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Nasopharyngeal Carcinoma (NPC)

Endemic head-and-neck malignancy: EBV-related, presents with neck mass and conductive hearing loss

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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)

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What is Nasopharyngeal Carcinoma (NPC)?

NPC originates from the squamous epithelium of the nasopharyngeal mucosa, particularly the fossa of Rosenmüller (lateral pharyngeal recess). WHO classifies it as Type I (keratinizing squamous - non-endemic), Type II (non-keratinizing differentiated), and Type III (non-keratinizing undifferentiated - lymphoepithelioma, EBV-related). Types II-III are most common in endemic areas (China, North Africa, Mediterranean).

Etiology is multifactorial: EBV infection (>90% of endemic NPC), genetic predisposition (HLA-A2, HLA-B17), and dietary factors (salted fish, nitrosamines). EBV DNA in plasma is both a diagnostic and prognostic marker (>1500 copies/mL = poor prognosis).

Staging (TNM 8th edition): T1 limited to nasopharynx, T2 parapharyngeal extension, T3 skull base, T4 intracranial. N staging based on cervical lymphadenopathy laterality and supraclavicular involvement. Treatment is primarily radiotherapy (IMRT) ± concurrent cisplatin chemotherapy; advanced disease requires induction chemotherapy. 5-year survival: stage I 95%, stage IV 50%.

Symptoms

Painless unilateral cervical lymphadenopathy (most common - 75%)
Unilateral serous otitis media, hearing loss (eustachian tube obstruction)
Epistaxis, blood-tinged nasal discharge
Nasal obstruction, rhinorrhea
Cranial nerve palsy (advanced - V, VI most common)
Headache, retro-orbital pain (skull base invasion)
Trismus (parapharyngeal extension)

Risk Factors

EBV infection (almost universal in endemic NPC)
Endemic geographic origin (Southern China, Southeast Asia, North Africa)
Salted fish, preserved meat consumption (nitrosamines)
Tobacco and alcohol use (Type I keratinizing)
Family history of NPC, HLA-A2/B17
Occupational exposure (formaldehyde, wood dust)

When to See a Doctor?

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

  • Painless neck mass lasting >2 weeks
  • Unilateral hearing loss with ear fullness in adult
  • Recurrent epistaxis or blood-stained nasal discharge
  • Persistent unilateral nasal obstruction
  • New-onset cranial nerve symptoms (diplopia, facial numbness)
  • Persistent headache, especially retro-orbital

Treatment Methods

01
Intensity-modulated radiation therapy (IMRT) - primary treatment, 70 Gy in 33-35 fractions
02
Concurrent cisplatin chemoradiation (stage II-IVA)
03
Induction chemotherapy (gemcitabine + cisplatin) for locally advanced disease
04
Adjuvant chemotherapy (5-FU + cisplatin) post-radiation
05
Salvage neck dissection for residual cervical disease
06
Re-irradiation or salvage nasopharyngectomy for local recurrence
07
Plasma EBV DNA monitoring for surveillance
08
Targeted therapy (cetuximab, immune checkpoint inhibitors) for recurrent/metastatic disease

Which Department to Visit?

You can visit our KBB (Kulak Burun Boğaz) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About KBB (Kulak Burun Boğaz) Department

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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.