‘Don’t take nose cancer lightly’

KUALA LUMPUR: One-sided, painless and progressive neck swelling may be matters of concern. They can be signs of nose cancer, says a doctor.

Ear, nose, throat, head and neck consultant surgeon at Mahkota Medical Centre Melaka, Dr S. Ram Kumar Sharma, said in 70% of newly diagnosed nose cancer cases, there is a painless lump in the neck.

Nose cancer, or nasopharyngeal carcinoma (NPC), occurs when the cells lining the nasopharynx – the area between the nose and mouth – become cancerous.

According to the second Malaysian National Cancer Registry released in 2019, NPC is the fifth most common cancer in Malaysia.

The data showed that about 5.2% of men and 1.9% of women were diagnosed with NPC from 2012 to 2016.

Dr S. Ram said almost 50% to 60% of patients tend to be diagnosed with NPC at the advanced stage.

“This is because NPC is not easily seen by the patient as it begins inside and behind the nose at the nasopharynx. This site sits at the junction of important structures (the skull bone, various nerves, the brain, ears and eyes), where cancer can easily spread to these critical areas.

“Surrounding the nose, head and neck region, there is the presence of numerous groups of lymph nodes. These act as ‘guardians’ in the event of any infection or cancer. In NPC, the neck nodes are triggered and enlarged,” he told Bernama when contacted recently.

During the early stage of NPC, neck pain may or may not be associated with nose, ear, face and head complaints.

“These include one-sided progressive and persistent nose blocks with or without blood-stained discharge. For the ears, a patient may experience one-sided reduced or progressive hearing loss with or without a buzzing sound. For facial and head, these may include headache, double vision, facial numbness, facial weakness and a change in voice. In later stages, cancer may spread to adjacent bones, the liver and the lungs,” he explained.

A diet rich in preserved chemicals or salts has also been associated with NPC.

“Always take note that preservative ingredients have the ability to transform into cancer agents (carcinogens). Examples of artificial preservatives include nitrates, sulfites, sorbates, parabens and formaldehyde.

“Nitrosamine, a notoriously carcinogenic compound that has nitrites and nitrates, not only causes cancer but can cause other debilitating conditions such as hypersensitivity allergies and neurological damage. Therefore, it is important for us to be aware of the food content we consume.

“About 8% to 10% of my NPC patients had no associated risk factors. In the past three months, I have already seen six cases of NPC. All these patients are adults, with ages varying between 36 and 63 years old.

“A simple endoscopy in the clinic confirmed the presence of NPC, and subsequently, a biopsy was taken,” said Dr S. Ram, noting that it is crucial for people to seek early consultation if they have any symptoms suggestive of NPC.

On the variable factors in determining survival rate, Dr S. Ram said these include how bad the disease or tumour stage is and the site and location of the tumour’s spread with involvement of vital structures.

“We must take note of the patient’s age, underlying medical condition, or patient’s general health to sustain treatment comprising radiotherapy, chemotherapy, surgery and/or a combination of all three modalities,” he said, adding that the patient’s accessibility to a clinical oncologist and subsequent follow-up are also taken into account.

In the event of a high index of suspicion of NPC, Dr S. Ram said a good and thorough history along with a complete physical examination are essential as the initial precursors to arriving at the diagnosis.

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