Nasopharyngeal carcinoma is a condition in which cancerous cells form in the nasal cavity.
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What Is Nasopharyngeal Carcinoma?
Nasopharyngeal carcinoma (NPC) is the most common cancer occurring in the nasopharynx, which is located behind the nose and above the soft palate (at the back of the throat).
During nasal breathing, air passes through the nose and nasopharynx before reaching the larynx, trachea, and lungs. On each side of the nasopharynx are tubes that connect to the ears, known as the eustachian tubes. These tubes are responsible for equalizing the pressure inside the ears, causing the familiar “pop.”
Nasopharyngeal cancer typically arises in the thin lining of the nasopharynx in the space behind the eustachian tubes.
How common is nasopharyngeal cancer?
Nasopharyngeal carcinoma is rare in the United States, although in other parts of the world — specifically southern China — it occurs much more frequently, and most commonly in men.
What causes nasopharyngeal cancer?
The exact cause of most cases of NPC is not known. But scientists have found links with certain diets, infections, and inherited factors.
Eating certain foods
Eating a diet high in salt-cured fish and meat seems to increase the ability of EBV to cause NPC. Studies show that foods preserved in this way produce chemicals that may damage DNA. The damaged DNA then changes a cell’s ability to control its growth and reproduction.
Epstein-Barr virus infection
Scientists have studied how the Epstein-Barr virus (EBV) may cause cells in the nasopharynx to become cancerous, but there's still a lot to learn. In developed countries, most people infected with EBV get infectious mononucleosis (mono), and their immune systems can recognize and destroy the virus. These people recover without any long-term problems. But in some cases, pieces of EBV DNA mix with the DNA of cells in the nasopharynx.
DNA, the chemical in each of our cells that makes up our genes, contains the instructions for how our cells work. Some genes contain instructions that control when cells grow and divide into new cells.
Viruses like EBV also contain DNA. When a cell is infected with the EBV virus, the viral DNA may mix with the normal human DNA. Then the EBV DNA may tell the cells of the nasopharynx to divide and grow abnormally.
Still, EBV infection rarely leads to NPC, so other factors, such as lifestyle and genetic factors, probably play a role in whether it causes cancer.
Inherited factors
Some studies suggest that inheriting certain tissue types may contribute to a person’s risk of developing NPC. Because the tissue type plays a role in the function of the immune system, some scientists suspect that an abnormal immune reaction to EBV infection may be involved.
Nasopharyngeal cancer risk factors
- Age — In areas where NPC is common, the cancer tends to be seen in younger people. About one in five people diagnosed with NPC are under age 30, with most diagnoses being made before the age of 60.
- Alcohol use — Some studies have linked heavy alcohol drinking to this type of cancer, particularly in the U.S. and Europe.
- Diet — There is strong evidence that eating high amounts of Cantonese-style salted fish increases the risk of nasopharyngeal cancer. Cantonese-style salted fish is generally made by drying the fish, using less salt and a higher degree of fermentation during the drying process than fish preserved (or salted) by other means.
- Epstein-Barr virus (EBV) – EBV infection is a cause of nasopharyngeal cancer. Yet, this virus alone is not enough to cause the cancer to develop. Other factors, such as genetics, or lifestyle choices, such as smoking, may affect how the body deals with EBV, which may affect EBV’s role in the development of NPC.
- Family history — Family members of people with NPC are more likely to get this cancer. It's unclear if this is due to inherited genes, shared environments, or both. Just like blood types, people have different tissue types. Some inherited tissue types increase the risk of NPC, possibly affecting how the body responds to EBV infection.
- Human papillomavirus (HPV) infection — HPV is a group of more than 150 types of viruses, some of which can cause cancer, including mouth, throat, and head and neck cancer. High-risk HPV types may be linked to NPC in young people who don’t smoke.
- Occupational exposure – Jobs that expose a person to wood dust and formaldehyde put them at higher risk for nasopharyngeal cancer.
- Tobacco use — Smoking tobacco is a cause of nasopharyngeal cancer. Smoking might increase the risk of NPC by reactivating an EBV infection.
Complications of nasopharyngeal cancer
Left untreated, NPC can become life-threatening.
