Nasopharyngeal carcinoma: symptoms, causes, diagnosis and treatment

The nasopharynx is the top part of the throat (pharynx). Cancer Research UK explains that it connects the back of your nose to the back of your mouth and lies above the soft palate, so you cannot see it yourself. Cancer that starts there is called nasopharyngeal cancer or nasopharyngeal carcinoma, where carcinoma means a cancer that starts in lining cells.

The most common type is keratinizing squamous cell carcinoma, according to Cancer Research UK, which lists nonkeratinizing carcinoma and basaloid squamous cell carcinoma as other types. Doctors do not generally use the term throat cancer as an exact medical name, so it helps to know the exact name of the cancer you have, because cancers are treated according to where they started.

Nasopharyngeal cancer may spread to the lymph nodes in the neck, which Cancer Research UK describes as often the first place cancer cells spread to, and to other parts of the body such as the lungs or bones.

Cancer Research UK says some people with nasopharyngeal cancer do not have symptoms. When symptoms do occur they often involve the ears and nose, as well as a lump in the neck. Macmillan lists a painless swelling or lump in the upper neck, which it says is often the first symptom, changes in hearing, earache, fluid leaking from the ear, a blocked nose, nosebleeds and headache.

Cancer Research UK adds that the symptoms can also include tinnitus, fluid collecting in the ear (glue ear), blood-stained discharge from the nose, double vision, difficulty swallowing, numbness in the face, a hoarse voice and weight loss. Hearing loss and a blocked nose are usually on one side only.

Most people with these symptoms do not have nasopharyngeal cancer, because the symptoms can be caused by other, much more common conditions. Cancer Research UK stresses that they still need to be checked by a doctor.

• A lump or growth anywhere in the neck that does not go away after 3 weeks (it may be the only symptom).

• Hearing loss, usually on one side only, or fluid in the ear (glue ear).

• Ringing in the ears (tinnitus) or earache.

• A blocked or stuffy nose, particularly if only one side is blocked.

• Blood-stained nasal discharge or nosebleeds.

• Headaches, double vision, facial numbness, difficulty swallowing, a hoarse voice or weight loss.

Cancer Research UK says nasopharyngeal cancer is rare in the UK, and gives smoking certain substances and a history of Epstein-Barr virus (EBV) as examples of risks and causes. Macmillan describes EBV as the most common risk factor. EBV is a very common virus, so having had it does not mean you will develop cancer; the sources do not explain why a small number of people do.

Macmillan says that if you have nasopharyngeal cancer, tests on the cancer cells can show whether it is linked to EBV. The sources read for this page do not give other risk factors, so none are listed here.

Is it contagious? Cancer itself cannot be caught from another person. EBV is a virus, but the sources read do not describe the cancer as spreading between people.

Cancer Research UK says you usually start by seeing your GP, who asks about your general health and symptoms, examines you and decides whether to arrange tests or refer you to a specialist. If your only symptom is a lump in the neck, Macmillan says you may be referred to a hospital with a neck lump clinic.

Cancer Research UK says you usually have a nasendoscopy or panendoscopy to diagnose nasopharyngeal cancer; a nasendoscopy looks at the inside of your nose, throat and voice box. If your lymph nodes are swollen you may have tests on them. Macmillan says a lump or swelling in the neck is usually checked with an ultrasound scan, and that a fine needle can be passed into the lump to take a sample.

The stage of a cancer tells you about the size of the tumour and whether it has spread, and your doctor uses this information to decide on treatment.

Cancer Research UK says radiotherapy is one of the main treatments, and the main type of treatment, for nasopharyngeal cancer. What you have depends on the type of cancer, its size, whether it has spread and your general health. Chemotherapy may be given on its own or combined with radiotherapy as chemoradiotherapy. Surgery is not a common treatment and is more likely for cancer that has come back.

After treatment you have regular check-ups to find out how you are getting on, what side effects you may have and to look for signs of the cancer coming back. Cancer Research UK notes that some treatments might affect your hearing, and that nasopharyngeal cancer and its treatment can cause eating problems and eyesight changes in some people, with support available from your healthcare team.

Cancer Research UK says survival depends on many factors and that because this cancer is less common it is harder to estimate than for more common cancers. There are no UK-wide statistics for survival by stage, so it shows American figures from the SEER programme for people diagnosed between 2012 and 2018, and warns they may not be a true picture of UK survival.

Using those figures, more than 80 out of 100 people with localised cancer survive 5 years or more after diagnosis, more than 70 out of 100 with regional cancer, and around 50 out of 100 with distant cancer. Cancer Research UK points out that five-year survival does not mean you will only live for five years, and that your doctor can tell you about your own outlook.

See your GP if you have any of the symptoms above, particularly if they last 3 weeks or more, says Cancer Research UK. A lump in the neck that does not go away after 3 weeks should always be checked. If your GP suspects cancer they refer you to a specialist.

Call NHS 111 or your GP surgery if you are unsure how urgent your symptoms are. For heavy nosebleeds that will not stop, difficulty breathing or sudden severe symptoms, call 999 or go to A&E.

On the NHS, a GP refers suspected cancer to a specialist, usually through an ear, nose and throat (ENT) or neck lump clinic, and treatment is planned by a multidisciplinary team, with a clinical nurse specialist as a point of contact. Cancer Research UK points to its nurse helpline and Macmillan to its support services for questions along the way.

People who choose to see an ENT specialist privately for a neck lump or ear symptoms can do so, and any suspected cancer is usually then treated within a specialist cancer service. Bring a list of your symptoms, when they started and how long the lump has been there.