| Nasopharyngeal Carcinoma (NPC) is the 6th most | | | | neck lump, reduced hearing in one ear, nose bleeds, |
| common cancer among males in Singapore. This | | | | blood stained postnasal drip, blocked nose, headaches |
| disease hits hard because the peak incidence occurs | | | | and double vision. The symptoms can be quite |
| in people who are in the prime of their working and | | | | non-specific and there seems to be a tendency for |
| family lives. In Singapore, it is the second and third | | | | patients to seek medical attention late. Even doctors |
| commonest cancer in males aged 15 to 34 years and | | | | can be misled, leading to a delay in referring the patient |
| 35 to 64 years respectively. The key to the | | | | to the specialist. A Singapore study showed that in |
| management of NPC is early detection. There is a | | | | nearly one fifth of NPC patients, the diagnosis was |
| 90% cure rate if the disease is treated at an early | | | | delayed by an average of 7.2 months due in part to |
| stage. | | | | clinicians not considering a diagnosis of NPC. It is for |
| This cancer has a distinct racial and geographical | | | | this reason that NPC is commonly diagnosed at a late |
| distribution. The highest incidence of NPC is in the | | | | stage (stage 3 or 4). This is unfortunate because the |
| Southern part of China (Guangdong province) and | | | | cure rate after treatment for stage 3 is only 60% and |
| Hong Kong hence the name "Cantonese Tumour". The | | | | it drops to below 50% for stage 4 disease. On the |
| incidence is also high among North Africans, the Inuits | | | | other hand, the cure rate for the earliest stage disease |
| of Alaska and the Chinese in South East Asian | | | | can be in excess of 90%. |
| countries. About 92% of NPC sufferers in Singapore | | | | The best way to examine the nasopharynx is via a |
| are Chinese while 6% and 1% are Malay and Indian | | | | nasoendoscopy done by an ENT specialist in the clinic. |
| respectively. NPC is three times more common in men. | | | | A biopsy is done if a suspicious mass or irregularity is |
| What causes NPC? | | | | seen in the nasopharynx. Patients with NPC may also |
| It is known that NPC is caused by the Epstein Barr | | | | have high titres of certain antibodies to EBV in their |
| Virus (EBV). This virus is extremely common and more | | | | blood. Blood tests for these antibodies are available |
| than 90% of people are infected with the virus by the | | | | commercially and can be used to screen for NPC in |
| time they reach adulthood. Infection with EBV causes | | | | selected high risk patients. An MRI scan with contrast |
| a minor flu like illness in children and occasionally a | | | | is a useful adjunct in NPC detection because it can |
| systemic disease called glandular fever in teenagers | | | | sometimes show up a growth even when the |
| and young adults. EBV persists in white blood cells in a | | | | nasopharynx looks ‘normal' on nasoendoscopy. |
| dormant phase after the initial infection. The | | | | Treatments for NPC |
| mechanism by which this virus subsequently causes | | | | NPC tumour cells are very sensitive to radiation hence |
| NPC in people is not fully understood and is currently | | | | the conventional treatment for early stage NPC is |
| under intense scrutiny by scientists and researchers. | | | | definitive radiation therapy (RT). Late stage disease is |
| The suspicion that NPC is also associated with the | | | | treated with a combination of radiation and |
| consumption of preserved foods like salted fish came | | | | chemotherapy. During treatment, there is a significant |
| about because of the high incidence of the disease | | | | irradiation of the adjacent structures in the head and |
| among the boat people of Hong Kong. It is theorized | | | | neck leading to potential RT long term effects like dry |
| that carcinogens released during the cooking or | | | | mouth, hearing loss, poor vision and temporal lobe |
| consumption of these foods primes the cells in the | | | | necrosis. Improvements in RT equipment over the past |
| nasopharynx for EBV to cause cellular malignant | | | | 10 years has reduced salivary flow continues to be a |
| change. Consumption of these foods at a young age | | | | problem in majority of patients. Surgical removal of the |
| is also thought to be a significant risk factor (weaning | | | | tumour is a difficult operation and is reserved for |
| children with salted fish was a common practice in | | | | disease that recurs after radiation and chemotherapy. |
| Southern China and Hong Kong) | | | | These surgeries are usually performed in selected |
| Genes play a significant role in NPC. A study done in | | | | patients. It is a keyhole (scarless) procedure for |
| Singapore documented that 15.5% of first degree | | | | surgically removing NPC that recurs after primary |
| relatives of NPC patients subsequently got the | | | | treatment with radiation and chemotherapy. |
| disease. The mean interval to getting NPC between | | | | This disease can be defanged if detected early. Public |
| affected siblings was 5.3 years while that between | | | | education regarding the symptoms of NPC is one way |
| affected parent and child was 24.5 years. | | | | to bring the patients in early. High risk groups like first |
| How is NPC diagnosed? | | | | degree relatives of patients with NPC should be |
| NPC can be difficult to detect because it grows in a | | | | screened for the disease as soon as possible. Doctors |
| ‘hidden' area at the back of the nose called the | | | | and primary care physicians should be thoroughly |
| nasopharynx. The problem is confounded by the fact | | | | familiar with the symptoms and signs NPC and have a |
| that individuals with early disease may not have | | | | high index of suspicion for this disease. |
| symptoms. More advanced disease can present as a | | | | |