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Health condition · Clinically reviewed

Nasopharyngeal carcinoma, from a neck lump to a specialist treatment plan.

A rare cancer of the upper throat, closely linked to Epstein-Barr virus, that is highly treatable when picked up early and referred promptly.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG12 and peer-reviewed head and neck oncology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on urgent referral, MRI staging and chemoradiotherapy for nasopharyngeal cancer.

Key facts

Nasopharyngeal carcinoma at a glance.

The essentials, in plain English - what it is, who it affects, and how it's treated in the UK today.

  • What it is

    A rare cancer arising in the nasopharynx, the upper part of the throat that sits behind the nose.

  • Main cause

    Strongly associated with Epstein-Barr virus infection, with tobacco smoke and salted or preserved food as added risk factors.

  • Who it affects

    Much more common in Southeast Asian and North African populations than in the wider UK population.

  • First sign

    Often a painless lump in the neck, caused by early spread to the lymph nodes.

  • Mainstay treatment

    Radiotherapy, because nasopharyngeal cancer is highly radiosensitive - usually combined with chemotherapy for locally advanced disease.

  • Follow-up

    Long-term surveillance is essential, since late recurrence can occur years after treatment.

Why this guide matters

Easy to miss, but highly treatable once found.

Nasopharyngeal carcinoma is rare in the UK, so early symptoms are often mistaken for something ordinary. The three points below shape everything else on this page.

  • A neck lump is often the first clue

    Painless, firm and persistent - a neck lump in an adult should never be dismissed without assessment.

  • Ear symptoms deserve attention too

    Unilateral hearing loss or a stubborn middle ear effusion in an adult is a specific NICE NG12 referral trigger.

  • Radiotherapy is highly effective

    Because the tumour is radiosensitive, chemoradiotherapy achieves good outcomes, particularly when caught before distant spread.

How the diagnosis is made

From first symptoms to a staged treatment plan.

The steps a UK GP, ENT surgeon or head and neck oncology team will normally follow, in order - so you know what to expect and why.

  1. 01

    Noticing

    Neck lump or ear symptoms noticed

    A painless neck lump, unilateral hearing loss or persistent middle ear effusion prompts assessment - especially in adults.

  2. 02

    Noticing

    Urgent referral criteria (NG12)

    NICE NG12 recommends urgent referral for unexplained neck lumps in adults or persistent unilateral middle ear effusion.

  3. 03

    Confirming

    Nasendoscopy with biopsy

    A thin flexible camera examines the nasopharynx directly, and any suspicious tissue is biopsied for histology.

  4. 04

    Confirming

    EBV serology

    Epstein-Barr virus antibody and DNA testing supports diagnosis and can help track response to treatment.

  5. 05

    Confirming

    MRI for local staging

    The nasopharynx has complex surrounding anatomy, so MRI is the preferred way to map local tumour extent and nerve involvement.

  6. 06

    Planning

    CT or PET-CT for distant staging

    Whole-body imaging checks for spread beyond the head and neck before a treatment plan is finalised.

  7. 07

    Planning

    Specialist head and neck MDT

    Care is planned by a specialist commissioned ENT and head and neck oncology multidisciplinary team.

Typical timeline: urgent referral to a confirmed MDT plan in a matter of weeks.

Symptoms

What nasopharyngeal carcinoma actually looks like.

The classic mix of a neck lump, ear and nasal symptoms - and the features that mean it's time to escalate.

  • Painless neck lump

    Often the first noticeable sign - caused by cancer spreading early to lymph nodes in the neck.

  • Unilateral hearing loss

    One-sided hearing loss or a feeling of blocked ears, from Eustachian tube obstruction by the tumour.

  • Persistent middle ear effusion

    Fluid behind the eardrum on one side that does not settle - a key red flag in adults per NICE NG12.

  • Nasal obstruction

    A blocked nose, usually on one side, that does not respond to the usual treatments.

  • Nosebleeds or blood-stained discharge

    Recurrent or unexplained nosebleeds, sometimes with blood-tinged nasal or postnasal discharge.

  • Headache

    Persistent headache, sometimes from local tumour extension towards the base of the skull.

  • Cranial nerve palsies

    Double vision or facial numbness in more advanced disease, as the tumour affects nearby cranial nerves.

  • Red flag - combination of symptoms

    A neck lump together with unilateral ear or nasal symptoms should prompt urgent specialist assessment.

Treatment

How nasopharyngeal carcinoma is treated in the UK.

Radiotherapy first, chemotherapy alongside it for locally advanced disease, and MDT-led rehabilitation and surveillance throughout.

  • Radiotherapy

    The mainstay of treatment - nasopharyngeal cancer is highly radiosensitive, with modern intensity-modulated techniques sparing surrounding tissue.

  • Chemoradiotherapy

    Radiotherapy combined with concurrent chemotherapy for locally advanced disease, improving control and survival.

