Beyond The Sniffles, How Nasopharyngeal Cancer Often Goes Overlooked

KUALA LUMPUR, Feb 12 (Bernama) -- Persistent nasal congestion, unexplained ear symptoms such as blocked hearing, ringing in the ears, or painless neck lumps are often dismissed as common ear, nose and throat complaints, but medical experts warn that in some cases these symptoms may be linked to nasopharyngeal cancer (NPC).

NPC is a disease that develops in a concealed area behind the nose and frequently presents with non-specific early signs, and in Malaysia, it is one of the most common cancers affecting men, with cancer-related deaths accounting for 14.3 per cent of all deaths in 2024, up from 13.8 per cent in 2023.

Sunway Medical Centre Velocity (SMCV) Consultant Clinical Oncologist Dr Hafizah Zaharah Ahmad said early detection plays a decisive role in improving clinical outcomes, with survival rates exceeding 90 per cent when the disease is identified at an early stage.

She noted that symptoms are often initially managed as sinusitis, allergies or ear infections, stressing the importance of recognising the disease when symptoms persist beyond the usual course of treatment.

The disease arises from the nasopharynx, the area located behind the nose and above the back of the throat, and its deep anatomical position makes early tumours difficult to detect during routine examinations, allowing the disease to progress quietly before clear warning signs emerge.

“From symptoms to diagnosis, NPC often follows recognisable patterns linked to tumour location and spread, with nasal symptoms such as persistent blockage, nosebleeds or nasal discharge occurring when the tumour develops within the nasopharynx,” she said in a statement today.

She explained that tumour involvement near the Eustachian tube, the canal connecting the middle ear to the nasopharynx, can lead to fluid accumulation in the middle ear, resulting in one-sided hearing loss, ear fullness, ringing in the ears or ear pain, symptoms commonly mistaken for routine ear conditions.

Dr Hafizah Zaharah added that the disease extends to surrounding structures, patients may experience headaches, double vision or facial numbness, while painless neck lumps caused by lymph node spread remain a common presenting feature.

In the same statement, the SMCV Consultant Ear, Nose, Throat and Head and Neck Surgeon, Dr David Yee Leong Wai, explained that many patients only seek medical attention after noticing painless neck swellings caused by enlarged lymph nodes, which are often overlooked or assumed to be harmless because they do not cause discomfort.

He added that risk factors associated with NPC include Epstein Barr virus infection, smoking, family history, genetic susceptibility and diets high in preserved or salted foods, noting that the disease is diagnosed more frequently in men, particularly those between 40 and 60 years of age, and shows higher prevalence among individuals of Asian descent.

Thus, he said, accurate diagnosis relies on a structured assessment and staging process, including nasoendoscopy to directly visualise the nasopharynx with imaging tools such as MRI and CT scans to assess tumour size and spread, and a biopsy for tissue confirmation.

“A biopsy is mandatory to confirm the diagnosis and determine the cancer type. By doing the biopsy, we can histologically grade the NPC using World Health Organisation (WHO) classification, which plays an important role in predicting prognosis and treatment trajectory,” Dr Yee said.

Meanwhile, according to Dr Hafizah Zaharah, treatment decisions are closely guided by disease stage, with early stage disease potentially treated with radiotherapy alone, while locally advanced cases typically require concurrent chemotherapy and radiotherapy to improve disease control.

She said radiotherapy remains the cornerstone of treatment due to the tumour’s sensitivity to radiation, with advances such as intensity-modulated radiotherapy and volumetric modulated arc therapy allowing precise targeting of the tumour while minimising damage to surrounding critical structures, including the brainstem, nerves and salivary glands.

Adding to that, Dr Yee said although surgery is not commonly used as a primary treatment, it plays an important role in selected cases, particularly for residual or recurrent disease after radiochemotherapy, with advances in endoscopic techniques now allowing surgeons to access the nasopharynx through the nasal passages, reducing surgical trauma and supporting improved recovery and quality of life.

“During treatment, patients may experience side effects such as fatigue, nausea, reduced appetite, skin reactions and oral ulcers, which are managed through supportive medication, nutritional intervention and close monitoring, with dietitian support playing an important role in maintaining strength and weight.

“Following completion of treatment, regular follow-up with ENT specialists and oncologists is essential to monitor recovery and detect recurrence early,” he said.

--BERNAMA