Cancer of Nasopharynx : An Assortment of Warning Signs

JC Sanasam *

FDG-PET/CT scan of a patient with nasopharyngeal cancer. Transverse slice demonstrating FDG-positive primary site
Pix - Wikipedia.org / Gulec SA et al.

Cancer of Nasopharynx is one of the most commonly prevalent cancers in Manipur. The incidence is more among males than in females, the age group most commonly affected, as seen in the health centers, is in the range of 30 to 50 years of age. In the world scenario it is found to be affecting more among the Mongoloid group of people like the Chinese. In Manipur people from Ukhrul and Senapati districts are found to be more prone to this cancer although it is fairly common among all Manipuris of all tribes.

Nasopharynx is the space behind the nose, above the palate, the space continuing down to the throat. Its main function is for the respiratory air to pass to and fro, from outside inwards to the lungs during inhalation and from the lungs to the exterior during exhalation. The space is in a hidden area, neither visible through the nose nor through the mouth under general clinical examination.

A special examination in the form of inspection through a special mirror and obtain a vision of its mirror-image can be done, not comfortable to and not liked much by patients. Palpation of its walls by finger via the mouth cavity too is a more cumbersome procedure hated by patients. Modern endoscopic telescopes inserted through the nose are used now for its inspection, photographic documentation as evidence of clinical findings and for biopsy when an area is seen to have a dubious lesion, especially when suspected of a tumor or cancer or other lesions with similar appearance.

This modern procedure, of course, is costly as sophisticated equipments are used and not readily available as routine outpatient office procedure in Manipur. An appointed time and date in a well furnished minor operation theatre so far is necessary for this procedure in Manipur till now.

Incense burns, wood dust (specifically of mahogany wood) among carpenters, ingestion of open-fire-roasted/burnt food, (roasted or burnt meat are more suspected) and many other factors are statistically blamed as causes of this cancer. But as found out recently in a more scientific basis, mutation of genes in the DNA is pinned to be the basic cause or the predisposing factor.

This theory is supported by the fact that its incidence goes down to much a less frequency among Chinese who have migrated in the USA from Kwangton district of China where the prevalence is so high. A protein tagged as P53 in the gene is the suspect to play the bad game. And the presence of Epstein-Barr Virus (EBV) in the Nasopharynx, like Human Papilloma Virus (HPV) in cervix among women, is suspected to induce the mutation of the gene at an opportune time and situation.

As this cancer is not so common in the European and western countries the literature on this disorder is not plenty and not sufficient to cover all aspects.

The early warning signs given here are not universally documented versions; rather are an assorted collection in accordance with the writer's experience as a clinician. Most of the time the early warning signs do not appear readily; patients who have developed this cancer usually become aware of the symptoms only when it is late enough. However if at all they appear they can manifest as follows:

• Persistent, but seemingly insignificant, sensation of stuffy nose on one side or kind of sticky sensation at the back of the nose
• Persistent, but seemingly insignificant, foreign body sensation at the back of the nose
• Nasal obstruction sensation but which may not be so obvious
• Bleeding episodes from the nose
• Blood stained saliva or spitting of blood or bleeding from the mouth whereas no obvious source of bleeding in the mouth or throat or lower respiratory tract or upper swallowing tract can be established.
• A persistent nasal twang in the voice without any obvious reason like inflammation of the nasal cavity or upper respiratory tract infection which is usually associated with fever
• Persistent extra sound in the ear with or without impairment of hearing

• Potato-like swellings, sizes may vary from small to large, in the upper part of the neck just below and behind the angle of the lower jaw.
• Obvious impairment of hearing in the ear on the affected side
• Restriction in opening the mouth
• Squint eye on the affected side
• Persistent pain in the ear on the affected side
• Deep persistent pain behind the eye
• Persistent foul smell of the breath