A painless lump on the neck and a persistent sore throat are typical symptoms of nose cancer, also known as nasopharynx cancer after the nasopharynx which lies behind the nose, above the back of the throat. This cancer, in which the cells lining the nasopharynx become cancerous, affects men more than women; it is the 8th most common cancer among men in Singapore.

Question by mosmos

Hi Dr Terence Tan, What are the causes of nose cancer if we are non-smokers?

Answered by Dr Terence Tan Senior Consultant Department of Radiation Oncology National Cancer Centre Singapore

In all my replies I am going to use the proper name “Nasopharyngeal Cancer” because nose refers to the external part of the nasal passage. The nasopharynx is actually the space behind the nasal passage.

The relationship of smoking to nasopharyngeal cancer is much weaker than its relationship to other cancers, so the risk factors are largely the same for smokers and non-smokers. The exact cause is not really known but the following are risk factors: exposure to the Epstein Barr virus, a diet high in salt-cure fish and meat, and genetic pre-disposition.

Question by octane

Dear Dr Tan, How do we prevent nose cancer? Is there any activity or food to avoid that can cause nose cancer?

Answered by Dr Terence Tan Senior Consultant Department of Radiation Oncology National Cancer Centre Singapore

It is difficult to prevent nasopharyngeal cancer since its cause is not really known. About the only action one can take is to avoid salt-cured fish & meat. Other than this, the next best thing to do is to seek Medical attention early if you are experiencing suspicious symptoms (see question below) and to go for screening if you do have a family history (also covered in a question below).

Question by raytmt02

Good morning Dr. Tan.

Would be very grateful to have your view/opinion on my condition. About 8 months back I suffered frequent nasal congestion (left nostril), then later followed by discharges. Sometime in June 2012, the discharges were more watery and coloured brownish. For the next 3 days the brownish discharges dripped when I bent my head down.

Though I do not have these symptoms currently, there still is occasional discharges following sneezing. However now these are clear mucous. What worries me is the giddiness felt and tend to tilt towards the left side.

Some years ago I consulted a doctor for feeling dizzy and he explained that it could be due to pathogenic changes in the nasal passages.

Thank you

Answered by Dr Terence Tan Senior Consultant Department of Radiation Oncology National Cancer Centre Singapore

What is clear is that you do have an ENT condition. Although this sounds most likely to be a non-cancerous condition like sinusitis, but it is right to be concerned if it is a malignancy. The way to resolve this is to have a consultation with an Ear-Nose-Throat specialist who would be able to make the appropriate diagnosis for you and then offer you the appropriate treatment.

Question by alvinchang72

My dad had Stage 1 nose cancer which resolved with radiotherapy in year 2007. Am I at risk of developing it and if so, are there any screening tests that can be done and at what age would be an appropriate time for it? Thanks

Answered by Dr Terence Tan Senior Consultant Department of Radiation Oncology National Cancer Centre Singapore

Screening for Nasopharyngeal cancer is generally not recommended as the pick-up rate is very, very low. For high-risk individuals just as those with a strong family history, it will be justified to be screened for this disease. The screening would involves doing a blood test for EBV serology and going on to an endoscopic examination of the nasopharynx for those with abnormal results.

Question by annie.lau

Is it true that severe nose bleeding can be one of the symptoms for nose cancer?

Answered by Dr Terence Tan Senior Consultant Department of Radiation Oncology National Cancer Centre Singapore

Yes, it is true that nose bleeds can be one of the symptoms of Nasopharyngeal cancer. The manifestation ranges from spots of blood mixed with mucus to severe bleeds.

Question by lalitha.veerasamy

Dear Dr Tan

Frequently i suffer with nosebleed especially during sleep. most of the time, i could feel it so i used to get up and put some ice or some home remedies till it stopped. Usually it starts with severe headache during evening.

Have undergone surgery for deviated septum in 2011.

Recent episode, it was in early morning with some gelly like clotted blood along with fresh blood. it lasted for more than 5 minutes..

May we know more details and symptoms for nose cancer? What kind of preventive actions will help to mitigate?

Appreciate your advise

Thanks

Answered by Dr Terence Tan Senior Consultant Department of Radiation Oncology National Cancer Centre Singapore

The possible symptoms of nasopharyngeal cancer include nose bleeds, nose blocks, nasal discharge, hearing loss, ringing in the ears, headaches, double vision, facial pain or numbness, and masses in the neck. The best way to mitigate it is to be aware of these symptoms, and to seek medical attention early if you have any of these symptoms which are persistent.

Question by markbrighi

Hi Dr Tan,

I've once heard an uncle said that his brother fractured his nose after a bad fall. After he went to the doctor for a scan, he was found to have more than just a fractured nose. He had nose cancer.

Can I check with you if the fall has anything to do with him having the cancer?

Thank you. :)

Regards,
Mark Brighi

Answered by Dr Terence Tan Senior Consultant Department of Radiation Oncology National Cancer Centre Singapore

No, the fall did not have anything to do with the cancer. It was fortunate that he had a scan done to evaluate the trauma, otherwise the cancer will not have been discovered till later.

Question by lifeartsg

Is early stage nose cancer a slow growing one? If tumor recurs after treatment and doctors deem it unwise to go for further rounds of treatment, what's the prognosis for survival and tumor development? Thanks.

Answered by Dr Terence Tan Senior Consultant Department of Radiation Oncology National Cancer Centre Singapore

Cancers in the early stages often appear to grow slowly because there are fewer cells. In the advanced stages they progress faster because there are more cells (Geometric progression). If a tumour recurs after treatment and has not spread, we can usually still attempt salvage with either surgery or another course of radiotherapy. If the cancer has spread, then we would usually treat with chemotherapy. If a doctor deems it unfit to go for further treatment for whatever reason (patient is not fit or no further effective treatments available), then the tumour will eventually progress and the prognosis for survival would be in the order of months

Question by qa24369

Dear Dr Terence Tan,

Had a annual health screening and shown following reading in the blood test.

EBV EA + ebna-1 iga 19EU/ml

Did a follow up another blood test.

Anti-EBV VA-IGA <5 Anti-EBV VCA-IGA 40

Should I be worry? How so I do next?

Please advise.
Regards

Answered by Dr Terence Tan Senior Consultant Department of Radiation Oncology National Cancer Centre Singapore

Your Anti-EBV VA-IgA is negative while your Anti-EBV VCA-IgA and EBV EA + EBNA-1 IgA are slightly elevated. I would suggest a nasendoscopic examination by an ENT specialist and a repeat of the blood test a year later.

Ref: S13