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Nasopharyngeal Cancers

Signs and Symptoms of Nasopharyngeal Cancer

In many cases, nasopharyngeal cancers get quite large before patients become aware of symptoms. The exact symptoms depend on where the tumor is located, how large it has gotten and whether it has spread before being detected. In general, you can have nasal symptoms, ear symptoms, cranial nerve symptoms or neck symptoms.13, Sham JS, et al. serous otitis media. An opportunity for early recognition of nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 1992;118:794-797.14, Neel HB, 3rd. Nasopharyngeal carcinoma: diagnosis, staging, and management. Oncology (Williston Park). Feb 1992;6(2):87-95; discussion 99-102.15 Wei WI, Sham JS. Nasopharyngeal carcinoma. Lancet. Jun 11-17 2005;365(9476):2041-2054.

  • A lump in the neck: Believe it or not, one of the most common ways that a nasopharynx cancer is detected is after it has spread to the lymph nodes in the neck. Up to 80 percent of people with NPC actually come to their doctor with a lump in the neck.14 Neel HB, 3rd. Nasopharyngeal carcinoma: diagnosis, staging, and management. Oncology (Williston Park). Feb 1992;6(2):87-95; discussion 99-102.
  • A blocked-up nose: Difficulty breathing from one or both sides of the nose (obstruction) can be caused by a large tumor blocking the nasal breathing passage.
  • Bleeding from the nose or mouth: This can be caused by a tumor in the back of the nose.
  • Ear problems: Ear related problems such as hearing loss on one side, ringing in the ear on one side, an ear infection in an adult or fluid behind the eardrum can be caused by a tumor mass blocking the Eustachian tube.
  • Cranial nerve (CN) problems: A problem with the cranial nerves can be caused by a tumor extending into the skull or along the skull base where the nerves exit. A tumor growing into one of these nerves can cause a variety of problems depending on which nerve is affected:
    • Slurred speech: CN XII is called the hypoglossal nerve, and it controls the muscles of the tongue.
    • Double vision: CN III, IV and VI are three different oculomotor nerves, and they control the muscles that move the eye.
    • Loss of feeling in part of the face: CN VIII is the third division of the trigeminal nerve, and it sends sensation signals from the lower part of the face to the brain.
    • Difficulty with shoulder movement: CN XI is called the spinal accessory nerve and controls movement of some of the shoulder and neck muscles.
    • Change in voice and swallowing: CN IX and X are called the glossopharyngeal nerve and vagus nerve and have a number of different functions, some of which include controlling muscles of the voice and swallowing.
  • Headache: A bad headache can be caused by a tumor growing into the skull.
  • Difficulty with mouth opening (trismus): This can happen when the tumor invades into muscles that move the jaw.

In rare cases, the cancer may not be detected until a patient has severe bone pain (in the legs or spine), and tests show a cancer. Then further tests find the nasopharynx cancer.16 Sham JST, Cheung YK, Chan FL, Choy D. Nasoparyngeal carcinoma: pattern of skeletal metastases. Br J Radiol. 1990;63:202-205. Even more rarely, metastases into the lungs or liver can lead to finding a nasopharynx cancer.

But don’t jump to any conclusions. You could have one or more of these symptoms but NOT have nasopharyngeal cancer. There are several non-cancerous causes of the same symptoms. That’s why you need to see a specialist.

References

1 Ho JH. An epidemiologic and clinical study of nasopharyngeal carcinoma. International journal of radiation oncology, biology, physics. Mar-Apr 1978;4(3-4):182-198.

2 Hildesheim A, Levine PH. Etiology of nasopharyngeal carcinoma: a review. Epidemiologic reviews. 1993;15(2):466-485.

3 Vaughan TL, Shapiro JA, Burt RD, et al. Nasopharyngeal cancer in a low-risk population: defining risk factors by histological type. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. Aug 1996;5(8):587-593.

4 Xu FH, Xiong D, Xu YF, Cao SM, Xue WQ, Qin HD, Liu WS, Cao JY, Zhang Y, Feng QS, Chen LZ, Li MZ, Liu ZW, Liu Q, Hong MH, Shugart YY, Zeng YX, Zeng MS, Jia WH. An epidemiological and molecular study of the relationship between smoking, risk of nasopharyngeal carcinoma, and Epstein-Barr virus activation. J Natl Cancer Inst. 2012 Sep.

5 Pelucchi C, Gallus S, Garavello W, Bosetti C, La Vecchia C. Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism. 2006;29(3):193-198.

6 Buell P. The effect of migration on the risk of nasopharyngeal cancer among Chinese. Cancer research. May 1974;34(5):1189-1191.

7 Yu, et al. Cantonese-style salted fish as a cause of nasopharyngeal carcinoma: a report of a case-control study in Hong Kong. Cancer Res. 1986;46:956-961.

8 zur Hausen, et al. EBV DNA in biopsies of Burkitt tumors and anaplastic carcinomas of the nasopharynx. Nature. 1970;228:1056-1058.

9 Henle G, et al. EBC specific IgA serum antibodies as an outstanding feature of nasopharyngeal carcinoma. Int J Cancer. 1976;17;1-17.

10 Yu MC, et al. Occupational and other non-dietary risk factors for NPC in Guangzhou, China. Int J Cancer. 1990;45:1033-1039.

11 Morris RE, Mahmeed BE, Gjorgov AN, Jazzaf HG, Rashid BA. The epidemiology of lip, oral cavity and pharyngeal cancers in Kuwait 1979-1988. The British journal of oral & maxillofacial surgery. Aug 2000;38(4):316-319.

12 Decker J, Goldstein JC. Risk factors in head and neck cancer. The New England journal of medicine. May 13 1982;306(19):1151-1155.

13 Sham JS, et al. serous otitis media. An opportunity for early recognition of nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 1992;118:794-797.

14 Neel HB, 3rd. Nasopharyngeal carcinoma: diagnosis, staging, and management. Oncology (Williston Park). Feb 1992;6(2):87-95; discussion 99-102.

15 Wei WI, Sham JS. Nasopharyngeal carcinoma. Lancet. Jun 11-17 2005;365(9476):2041-2054.

16 Sham JST, Cheung YK, Chan FL, Choy D. Nasoparyngeal carcinoma: pattern of skeletal metastases. Br J Radiol. 1990;63:202-205.

17 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

18 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 7, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

19 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

20 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010.