Nose Cancer

One of the the most common head and neck cancers in Singapore is nasopharyngeal cancer (NPC) also known as Nose Cancer. It occurs in a small area behind the nose known as the nasopharynx or the post nasal space. The nasopharynx is closely related to the ears through the Eustachian tubes and to the skull base which separates it from the brain. The nasopharynx has a very profuse lymphatic drainage system that connects it to the lymph nodes in the neck.

Nose cancer is more common among the Chinese population and rare among Indians and the western population. Among the Chinese ethnic groups it is more common among the Cantonese. In Singapore, NPC occurs in 7% of all malignancies in males and 4% of all malignancies in females.

As the nasopharynx is located in a “silent” area, the early symptoms are vague and often ignored by patients. Early symptoms of NPC include headaches, tinnitus (especially in one ear only), nasal stuffiness, facial pain and minor episodes of nosebleeds.

In later stages patients present with: 1. Lymph node in the neck 2. Hearing loss due to fluid accumulation in the middle ear 3. Double vision due to involvement of the nerve supplying the eye muscles and 4. bleeding from the nose.

1.Endoscopic examination of the nose shows a tumor in the nasopharynx. This patient presented with bleeding from the nose
2. Examination of the ear shows an opaque ear drum due to fluid collection in the middle ear.
3. A large left neck lump mass in a patient with nose cancer. The cancer has spread to the lymph nodes in the neck.

Nasal endoscopy is the key to early diagnosis and is recommended if patient have vague nasal symptoms that do not respond to medical treatment, particularly if there is family history of nose cancer. With nasal endoscopy, it is possible to diagnose the cancer before it has spread out of the nasopharynx.
Tinnitus and hearing loss especially when it is one-sided may be a symptom of nose cancer. This results when the nose cancer extends to involve the muscles of the Eustachian tube which becomes dysfunctional. As a result a persistent negative pressure within the middle ear results in effusion or collection of fluid. This imparts a “straw colour” to the normally translucent ear drum.

Diagnosis

The diagnosis is confirmed by taking a tissue sample of the tumour. This is carried out with endoscopic guidance. The specimen obtained is sent for histopathology. Once the diagnosis is confirmed the patient is referred to the Cancer Centre for staging of the cancer and treatment. MRI / PET scans are usually done to stage the cancer.

Treatment

Treatment for NPC is radiotherapy as the tumour is radiosensitive. Depending on the histological type and the stage of the cancer, it may be combined with chemotherapy. The role of surgery is minimal and is reserved for recurrent tumours that have not responded to radio-and chemotherapy.