In conjunction with World Head & Neck Cancer Day, Dr Kiattisa Sommat, Senior Consultant from the Division of Radiation Oncology at National Cancer Centre Singapore (NCCS), a member of the SingHealth group, answers questions about nose cancer (medically known as nasopharyngeal cancer) – the most common type of head and neck cancer.

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Nasopharyngeal cancer is commonly known as nose cancer.

Nasopharyngeal cancer (also known as nose cancer) is the most common type of head and neck cancer and is the eighth most common cancer amongst Singaporeans.

Symptoms of nose cancer include: 

  • A painless neck lump 

  • Persistent blood stained saliva/sputum 

  • Bleeding/bloody discharge from the nose or in nasal secretions 

  • Nasal blockage that does not go away 

  • Hearing loss or ringing in the ears (often one sided) 

  • Persistent sensation of blocked ear/ears 

  • Unusual face pain or numbness 

  • Headache 

  • Double vision 

In advanced nose cancer, where the cancer has spread to other parts of the body such as the lung, bone or liver, symptoms such as breathlessness, cough or pain may surface.

What causes nasopharyngeal cancer (nose cancer)?

While the exact cause of nasopharyngeal cancer is unknown, several factors have been found to contribute to its development. Risk factors include: 

  • Gender – Nose cancer is more common in men than in women 

  • Having a diet high in salted or preserved (cured/smoked/pickled) foods 

  • Epstein-Barr virus (EBV) infection 

  • Ethnicity – Nose cancer more commonly affects people in parts of China and Southeast Asia. In Singapore, people of Southern Chinese heritage have a higher incidence.

  • Having a family history of nose cancer 

  • Smoking

If you have a question on nose cancer, don't hesitate to ask our specialist by sending in your question. Hurry, this forum is for a limited time only!

About Dr Kiattisa Sommat

Dr Kiattisa Sommat is a Senior Consultant in the Division of Radiation Oncology at National Cancer Centre Singapore (NCCS). She trained in Radiation Oncology at NCCS and did a fellowship in Clinical Oncology at The Royal Marsden Hospital in the United Kingdom. Her clinical interests include all aspects of radiation oncology, with particular interests in nasopharyngeal, head and neck cancers and gynaecological cancers. 

Dr Kiattisa was instrumental in introducing MRI guided interstitial brachytherapy for gynaecological cancers in NCCS. She has published articles in major international peer-reviewed oncology journals and presented at international meetings. She has also received several grants to support her research in these areas.

Questions and answers on nasopharyngeal cancer (nose cancer)

1. Question by Patricia

Hi Dr. Kiattisa,

What are the chances a family member getting nose cancer:

With a family history?

The family member does not smoke or drink but leads a healthy lifestyle. Age: 53, Male, Married and working full time in the office.

Please advise. Thank you for your time.

Answer by Dr Kiattisa Sommat

Hi, first-degree relatives (e.g., parent or sibling] )of NPC patients have about 4 to 10 times increased risk of developing NPC, compared with those without a family history.

2. Question by Devi

Hi Dr Kiattisa Sommat, 

Firstly, thank you for offering your time to answer our questions.

I have blood stained saliva/sputum especially in the morning only. However, I don't have any history of cancer in my family.

Kindly advise, should I go for any checks? Thank you.

Answer by Dr Kiattisa Sommat

Hi, blood-stained saliva in the morning can be due to various reasons, including infections, inflammation, nasal polyps, or other benign conditions. However, it could also be a sign of more serious issues, such as nasopharyngeal cancer or other types of cancers in the head and neck region. Even without a family history of cancer, it’s important to rule out any serious conditions. It's a good idea to see an ENT specialist, who can check it out and make sure it's nothing serious.

3. Question by Jeanie

Hi Dr,

In 2010 during a comprehensive health screening, EBV was detected in my blood test. I was subsequently referred to SGH ENT and was monitored yearly.

Blood test and scope were done yearly. My yearly scope was normal although the EBV reading didn’t change much.

After a few years, the senior consultant discharged me but advised me to return if I notice any symptoms. So far there is nothing unusual.

However, a month ago, my brother is diagnosed with Nasopharyngeal cancer. No other family members had this before. My brother was a smoker and frequently consumed alcohol, but gave up smoking 8 years ago.

My question is: Should I resume having an annual scope done at SGH?

Appreciate your advice.

Answer by Dr Kiattisa Sommat

Hi, given your history of detectable EBV levels and your brother's recent diagnosis of nasopharyngeal cancer, it’s understandable to be concerned. Although your previous scopes have been normal and you have no current symptoms, it may be wise to resume annual check-ups for peace of mind and early detection.

I recommend discussing your concerns with an ENT specialist, who can provide personalized advice based on your medical history and your brother's recent diagnosis.

4. Question by Mervin

Hi Dr Kiatissa,

I have undergone a brain CT scan recently. The scan coincidentally found a small lump at my left Parotiq gland.

