SINGAPORE - Bukit Panjang SMC MP Liang Eng Hwa said on Wednesday that he has been diagnosed with early-stage nose cancer, or nasopharyngeal cancer, and that he will be starting daily radiotherapy treatments.

Mr Liang, 59, said he had been experiencing muffled hearing in his left ear for months, which prompted a visit to an ear, nose and throat doctor.

In November 2021, Tampines GRC MP Baey Yam Keng was also diagnosed with stage one nose cancer.

Mr Baey, now 52, discovered he had cancer after he was found to have a small area of limited vision in his right eye during a regular eye check for glaucoma.

Subsequent tests found a cancerous tumour in his right nasal passage. He was cleared of the cancer in 2022 after undergoing radiotherapy.

The Straits Times speaks to experts to find out more about nose cancer, its symptoms, and how early you should check for it.

What is nasopharyngeal cancer?

Nasopharyngeal cancer (NPC) is a disease in which cancer cells develop from the tissues of the nasopharynx, said Assistant Professor Kiattisa Sommat, a senior consultant in the Division of Radiation Oncology at National Cancer Centre Singapore.

The nasopharynx is the passageway behind the nose, just above the throat (oropharynx), which connects the nose to the respiratory system. The nasopharynx is also connected to the ear via the Eustachian tubes which open into the middle ear, added Prof Sommat.

Nose cancer is fairly common in Singapore and South-east Asia, and mostly affects Chinese people, particularly southern Chinese, said Dr Donovan Eu, a consultant in the Department of Otolaryngology – Head & Neck Surgery at National University Hospital.

Dr Eu, who is also a consultant in the Division of Surgical Oncology at the National University Cancer Institute, Singapore, added that it is more prevalent in males and affects patients in the 30- to 60-year-old age group more frequently.

There are many types of nose cancers, said Dr Eu. Apart from NPC, cancers of the nose also include sinonasal cancer and skin cancer. In Singapore, NPC is the most common type of cancer of the nose, he added.

What are some risk factors?

While the exact cause of NPC is unknown, there are several factors known to contribute to its development, said Prof Sommat.

 In addition to gender and that people of Southern Chinese heritage are more susceptible to this cancer, Prof Sommat said diets high in salt or preserved foods, those with a family history of NPC, and smoking are all risk factors that contribute to the development of nose cancer.

Additionally, NPC is related to the Epstein-Barr virus (EBV), said Dr Eu. This virus has the ability to enter the cell and lead to mutations, ultimately leading to the development of NPC.

What are some signs and symptoms of nose cancer?

The three most common signs of NPC are a blood-stained nasal or throat discharge, blocked ear, and enlarged lymph nodes, said Dr Tay Hin Ngan, an otorhinolaryngologist and head and neck robotic surgeon at Mount Elizabeth Hospital.

“Other symptoms and signs like double vision, facial numbness, breathing or swallowing problems are less common and appear only when the tumour has invaded surrounding structures,” he added.

The difficulty in diagnosing nose cancer in general is that it is particularly silent in its onset, said Dr Eu.

“This might be fairly innocuous, such as a unilateral blocked ear sensation, as with Mr Liang. Other symptoms include blood-stained sputum or single-sided nasal blockages,” he said.

How many people are affected by nose cancer a year?

The incidence of NPC in Singapore remains one of the highest in the world, with 8.9 per 100,000 males affected per year, said Prof Sommat.

Dr Eu said that an estimated 300 patients are diagnosed every year in Singapore.

However, the number of cases has actually been on a decline compared with previous years, Dr Eu added, citing the most recent report by the Ministry of Health in which the incidence of NPC has been excluded from the top 10 cancers in men.

What are the treatment options for NPC?

Non-metastatic NPC, or tumours that have not spread below the collar bones, generally have a higher cure rate of treatment, said Dr Ivan Tham, a radiation oncologist at Gleneagles Hospital.

He added: “This consists of 6½ to seven weeks of radiation therapy, and the addition of chemotherapy for more locally advanced cases.”

Radiation therapy using X-rays have been used for the past two decades, and remains the main treatment used in Singapore, Dr Tham said.

Additionally, there is an alternative delivery method of radiation therapy, which uses protons, which was rolled out in May. It potentially reduces the acute or late side effects of treatment, said Dr Tham.

“The Ministry of Health currently allows proton therapy to be used in NPC cases which are locally advanced and/or unresectable, or when concurrent chemotherapy is used,” he added.

What is the survival rate?

The survival rate for nasopharyngeal cancer has increased with more advanced treatment, said Dr Tay.

He added that cure rates for stage one and two NPC are 93 per cent and 87 per cent, respectively, with radiotherapy.

Treatment for advanced-stage NPC, stage three or four, will require the addition of chemotherapy or targeted therapy, during and sometimes before or after radiotherapy, said Dr Tay.

Survival rates for these stages are 81 per cent and 65 per cent, respectively, he added.

Patients’ outlook for recovery also depends on their age and general health at the time of diagnosis, and whether they respond to the treatment, added Prof Sommat.

“Generally, NPCs are treatable and have a high cure rate in the early stages,” she said.

What are the key factors and methods for early detection of NPC, and how can I proactively mitigate any risk factors?

Blood tests for EBV may help with early detection of NPC, said Dr Tay.

He added that MRI (magnetic resonance imaging), CT (computerised tomography) and PET (positron emission tomography) scans can also help to determine the stage of the disease and thus, the appropriate treatment.

Additionally, patients with a family history of the disease should go for regular screenings to allow for early detection and treatment of NPC, said Dr Eu.

Patients who are concerned about nose cancer should see a doctor early and undergo a formal examination to evaluate the nasal cavity.

He added that a healthy diet, where one cuts down on foods high in preservatives like salted vegetables, may help to decrease risk factors.

Dr Eu said: “Early detection and diagnosis confer the best chance of cure.”