Without treatment, nasopharyngeal carcinoma can:
- Block airflow — Causing nasal speech and affecting nearby structures like the ears and sinuses.
- Cause debilitating symptoms — Including headaches, ear infections, hearing loss, neck pain, nerve damage, and neurological issues.
- Invade critical areas — Like the skull base, cranial nerves, or spine.
- Metastasize to other organs — Such as the lungs, liver, or bones.
- Spread to lymph nodes — Even before symptoms appear.
How can I prevent nasopharyngeal cancer?
There are no blood tests or screening exams that can find this cancer early. That’s why it’s recommended that you visit your dentist regularly for your overall health. Dentists examine the tissues of your mouth, nose, and throat at each visit and can recognize changes before you may notice them.
What Are the Signs and Symptoms of Nasopharyngeal Carcinoma?
Because the cancer grows within air-filled spaces, symptoms of NPC may not arise until the tumor has grown large enough to obstruct airflow or affect the sense of smell or vision.
Other symptoms of NPC include:
- A lump in the neck caused by a swollen lymph node.
- A sensation of fullness or pressure in the ear.
- Headaches.
- Impaired “hypernasal” speech.
- Nasal regurgitation (having food and liquid come out of your nose).
- Popping noises, hearing loss, and ear infection.
In advanced cases, infiltration of NPC into the spine can cause:
- Neck instability
- Pain
- Stiff neck
How Do You Diagnose Nasopharyngeal Carcinoma?
If nasopharyngeal carcinoma (NPC) is suspected, your doctor will perform an exam of the nasal and sinus areas and ask about your symptoms.
Tests to diagnose nasopharyngeal cancer
Your doctor may request imaging tests to help determine whether the cancer has spread.
Lab tests
Doctors may run blood tests to check overall health and look for signs the cancer has spread.
These include:
- CBC (complete blood count).
- Liver and kidney function tests.
- EBV IgA test: Can help diagnose and predict outcomes, especially in areas where this cancer is more common.
Imaging scans
Different scans help doctors see how far the cancer has spread:
- CT scan (with contrast) — Best for checking bones, soft tissues, and neck lymph nodes.
- MRI — Shows brain involvement, nerves, and muscles in great detail without the use of radiation.
- PET scan — Used to check if treatment worked or if the cancer has come back. Also helps find cancer in other parts of the body.
Biopsy
Doctors can take a small tissue sample from the nasopharynx using an endoscope, a thin tube placed through the nose. If swollen neck lymph nodes are found, they can be tested using fine needle aspiration.
Nasopharyngeal cancer prognosis
Thanks to better radiation treatments, patients with NPC now have a much higher chance of survival. In the past, only about 25% to 40% of people lived at least five years after diagnosis. Today, that number has risen to around 70%.
How Do You Treat Nasopharyngeal Carcinoma?
At UPMC, the preferred surgical treatment for nasopharyngeal carcinoma is the endoscopic endonasal approach (EEA). This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors.
Benefits of EEA include:
- No incisions to heal.
- No disfigurement.
- Faster recovery time.
Treatment for nasopharyngeal carcinoma may consist of:
- Surgery.
- Radiotherapy.
- Chemotherapy.
Usually, a combination of these treatments is offered, depending on several factors, including:
- The stage and type of the tumor.
- Your age.
- Your preexisting medical conditions.
Most nasal tumors, whether cancerous or not, require surgery.
Surgery
Nasopharyngeal carcinoma may be approached directly using the endoscopic endonasal approach (EEA). This state-of-the-art, minimally invasive approach allows surgeons to access the tumor through the natural corridor of the nose, without making an open incision. Surgeons then remove the tumor through the nose and nasal cavities.
EEA offers the benefits of:
- Faster recovery time.
- No disfigurement.
- No incisions to heal.
Radiotherapy
UPMC offers state-of-the-art radiation therapy as a treatment option. This allows doctors to directly target the nasal cavity and treat the cancer effectively — while limiting radiation that might adversely affect areas, such as the eyes, optic nerves, brain, and spinal cord.
Chemotherapy
Anticancer drugs (chemotherapy) may be used in combination with surgery and radiation therapy treatments.