The hospital originally scheduled me for a needle biopsy which was aborted at the advice of their consultant. As I do not experience the symptoms you mentioned of nose cancer, the doctor decided that I should just go for an ultrasound scan a year later to monitor the growth of the lump.

Should I be concerned that I might not be giving full attention to this growth? What's your advice? Thank you.

Answer by Dr Kiattisa Sommat

Hi, I understand your concern about the lump in your parotid gland. It's important to have a thorough consultation to make an accurate recommendation. I suggest discussing your worries with your healthcare provider, who can give you the best advice based on your complete medical history.

5. Question by Sam

Hi Doctor,

I was recently diagnosed as having nose cancer. Would like to know what is the severity rate of contracting this disease? What are the chances of overcoming this cancer through treatments? Thank you.

Answer by Dr Kiattisa Sommat

Hi, I'm sorry to hear about your recent diagnosis of nasopharyngeal cancer. I understand that receiving such news can be very overwhelming. It’s important not to lose hope. Overall, the prognosis for nasopharyngeal cancer is generally positive, especially when diagnosed early.

Treatment outcomes can vary depending on the stage of the cancer at diagnosis. Treatment options typically include radiation therapy, chemotherapy, or a combination of both. Many people with nasopharyngeal cancer respond well to treatment. It’s important to discuss your specific case with your healthcare team, who can provide personalized information about your prognosis and treatment options.

6. Question by Jingying

Hello Dr,

Is it possible for nose cancer patients to get nasal voice without feeling blocked nose?

I recently observed that my mom’s voice has become very nasal although she insisted that she does not have any blocked nose. I also noticed that her right eye is slightly bulging and looks a little watery but she mentioned that she only get watery eyes when she stares at the phone screen for too long.

Should I be concerned on the above and get her to see an ENT specialist? Thanks!

Answer by Dr Kiattisa Sommat

Hi, It's understandable to be concerned about changes in your mom's voice and her eye symptoms. While nasal voice can be a symptom of nasal or nasopharyngeal issues, including cancer, it can also occur without a blocked nose. Similarly, watery eyes and slight bulging could indicate various conditions. It might be a good idea to have her see a doctor who can check things out and ensure it's nothing serious.

7. Question by Helen

Dear Dr Sommat,

I read your article on nose cancer and would like to submit a question:

My mother died of nose cancer around 1999. Maybe due to (a) she loved to eat salted or preserved ikan bilis with spinach, and/or (b) she is exposed to secondary smoking (as my dad is a heavy smoker and he died of lung cancer around 2005).

So is this considered having a family history of nose cancer?  If so, what are the regular checks or blood tests or appropriate screenings that I should do? Or any lifestyle or diet that I should take note of? 

Many thanks Doctor. Hope to hear from you.

Answer by Dr Kiattisa Sommat

Hi, I'm sorry to hear about the losses your family has experienced due to cancer. Yes, having a mother who passed away from nose cancer can be considered a family history of the disease. This is important information for your healthcare provider to know.

Screening is advisable, especially given your family history. In Singapore, the Report of the Screening Test Review Committee (2019) recommends the use of EBV (Epstein Barr Virus) serology in combination with nasoendoscopy for screening only in high-risk individuals (i.e., individuals with a first degree relative [e.g., parent or sibling] with NPC).

EBV (Epstein-Barr virus) serology refers to blood tests that detect antibodies produced by the body in response to EBV infection. EBV is a virus linked to nasopharyngeal cancer (NPC). Nasoendoscopy is a procedure to examine the inside of the nose and throat using a thin, flexible tube with a light and camera.

I recommend discussing with your healthcare provider about appropriate screenings, whichmay include periodic EBV blood tests and examinations by an ENT specialist.

8. Question by MJKR

Dear Doctor,

Is smelly nasal drip accompanied by slight deafness in the ear a sign of nose cancer?

Is double/blurred vision another sign? This has been diagnosed as cataract.

Thanks & best regards.

Answer by Dr Kiattisa Sommat

Hi, while these symptoms can sometimes be associated with NPC, they can also stem from various benign conditions. It's important to have these symptoms evaluated by a healthcare professional, such as an ENT specialist, to determine the underlying cause accurately and ensure appropriate management.

9. Question by Leanne

Hi Doctor,

Should all my children go for EBV testing at some point in their life to check if they have NPC since their dad had NPC?

If so, when is the best age to get tested? Thanks.

Answer by Dr Kiattisa Sommat

Hi, given their father's history of NPC, it may be prudent for your children to consider screening at some point in their lives. A working group from the Chapter Board of Otorhinolaryngologists Singapore has proposed screening individuals with ≥1 first-degree relative with NPC, especially among middle-aged adults from 30–70 years old. However, the decision should be based on discussions with their healthcare provider, taking into account factors such as their age and any symptoms they may experience.

There isn't a specific recommended age for EBV testing in this context. It's best to consult with a healthcare professional who can provide personalized advice based on your family's medical history and current guidelines.

Ref: H24