Understanding Nasopharyngeal Cancer

Nasopharyngeal cancer is a type of head and neck cancer that develops in the nasopharynx, the upper part of the throat located behind the nose and above the back of the mouth. According to the Singapore Cancer Registry Annual Report 2023, the incidence of nasopharyngeal cancer in Singapore remains one of the highest in the world, with 8.9 per 100,000 males affected per year. Outcomes for nasopharyngeal cancer have improved significantly, with advances in treatment modalities.

At the National Cancer Centre Singapore (NCCS), care for nasopharyngeal cancer is delivered and coordinated by multidisciplinary teams. This page explains how nasopharyngeal cancer is diagnosed and treated, and the support available throughout care.

What Is Nasopharyngeal Cancer

Nasopharyngeal cancer develops when cells lining the nasopharynx undergo genetic changes that cause them to grow and multiply in an uncontrolled manner. Over time, these abnormal cells can form a tumour and interfere with normal functions such as breathing, hearing and swallowing.

Nasopharynx cancer is sometimes grouped under the broader term nose cancer, although it is distinct from cancers that arise in the nasal cavity or sinuses. Its behaviour, risk factors and treatment approach are also different from other head and neck cancers.

How Nasopharyngeal Cancer Differs From Other Head and Neck Cancers

Nasopharyngeal cancer has several unique features:

• It often develops deep within the nasopharynx, making early detection more challenging
• It may spread early to lymph nodes in the neck
• It is more commonly treated with radiation therapy and chemotherapy rather than surgery

These characteristics influence how the disease is diagnosed, staged and managed.

Nasopharyngeal Cancer Symptoms

Nasopharyngeal cancer symptoms can vary depending on tumour size and spread. Early symptoms may be mild or non-specific.

Common nasopharyngeal cancer symptoms include:

• Persistent nasal blockage or congestion
• Nosebleeds or blood-stained nasal discharge
• Hearing loss, a feeling of fullness in the ear or recurrent ear infections on one side
• Ringing in the ear (tinnitus)
• Painless swelling of lymph nodes in the neck
• Headaches
• Facial numbness or weakness in more advanced cases

These symptoms can also occur with non-cancerous conditions. It is important to seek medical attention if such symptoms are persistent to determine their cause.

Nasopharyngeal Cancer Causes and Risk Factors

The precise causes of nasopharyngeal cancer are not completely known, though research has identified a number of factors that may increase risk.

Non-modifiable Risk Factors

• Infection with Epstein–Barr virus (EBV)
• Family history of nasopharynx cancer
• Male sex
• Increasing age

Environmental and Lifestyle Factors

• Diets high in preserved or salted foods
• Exposure to tobacco smoke
• Certain occupational exposures

Having these risk factors does not mean a person will develop nasopharyngeal cancer, and some individuals are diagnosed without any known risk factors.

How Nasopharyngeal Cancer Is Diagnosed

Diagnosis focuses on confirming the presence of cancer in the nasopharynx, evaluating how far it has spread and identifying features that influence treatment selection. Because early symptoms may be subtle, diagnosis often relies on a combination of clinical assessment, imaging and tissue analysis.

Clinical Examination and Endoscopy

Doctors may carry out a nasoendoscopy, which involves passing a thin, flexible camera through the nose to directly view the nasopharynx. This allows specialists to inspect areas that cannot be seen during a routine examination and to identify suspicious lesions for further testing.

Imaging Tests

Imaging is essential for evaluating disease extent and planning treatment. Depending on clinical findings, tests may include:

• MRI scans to assess tumour size, depth and involvement of nearby structures at the base of the skull
• CT scans to evaluate lymph node enlargement in the neck
• PET scans to detect cancer spread beyond the head and neck region

These imaging studies help define both local and distant disease.

Biopsy and Pathology

A biopsy is required to confirm nasopharyngeal cancer. Tissue samples obtained during endoscopy or guided procedures are examined by pathologists to confirm the diagnosis and determine the tumour's characteristics, which assist in treatment planning.

Blood Tests

Blood tests are used to assess general health and organ function. In some patients, additional tests may be performed to measure markers related to Epstein–Barr virus (EBV), which is commonly associated with nasopharyngeal cancer and may be useful in diagnosis or follow-up.

Staging and Classification

Staging describes the extent of nasopharyngeal cancer at diagnosis and provides a framework for selecting the most appropriate treatment approach.

Assessing Disease Extent

Doctors evaluate:

• The size of the tumour and its involvement of nearby structures, such as the nasal cavity or base of the skull
• Spread to lymph nodes in the neck, which is common in nasopharyngeal cancer
• Evidence of spread to distant organs, including the lungs, liver or bones

Why Staging Matters

Staging plays a central role in determining treatment intensity, predicting outcomes and planning follow-up care. It helps guide decisions on the use of radiation therapy, chemotherapy or combined approaches. Patients are encouraged to discuss what their stage means for their individual condition and treatment plan with their doctor.

