Nasopharyngeal cancer (also known as NPC) is a tumour which develops in the lining of the nasopharynx (the area of the upper part of the throat behind the nose). NPC is quite common and accounts for around 5% of all cancers in Malaysia.  It usually starts at the age of 35 years with a peak incidence of around 50-60 years

Main Causes of Oral Cancers are

• Genetic (common in Southern Chinese)
• Family history
• Smoking
• Salted fish or preserved vegetables
• Wood dust or industrial fumes (formaldehyde)
• Epstein-Barr Virus

Click to view BeyondFive video on NPC

Symptoms & Signs of NPC

• Tinnitus which is a buzzing sound in one ear (early sign)
• Decreased hearing in one ear
• Blocked or recurrent infection in one ear
• Blocked or congested nose
• Swollen gland in the neck
• Recurrent nose bleeds
• Headache or double vision (late sign)

CT, MRI & PET Scans helps to localise the NPC to help doctors plan treatment.

Stages of NPC

AJCC	TNM	Description
0	Tis N0 M0	The tumour is in the top layer of cells lining the inside of the nasopharynx, and has NOT grown any deeper (Tis).  The cancer has NOT spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
1	T1 N0 M0	The tumour is in the nasopharynx. It might also have grown into the oropharynx (the part of the throat in the back of the mouth) and/or nasal cavity but no further (T1).The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0)
2	T1 N1 M0	The tumour is in the nasopharynx. It might also have grown into the oropharynx (the part of the throat behind the mouth) and/or nasal cavity but no farther (T1).  The cancer has spread to 1 or more lymph nodes on ONE SIDE of the neck or it has spread to lymph nodes behind the throat. There are NO lymph nodes larger than 6 cm across (N1). The cancer has not spread to distant parts of the body (M0)
	T2 N0/1 M0	The tumour has grown into the tissues of the left or right sides of the upper part of the throat but NOT into bone (T2).  The cancer has not spread to nearby lymph nodes (N0) or it has spread to 1 or more lymph nodes on ONE SIDE of the neck or it has spread to lymph nodes behind the throat.  There are NO lymph nodes larger than 6 cm across (N1).  The cancer has not spread to distant parts of the body (M0).
3	T0/1 N2 M0	The tumour is in the nasopharynx. It might also have grown into the oropharynx (the part of the throat behind the mouth) and/or nasal cavity but no farther (T1) OR no tumour is seen in the nasopharynx but cancer is found in lymph nodes in the neck and is Epstein-Barr virus (EBV) positive, which makes it very likely to be NPC (T0).  The cancer has spread to lymph nodes on BOTH sides of the neck, none of which is larger than 6 cm across (N2). The cancer has not spread to distant parts of the body (M0).
	T2 N2 M0	The tumour has grown into the tissues of the left or right sides of the upper part of the throat but not into bone (T2). The cancer has spread to lymph nodes on BOTH sides of the neck, none of which is larger than 6 cm across (N2).  The cancer has not spread to distant parts of the body (M0).
	T3 N0-2 M0	The tumour has grown into the sinuses and/or the bones nearby (T3). The cancer might or might not have spread to nearby lymph nodes in the neck or behind the throat, but none are larger than 6 cm across (N0 to N2).  The cancer has not spread to distant parts of the body (M0).
4a	T4 N0-2 M0	The tumour has grown into the skull and/or cranial nerves, the hypopharynx (lower part of the throat), the main salivary gland, or the eye or its nearby tissues (T4). The cancer might or might not have spread to nearby lymph nodes in the neck or behind the throat, but none are larger than 6 cm across (N0 to N2). The cancer has not spread to distant parts of the body (M0).
	Any T N3 M0	The tumour might or might not have grown into structures outside the nasopharynx (any T). The cancer has spread to lymph nodes that are either LARGER THAN 6 cm across, or located in the shoulder area just above the collarbone (N3).  The cancer has not spread to distant parts of the body (M0).
4b	Any T Any N M1	The tumour might or might not have grown into structures outside the nasopharynx (any T). The cancer might or might not have spread to nearby lymph nodes (any N).  The cancer has spread to distant parts of the body (M1).

Treatment of NPC

Nasopharyngeal cancer is treated by a team of doctors and health professionals which include the ENT surgeon, Dietician and Oncologist.  Treatment requires

• Intensive Modulated Radiotherapy
• Concurrent Chemo-Radiotherapy
• Neck dissection or Naso-pharyngectomy surgery (required if chemo-radiotherapy fails)

Discuss the treatment options with your ENT specialist

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