus is usually associated with cancer in the nasopharynx.
• Biopsy: A small tissue sample is taken from the nasopharynx to be examined under a microscope.
• Imaging studies: These may be in the form of CT scans, MRI scans, and PET scans to outline the tumour and its possible spread to adjoining tissue or organs.

Stages of Nasopharyngeal Cancer

The staging of nasopharyngeal cancer is based on the size of the tumour and the extent of its spread:

• Stage 0: The cancerous cells are confined to the top layer of the nasopharyngeal tissue.
• Stage I: The tumour has grown into the surrounding area, such as the nasal cavity or to the back of the throat.
• Stage II: Cancer has spread to lymph nodes on one side of the neck.
• Stage III: The tumour has spread to lymph nodes on both sides of the neck.
• Stage IV: Cancer has spread to areas outside the head and neck region, such as the skull, eyes, cranial nerves, or remote organs like the liver or lungs.

Nasopharyngeal Cancer Treatment Options

The stage of the disease, as well as the patient's general state of health, primarily dictates treatment for nasopharyngeal cancer. The following are common treatment options:

• Radiation therapy: Uses high-energy rays to target and destroy cancer cells.
• Chemotherapy: Treatment that involves the use of drugs to kill cancer cells or prevent further growth and division.
• Chemoradiation: A combination of chemotherapy and radiation may be used to enhance the effectiveness of treatment.
• Targeted therapy: Medications that attack the cancer cells while limiting damage to healthy cells.
• Surgery: Though rarely done, surgery could be performed to remove a tumour or lymph nodes that have not improved through other treatments.

Possible Side Effects of Treatment

These treatments can result in side effects, which might vary from one patient to another. Some of the common side effects include:

• Fatigue
• Nausea
• Skin irritation
• Hair loss

Managing these side effects is part of the treatment, and health professionals may refer a patient for palliative care to assist in maintaining the quality of life while receiving treatment.

Prognosis and Survival Rates

The prognosis of nasopharyngeal cancer depends on various factors, including the stage of cancer and early diagnosis. In the United States, the five-year survival rate for nasopharyngeal cancer patients is approximately 63%. Early detection leads to better outcomes:

• Localized cancer: 82% five-year survival rate.
• Regional disease: 72% five-year survival rate.
• Metastatic disease: 49% five-year survival rate.

These are average survival rates, and individual outcomes may vary based on overall health and treatment responses.

Living with Nasopharyngeal Cancer

Living with nasopharyngeal cancer presents both physical and emotional challenges. Patients must work closely with their healthcare team to manage symptoms and ensure proper nutrition. Emotional support, such as from local or online support groups, can also help alleviate the mental stress that comes with the disease. Engaging in activities like mindfulness or meditation can further assist in reducing stress and enhancing overall well-being.