  • Induction chemotherapy

    Chemotherapy given before chemoradiotherapy in selected advanced cases to shrink the tumour first.

  • Adjuvant chemotherapy

    Additional chemotherapy after chemoradiotherapy in some locally advanced presentations.

  • Neck dissection

    Surgery to remove residual lymph node disease in the neck if it persists after chemoradiotherapy.

  • Speech and language therapy

    Part of MDT rehabilitation, supporting swallowing and speech affected by radiotherapy side effects.

  • Dietetic support

    Dietitian input manages weight loss and swallowing difficulty during and after radiotherapy.

  • Long-term surveillance

    Regular follow-up given the recognised risk of late recurrence, sometimes many years after treatment.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist head and neck oncology standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Suspected cancer: recognition and referral (NG12).

  • National Cancer Institute. Nasopharyngeal cancer treatment (PDQ).

  • Royal College of Radiologists. Head and neck cancer radiotherapy guidance.

  • British Association of Head and Neck Oncologists (BAHNO). Head and neck cancer standards.

Red flags

When to seek urgent assessment.

Nasopharyngeal carcinoma is rare, but these combinations of symptoms should never be watched and waited on.

  • Unexplained neck lump in an adult

    NICE NG12 recommends urgent referral for any unexplained neck lump in an adult, particularly if firm and painless.

  • Persistent unilateral middle ear effusion

    Fluid behind one eardrum that does not clear in an adult is a specific trigger for urgent ENT referral.

  • Cranial nerve palsies

    New double vision, facial numbness or weakness alongside nasal or ear symptoms needs urgent specialist assessment.

  • Unilateral nasal obstruction with bleeding

    One-sided nasal blockage with recurrent bleeding, especially in higher-risk ethnic groups, warrants prompt nasendoscopy.

  • Trismus or facial swelling

    Difficulty opening the mouth or new facial swelling can signal local tumour extension.

  • Weight loss with head and neck symptoms

    Unexplained weight loss alongside any of the above symptoms should be treated as a red flag combination.

  • Family history in a high-risk population

    A family history of nasopharyngeal cancer, especially in Southeast Asian or North African heritage, raises the threshold of suspicion.

  • Symptoms not responding to standard treatment

    Nasal or ear symptoms that fail to improve with usual primary care management should prompt re-assessment rather than repeat courses of treatment.

Living with it

Life after treatment, with the right support.

Four things that make the biggest difference during and after treatment - rehabilitation, nutrition, consistent follow-up and knowing what to ask.

A quiet reminder

Recovery is a team effort, not a solo one.

Speech and language therapy, dietetics and oncology follow-up work together, long after radiotherapy itself has finished.

  1. 01 Rehab

    Swallowing and speech support

    Speech and language therapy helps manage the after-effects of radiotherapy on swallowing and voice.

  2. 02 Nutrition

    Stay ahead of weight loss

    Dietitian-guided nutrition support during treatment prevents dangerous weight loss and supports recovery.

  3. 03 Follow-up

    Keep every surveillance appointment

    Late recurrence is a recognised risk, so long-term follow-up appointments matter even years after treatment ends.

  4. 04 Support

    Ask about EBV monitoring

    EBV DNA levels can help track response and detect recurrence early - ask your team how this is used in your follow-up.

Frequently asked

Everything we get asked about nasopharyngeal carcinoma.

Quick answers on symptoms, EBV, staging and treatment.

  • What is nasopharyngeal carcinoma?

    A rare cancer that starts in the nasopharynx, the upper part of the throat behind the nose. It is strongly linked to Epstein-Barr virus infection and is much more common in Southeast Asian and North African populations than in the wider UK population.

  • Why does it often present as a neck lump?

    Nasopharyngeal cancer spreads early to lymph nodes in the neck, so a painless neck lump is frequently the first sign a person notices, sometimes before any nasal or ear symptoms appear.

  • Why is unilateral hearing loss or ear fluid important?

    The tumour can block the Eustachian tube on one side, causing hearing loss or a persistent middle ear effusion. NICE NG12 flags persistent unilateral middle ear effusion in adults as a reason for urgent referral.

  • How is it diagnosed?

    Nasendoscopy with biopsy confirms the diagnosis. MRI maps local extent given the complex anatomy of the nasopharynx, while CT or PET-CT checks for spread elsewhere. EBV serology supports the diagnosis and can help monitor treatment.

  • What does treatment involve?

    Radiotherapy is the mainstay, since the tumour is highly radiosensitive. Chemotherapy is usually added for locally advanced disease. Neck dissection may follow if lymph node disease persists, and rehabilitation with speech therapy and dietetics supports recovery.

  • What does follow-up look like?

    Long-term surveillance in a specialist commissioned head and neck cancer centre, because late recurrence can happen years after initial treatment. EBV DNA testing and imaging are often used alongside clinical review.

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