Treatment for Nasopharyngeal Cancer

Management of nasopharyngeal cancer at NCCS is planned through close collaboration among specialists in head and neck oncology, medical oncology and radiation oncology. Treatment approaches are selected based on a detailed assessment of the disease and the individual's overall condition.

Key considerations include:

• Extent of disease at diagnosis, including lymph node involvement
• Biological and imaging features of the tumour
• General health and ability to tolerate treatment
• Individual priorities and preferences, where appropriate

Radiation Therapy

Radiation Therapy is the primary treatment for nasopharyngeal cancer. Advanced radiation techniques are used to deliver high-dose treatment to the tumour while limiting exposure to nearby structures such as the brain, eyes and salivary glands. Radiation therapy plays a central role across most stages of disease.

Proton Therapy

Proton therapy is an advanced type of radiation treatment that targets cancer cells using positively charged subatomic particles called protons. The unique physical properties of protons enable tumours to be more precisely targeted, minimising damage to nearby healthy tissues and organs. At NCCS, proton therapy is offered at the Goh Cheng Liang Proton Therapy Centre.

Chemotherapy

Chemotherapy is often combined with radiation therapy to improve treatment effectiveness. Depending on the stage and tumour behaviour, chemotherapy may be given:

• At the same time as radiation therapy to enhance its effect
• Before radiation therapy to reduce tumour size
• After completion of radiation therapy in selected situations

The timing and combination are carefully tailored to each patient.

Targeted Therapy and Immunotherapy

In selected cases, additional treatments such as targeted therapy or immunotherapy may be considered. These options are guided by tumour characteristics, disease stage and response to prior treatment, and are typically used in specific clinical situations.

What Treatment Aims to Achieve

Treatment goals in nasopharyngeal cancer focus on both disease control and long-term wellbeing. These may include:

• Eradicating the cancer where possible
• Lowering the likelihood of recurrence
• Managing symptoms related to tumour location
• Preserving speech, swallowing and overall quality of life

Supportive Care and Living With Nasopharyngeal Cancer

Care for nasopharyngeal cancer extends beyond active treatment, as the disease and its therapy can affect functions such as swallowing, hearing and speech. Supportive care is integrated early to help patients manage treatment-related effects and maintain daily function during recovery.

Support may include:

• Dietary and swallowing support, particularly for patients experiencing mouth dryness, sore throat or difficulty eating
• Assessment and management of hearing, voice or speech changes, which may occur due to tumour location or radiation therapy
• Rehabilitation services, including speech or swallowing therapy when needed
• Psychological and emotional support, helping patients adjust to treatment demands and recovery

Patients are encouraged to communicate any new or ongoing concerns so that supportive care can be initiated when needed.

Follow-Up and Monitoring

After treatment, structured follow-up is an important part of nasopharyngeal cancer care. Follow-up focuses on assessing treatment response, identifying early signs of recurrence and managing long-term effects related to the head and neck region.

Follow-up care may include:

• Clinical examinations, with attention to the nasopharynx and neck lymph nodes
• Imaging studies, used selectively to monitor disease status
• Blood tests, including monitoring markers when appropriate

Regular monitoring allows timely intervention if changes are detected and supports long-term recovery and wellbeing.

Guidance and Support at NCCS

Nasopharyngeal cancer presents unique challenges due to its location and the potential impact on hearing, speech and swallowing. At NCCS, care is delivered through close collaboration among surgeons, oncologists and supportive care teams to ensure that treatment and recovery are carefully coordinated.

Patients are supported with clear explanations, practical guidance and access to services that address both physical effects and emotional wellbeing throughout treatment and follow-up. Open discussion is encouraged so that patients can better understand their condition and participate actively in care planning.

For further information about nasopharyngeal cancer or to discuss your individual care plan, please speak with your NCCS care team or visit www.nccs.com.sg.

Commonly Asked Questions

1. Is nasopharyngeal cancer the same as nose cancer?

Nasopharyngeal cancer is sometimes referred to as nose cancer, but it specifically affects the nasopharynx and differs from cancers of the nasal cavity or sinuses.

2. Why is nasopharyngeal cancer often diagnosed later?

Nasopharyngeal cancer is often diagnosed late because early symptoms are mild and the nasopharynx is difficult to examine. Therefore, the cancer may not be detected until symptoms become more noticeable.

3. Can nasopharyngeal cancer affect hearing?

Yes. Tumours near the ear canal can affect hearing or cause ear fullness, especially on one side.

4. Is nasopharyngeal cancer linked to infections?

Yes. Infection with Epstein–Barr virus is strongly associated with nasopharyngeal cancer, although not everyone with EBV develops cancer.

5. Will treatment affect speech or swallowing?

Some treatments may temporarily affect speech or swallowing. Rehabilitation and supportive care are available to help manage these effects.