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Nasopharyngeal Carcinoma

EBV-associated head and neck malignancy with high responsiveness to chemoradiation.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Nasopharyngeal Carcinoma?

Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor arising from the nasopharyngeal mucosa, particularly the fossa of Rosenmuller. WHO classifies it into keratinizing squamous (Type I), non-keratinizing differentiated (Type II), and non-keratinizing undifferentiated (Type III) — the latter strongly associated with Epstein-Barr virus (EBV) and most prevalent in southern China, Southeast Asia, North Africa, and the Mediterranean.

Distinct epidemiology shows endemic regions with incidence over 25 per 100,000, contrasting with under 1 per 100,000 in Western populations. Risk factors include EBV infection, salted-fish diet (especially in childhood), tobacco use, and genetic susceptibility (HLA polymorphisms).

Most patients present with cervical lymphadenopathy, epistaxis, nasal obstruction, hearing loss, or cranial nerve palsies due to skull base invasion. Diagnosis combines flexible endoscopy with biopsy, MRI of the nasopharynx and neck, plasma EBV DNA, and PET-CT for staging. Concurrent chemoradiation with cisplatin is standard for stages II-IVA, with adjuvant or induction chemotherapy in high-risk disease.

Symptoms

Painless cervical lymphadenopathy (most common)
Unilateral nasal obstruction
Recurrent epistaxis or blood-tinged sputum
Unilateral serous otitis media (eustachian tube blockage)
Hearing loss or tinnitus
Cranial nerve palsies (V, VI most common)
Headache, facial pain
Trismus (pterygoid invasion)
Diplopia (cavernous sinus involvement)
Horner syndrome (sympathetic chain)
Hoarseness (recurrent laryngeal nerve)
Weight loss in advanced disease
Fatigue
Distant metastasis symptoms (bone pain, dyspnea)

Risk Factors

Epstein-Barr virus infection
Salted-fish or preserved food diet (childhood)
Genetic susceptibility (HLA-A2, HLA-B17)
Family history of NPC
Tobacco smoking
Wood dust or formaldehyde exposure
Southern Chinese, Southeast Asian, North African ethnicity
Male sex (2:1)
Age 30-60 (peak incidence)
Chronic otitis media (rare)
HPV (small subset)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent unilateral cervical lump
  • Unilateral nasal obstruction or epistaxis
  • Unilateral hearing loss with serous otitis
  • Cranial nerve palsy
  • Persistent headache or facial pain
  • Diplopia or facial numbness
  • Hoarseness with neck mass
  • Family history with new symptoms
  • Endemic region travel with persistent symptoms
  • Trismus or jaw stiffness

Treatment Methods

01
ENT and oncology multidisciplinary referral
02
Flexible nasopharyngoscopy with biopsy
03
MRI nasopharynx, skull base, and neck (best soft-tissue detail)
04
PET-CT for distant staging
05
Plasma EBV DNA quantification (prognostic and surveillance)
06
Audiogram, dental, and nutritional evaluation pre-treatment
07
Tumor staging by AJCC 8th edition
08
Definitive intensity-modulated radiotherapy (IMRT) 70 Gy to gross disease
09
Concurrent cisplatin (100 mg/m2 every 3 weeks) for stage II-IVA
10
Induction chemotherapy (gemcitabine-cisplatin) for high-risk T3-T4 or N2-N3
11
Adjuvant capecitabine for high-risk residual disease
12
Image-guided proton therapy for selected cases (sparing brain)
13
Salvage nasopharyngectomy for local recurrence
14
Re-irradiation for selected recurrences (high toxicity risk)
15
Immunotherapy (PD-1 inhibitors: camrelizumab, toripalimab, pembrolizumab) for metastatic disease
16
Cisplatin-gemcitabine for first-line metastatic NPC
17
Surveillance: clinical exam, EBV DNA, MRI every 3-6 months for 5 years
18
Speech and swallow rehabilitation
19
Long-term toxicity monitoring: hypothyroidism, xerostomia, osteoradionecrosis, secondary cancers
20
EBV-targeted CTL therapy in clinical trials
21
Family screening with EBV DNA in endemic high-risk relatives
22
Tobacco and dietary counseling

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Nasopharyngeal Carcinoma — Diagnosis and Treatment

KBB (Kulak Burun Boğaz)

Nasopharyngeal carcinoma (NPC) is a distinct epithelial malignancy arising from the nasopharyngeal mucosa, with marked geographic variation showing high endemicity in Southeast Asia, southern China, and northern Africa. It demonstrates strong association with Epstein-Barr virus (EBV) infection, dietary nitrosamines, and genetic susceptibility (HLA associations). Treatment is fundamentally radiation-based given anatomic location making surgery technically challenging, with modern intensity-modulated radiation therapy and concurrent platinum-based chemotherapy achieving excellent outcomes for early stage and substantial cure rates even in locoregionally advanced disease, while plasma EBV DNA monitoring enables surveillance for recurrence.

Anaemia

Dahiliye (İç Hastalıkları)

Anaemia is a low haemoglobin level that reduces oxygen delivery, causing fatigue, pallor, and shortness of breath. It is not a disease itself but a sign of many underlying conditions. Most cases are correctable with appropriate diagnosis and treatment.

Iron Deficiency Anaemia

Dahiliye (İç Hastalıkları)

Iron deficiency anaemia develops when dietary intake, absorption, or losses create an iron shortfall, most often affecting women and children. Identifying the underlying cause is the core of management, alongside iron replacement.

Vitamin B12 Deficiency

Dahiliye (İç Hastalıkları)

Vitamin B12 deficiency can cause megaloblastic anaemia, neurological symptoms, and cognitive impairment. Early treatment with intramuscular or oral B12 largely prevents irreversible complications.

Hypertension (High Blood Pressure) Management

Dahiliye (İç Hastalıkları)

Hypertension is often called the silent killer because it progresses symptom-free for years and can damage the heart, brain, kidneys, and eyes. Regular monitoring, lifestyle change, and evidence-based drug therapy dramatically reduce cardiovascular risk.

Chronic Kidney Disease

Dahiliye (İç Hastalıkları)

Chronic kidney disease is one of the most common complications of chronic conditions such as diabetes and hypertension, and can be silent in its early stages.

Hepatitis B (HBV)

Dahiliye (İç Hastalıkları)

Hepatitis B is a DNA virus infection causing acute and chronic hepatitis with risk of cirrhosis and hepatocellular carcinoma; diagnosis integrates HBsAg, HBeAg, anti-HBc, and HBV DNA with management based on disease phase using nucleos(t)ide analogues (entecavir, tenofovir) and universal infant vaccination.

Hepatitis C (HCV)

Dahiliye (İç Hastalıkları)

Hepatitis C is an RNA virus causing chronic hepatitis that may progress to cirrhosis and hepatocellular carcinoma; modern direct-acting antiviral (DAA) pangenotypic regimens (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) achieve sustained virologic response over 95% in 8–12 weeks with universal adult screening and cure for nearly all patients.

Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.