Nasopharyngeal cancer – How is it diagnosed?
Nasopharyngeal cancer is a rare head and neck cancer. The nasopharynx is the top part of the throat behind the nose. The type of cells from which cancer can develop in this area are surface lining cells (squamous epithelium) causing squamous cell carcinoma.
Symptoms
A blocked, painful or ringing ear is usually the earliest sign, and a blocked nose usually on one side progressing to both sides, sometimes with nose bleeds is another common symptom.
Sometimes there are no symptoms other than a neck lump which indicates that the cancer has already spread to lymph nodes.
If the disease is particularly advanced, the tumour can invade into the skull base, brain, or eyes with symptoms associated with those structures.
Making a diagnosis
The nasopharynx is a difficult area to examine for general clinicians because it requires specialised equipment, such as endoscopes.
Because the symptoms can be vague and mimic many more common ear, nose and throat (ENT) conditions, if the primary care physician doesn’t have a high index of suspicion for nasopharyngeal cancer, it can easily be missed.
ENT or head and neck surgeons are the best specialists to make the diagnosis.
A nasal endoscopy uses a thin, flexible tube with a tiny camera on the end, called an endoscope which allows the ENT to the see inside your nasopharynx. Local anaesthetic may be given.
After seeing a mass in the nasopharynx, an imaging scan like a CT- or MRI scan is indicated. This helps for staging if it’s a cancer and to exclude other conditions as a cause of a nasopharynx mass.
Biopsy under general anaesthesia is often necessary to make the histological diagnosis. This can sometimes also be achieved with ultrasound-guided needle biopsy of a neck node. This is done by a head and neck surgeon or radiologist.
Often another useful staging tool is a PET-CT scan to confirm whether the cancer has spread (haematogenous metastasis) or not.
Once all the tests have been performed to most accurately stage the cancer, recommendations regarding the optimum treatment should be made in a multi-disciplinary team. The goals are usually to cure the cancer, prevent recurrence, and maintain quality of life as high as possible.
This article is sponsored by Dr Reddy’s in the interest of education, awareness and support. The content and opinions expressed are entirely the healthcare expert’s own work and not influenced by Dr Reddy’s in any way.
Prof Chris Joseph is an ear, nose and throat surgeon practicing at Mediclinic Morningside, Gauteng. He is the current president of the South African Head and Neck Oncology Society.
Header image by Freepik
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