Nose Cancer and Nose Cancer Screening
Nose Cancer and Nose Cancer Screening
What is Nose Cancer (Nasopharyngeal carcinoma)?
Nasopharyngeal carcinoma (NPC) is a cancer that arises from the back of the nasal cavity. It is more common in Asia than in Western countries.
What are the Signs and Symptoms of Nose Cancer?
What to look out for?
Common presenting complaints include:
• Block nose
• Double vision
• Neck lumps and bumps
• Blood stained saliva
• Hearing loss
NPC can behave like a silent killer. One can be asymptomatic or showing no symptoms before experiencing symptoms.
Over time, the tumour can grow, ulcerate and invade into nearby structures leading to nerve involvement and other symptoms as stated above.
A tumour can also spread to distant spread to other parts of the body.
What are the risk factors for Nose Cancer?
- Age and Gender
It is a cancer that is more common in males.
There is also a bimodal age presentation where occurrence peaks in younger and older adults.
Epstein – Barr virus (EBV) infection
The strong association between EBV infection and NPC is evident by anti-EBV antibody in the blood, an increased amount of EBV DNA levels in NPC tumour cells.
This is why EBV antibodies are used in the clinical setting for the screening of Nose cancer.
Human Papillomavirus (HPV) infection
The role of HPV in NPC is less clear-cut in comparison to EBV in NPC but studies have shown that there might be an association with Nose Cancer.
There is postulation that smoking contributes to risks of NPC by causing reactivation of EBV.
Even though there might not be sufficient evidence, smoking itself does cause many other diseases.
Consuming preserved food which contains a high level of nitrosamines like salted fish, bacterial mutagens and EBV-reactivating substances is another risk of NPC.
Some traditional Chinese medical herbs intake can lead to reactivation of EBV.
NPC has been associated with certain genetic predisposition and risks of NPC is increased in patients with first-degree relatives with NPC.
Nose Cancer Screening
- History and Physical Examination.
A thin camera also known as a flexible naso-endoscopy is useful for examination of the back of the nasal cavity and if needed, a tissue biopsy sample to be obtained at the same setting.
- Future Tests include:
A simple non-fasting screening blood test can be done to aid the detection of NPC.
Given the close association between EBV and NPC, laboratory blood tests like EBV viral DNA and EBV IgA serology tests can be performed in the screening of NPC for patients belonging in high risks groups.
Screening tests are recommended for patients who fall under the high risks group eg, those with positive family history.
However, studies have also shown that early NPC being an indolent killer due to its relatively asymptomatic nature, has a higher 5-year survival rate when detected at an early stage. (see reference below)
In addition, these tests can help to prognosticate treatment response and future recurrence of the same disease in patients diagnosed with NPC.
Other imaging studies include magnetic resonance imaging (MRI) might be useful.
Treatment for Nose Cancer
Treatment options include radiotherapy, chemotherapy and surgery. Combined therapy of radiotherapy and chemotherapy together with surgery might be considered based on the location and extent of the lesion.
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1 ) Chan, K. C. A., Woo, J. K. S., King, A., Zee, B. C. Y., Lam, W. K. J., Chan, S. L., … Lo, Y. M. D. (2017). Analysis of Plasma Epstein–Barr Virus DNA to screen for nasopharyngeal cancer. New England Journal of Medicine,378(10), 973-973. doi:10.1056/nejmx180004