Globally, 80% of nasopharyngeal carcinoma patients are in China, and the incidence rate decreases gradually from south to north. The age of onset of nasopharyngeal cancer starts in the 20s and gradually rises to
It peaks from 45 to 60 years old. With the development of diagnostic technology and multidisciplinary comprehensive treatment, the efficacy of nasopharyngeal cancer has been greatly improved, and the 5-year survival rate of early-stage patients is over 90%. The growth site of nasopharyngeal cancer is in the nasopharynx, which is very hidden and cannot be seen or felt from the outside of the body. How to raise public awareness of nasopharyngeal cancer and achieve early detection and treatment is the key to further improve the efficacy of nasopharyngeal cancer. Clinicians need to pay extra attention when they find the following conditions
Painless neck lump About 60-80% of patients initially present with a neck lump. The “typical” site of the mass is behind the angle of the jaw and below the ear (Figure 1). The mass is hard, painless, and not itchy, so it is easily misdiagnosed as an inflammation of the lymph nodes. So for painless neck lumps must be paid attention to, it is best to go to a specialist hospital to check the nasopharynx.
2.Retractable blood Tumor growing in the posterior wall of nasopharynx can cause snot and blood (also known as retractable snot and blood) when forcefully sucking back nasal or nasopharyngeal secretion (mostly happens in the process of washing in the early morning) due to the friction between the back of soft palate and the surface of tumor, which is the cause of many early cases (Figure 2).
Tinnitus and hearing loss The tumor growing in the lateral wall of nasopharynx compresses the eustachian tube, causing negative pressure in the tympanic chamber and imbalance of lymphatic production and absorption, resulting in fluid accumulation in the mastoid air chamber (Figure 3). In some cases, there is running water in the ear, which is easily misdiagnosed clinically as otitis media. The above symptoms temporarily improve after tympanic membrane puncture and fluid extraction, but return to their original state within a short time.
4. Nasal congestion The tumor at the top of nasopharynx often infiltrates and grows anteriorly, which leads to mechanical obstruction of the ipsilateral posterior nostril and nasal cavity (Figure 4). Clinically, most of the nasal congestion is unilateral and worsening, and usually does not appear to be good or bad. Nasopharyngeal congestion caused by nasopharyngeal carcinoma will not change with the change of body position like the nasal congestion caused by cold.
5.Headache Tumor invading the bone structure of skull base can cause headache, which is mostly unilateral and persistent pain, mostly in temporal and top part, and often sharp stabbing pain. The location and severity of headache are related to the location and degree of tumor invasion. The headache often indicates that the tumor is in advanced stage.
6.Cranial nerve damage symptoms The nasopharynx is close to the skull base, the tumor grows upward and destroys the bones of skull base, pterygoid sinus, cavernous sinus and orbit, which leads to complex cranial nerve symptoms. For example, facial numbness, diplopia, eye movement disorder, tongue muscle atrophy, tongue extension deviation (Figure 5), vision loss, hoarseness, swallowing disorder, choking and coughing when eating, etc. Once the above neurological symptoms appear, it often indicates that the nasopharyngeal tumor has reached advanced stage.
7. Dermatomyositis Patients with dermatomyositis (Figure 6) have a higher incidence of malignant tumors than the general population, and in southern China and Southeast Asia, mainly combined with nasopharyngeal cancer.
If symptoms of appeal are found, detailed nasopharyngeal examination should be performed and early consultation should be made at a specialized hospital. For patients with clear family history, they should consult head and neck oncologists as early as possible to assess the risk and conduct early disease screening.