Nose cancer – detected early!

A few weeks ago a 52 year old man who works in a warehouse came to see me with a 2 year history of ringing in his left ear. He had been seen in another hospital and had hearing tests and also an MRI scan of his inner ears. He was offered some medication but this had not helped. His wife suggested that he seek my opinion.

When he first consulted me, I elicited that he also had symptoms of popping / crackling in the right ear and nasal congestion. I therefore decided to examine his nasal cavities with an endoscope. At the back of the left nasal cavity (an area we call the postnasal space or nasopharynx), there was nothing to see:

Left postnasal space / nasopharynx

However, when I examined his right nasal cavity, this is what I saw:

Right postnasal space / nasopharynx showing a smooth mass

I therefore performed a simple biopsy in clinic and this showed nose cancer or nasopharyngeal carcinoma (NPC). After I broke this news to him, I transferred his care to a neighbouring government hospital (as there were cost concerns) where I run head and neck cancer clinic as a Visiting Consultant. The staging scans we obtained – an MRI and PET CT scan – showed no evidence of local or distant spread. Hence a stage I tumour – small enough that a simple biopsy had removed most of it!

Nasopharyngeal cancer is endemic in Southeast Asia. In Singapore the incidence amongst Chinese males, who are most at risk, runs at 12 per 100,000. The cancer presents in the 40s and is often symptomless until it is in an advanced stage. Tinnitus or ringing in the ears is actually a rare solitary symptom. The cancer is due to a combination of factors – genetics being the most important as certain populations such as the Cantonese, Inuits and Bidayuh of East Malaysia having a predisposition. The second cause is early exposure to a common respiratory virus – the Epstein-Barr Virus (EBV), and finally a diet high in preserved foods such as salted fish.

Fortunately the advances in treatment means that stage I nose cancer has a 70-72% overall survival rate. With recent advances in treatment, we may even be looking at a cure rate of over 90% in this man.

Needless to say early detection is important, and in my next blog I shall write about a new molecular test soon to be available in Singapore for diagnosing early NPC.

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