Nasopharyngeal cancer (NPC) used to be known as
“Guangdong cancer” for its prevalence in southern
China. As the early symptoms are not very noticeable,
the disease is often neglected until an advanced stage.
Its high incidence in the past might be explained by
people’s frequent consumption of salted food such
as fish and vegetables. With reduced intake of these
foods, the disease is occurring less commonly than
before.
How Common is Nasopharyngeal
Cancer?
In 2022, nasopharyngeal cancer was the 12th most common cancer in Hong Kong, accounting for 1.7% of all cancer deaths. A total of 772 new cases were reported during that same year, mainly among males, with a crude incidence rate of 16.5 males and 5.3 females per 100,000 people).
What are the Causes And Risk
Factors?
- Family history of having a direct relative who has
had nasopharyngeal cancer plays a major role in the
development of the disease.
- Infection with the Epstein-Barr virus (EBV),
a common virus spread by droplets, is associated
with nasopharyngeal cancer in some patients.
- Genetic factors: Research suggests that people with
certain genetic make-up are at an increased risk of
developing nasopharyngeal cancer.
- Diet: Frequent consumption of salted food such as
fish and vegetables may increase a person’s risk of
having the disease.
What are the Common Symptoms?
Symptoms of early nasopharyngeal cancer:
- Persistently having blood-stained nasal discharge
or sputum
- Pain, tinnitus and trouble hearing, especially on one
side only
- Enlarged neck lymph nodes (the area below the ears
and lower jaw)
Symptoms of advanced nasopharyngeal cancer:
- Headache and facial numbness
- Blurred or double vision
- Difficulty swallowing and hoarseness of voice
The early symptoms are often neglected. If detected
and treated early, more than 90% of the patients can
be cured.
How Does the Doctor Make the
Diagnosis?
The following procedures are indicated for patients who
are suspected to have nasopharyngeal cancer:
- Nasopharyngoscopy: A flexible optical instrument
is passed into the nose or mouth to look at the
nasopharynx. Cell or tissue samples can be taken for
biopsy during the procedure.
- Biopsy: Cell samples taken from the nasopharynx
are examined under a microscope to look for
abnormalities, determine whether nasopharyngeal
cancer is the major cause of neck lymph node
enlargement and find out whether cancer cells have
spread to neck lymph nodes.
- Blood test: This is to detect EBV-DNA and / or the
IgA-VCA antibody in serum.
- PET-CT scan and MRI: The high sensitivity and
accuracy over conventional diagnostics make them
the effective tools in detecting early nasopharyngeal
cancer and monitoring tumour recurrence and
metastasis.
How is Nasopharyngeal Cancer
Treated?
The following types of treatment may be given alone or
together, depending on the patient’s condition:
- Radiotherapy is the mainstay of treatment for
nasopharyngeal cancer, with Intensity-modulated
Radiation Therapy (IMRT) as the gold standard.
IMRT enables the therapist to adjust the intensity of
the radiation beams, thus precisely enveloping the
tumour in a high dose while sparing normal tissues.
IMRT is more effective in local disease control and
preservation of normal organ functions. The groundbreaking TomoHD is now in use in the Hospital and
is capable of more even dose distribution, mitigating
side effects after radiotherapy.
- Chemotherapy is given in combination with
radiotherapy to remove cancer cells in the head,
neck and other organs.
- Surgery may be performed if there is residual disease
or recurrence after radiotherapy or combination
therapy. Stereotatic Surgery (also known as X-knife)
treats localised residual disease while conventional
surgery removes the local tumour and affected neck
lymph nodes.
Early nasopharyngeal cancer can be treated with
radiotherapy alone. For mid-and-late stage disease,
combination therapy should be used. Doctors will
plan the most appropriate treatment according to the
patient’s condition.
Is There Any Method to Screen for
Nasopharyngeal Cancer?
Those whose direct relatives have had
nasopharyngeal cancer are at an increased risk. As
the age of disease onset is usually about the same in
a family, they are recommended to start having regular
screening 5 to 10 years before the onset age. Blood
test is an effective screening tool because EBV-DNA
and/or the IgA-VCA antibody are often found in the
serum of nasopharyngeal cancer patients.
Among the cases confirmed by screening,
approximately 50% are classified as Stage I, while
it drops to fewer than 10% when clinical symptoms
surface. Early detection is thus crucial to the clinical
outcomes of cancer treatment.
We provide a nasopharyngeal cancer screening
package for those with a family history of the disease.
Procedures consist of basic physical examination,
medical history taking, blood test for the presence of
EBV-DNA and/or the IgA-VCA antibody and follow-up.
Please contact us for details.
We also provide patients and their relatives with
education on the nature and specifics of the related
malignancy, diagnosis and treatment.
How Can Nasopharyngeal Cancer
Be Prevented?
In nasopharyngeal cancer, diet is the only risk factor
that can be modified to prevent the disease from
happening. Dietary modifications mean avoiding salted
food and eating plenty of fresh fruits and vegetables. As
a healthy lifestyle always helps to prevent diseases, it is
also important to exercise regularly and stay away from
smoking. Those at an increased risk of nasopharyngeal
cancer should have regular screening tests so that
the disease can be detected early if they become
unfortunately affected.