Nasopharyngeal cancer (NPC) is most often diagnosed when a patient goes to a doctor because of symptoms or a lump in the neck.

Symptoms and signs of nasopharyngeal cancer

About 3 out of 4 patients complain of a lump or mass in the neck when they first see their doctor. This is caused by the cancer spreading to lymph nodes in the neck, causing them to become larger than normal. (Lymph nodes are bean-sized collections of immune system cells found throughout the body.)

Other possible symptoms of NPC include:

• hearing loss, ringing in the ear, or feeling of fullness in the ear (especially on one side only)
• nasal blockage or stuffiness
• nosebleeds
• headache
• facial pain or numbness
• trouble opening the mouth
• blurred or double vision

Although these are possible symptoms and signs of nasopharyngeal cancer, they are more likely to be caused by non-cancerous diseases. Still, if you have any of these problems, it's important to see your doctor right away so the cause can be found and treated, if needed.

Medical history and physical exam

If you have any signs or symptoms that suggest you might have nasopharyngeal cancer, your doctor will want to get your complete medical history to check for symptoms and risk factors, including your family history.

A physical exam will be done to look for signs of nasopharyngeal cancer (NPC) and other health problems. During the exam, the doctor will pay special attention to the head and neck area, including the lymph nodes in the neck; the nose, mouth, and throat; and the facial muscles.

If the results of the standard exam are abnormal, your doctor may do more involved tests or refer you to an otolaryngologist (a doctor specializing in ear, nose, and throat problems) for a more detailed exam. A thorough physical exam of the nasopharynx is usually done by an otolaryngologist because they have more specialized equipment and training.

Exams of the nasopharynx

Because the nasopharynx is located deep inside the head and is not easily seen, special techniques are needed to examine this area. Different types of exams can allow the doctor to look inside the nasopharynx for abnormal growths, bleeding, or other signs of disease.

• Indirect nasopharyngoscopy uses special mirrors and lights to look at the nasopharynx and nearby areas.

• For direct nasopharyngoscopy, the doctor uses a fiber-optic scope (a flexible, lighted, narrow tube inserted through the mouth or nose) to look directly at the lining of the nasopharynx.

If a tumor starts under the lining (in the submucosa), it may not be possible to see it directly on physical exam, which is why imaging tests such as CT scans (see below) may be needed as well.

Biopsy

While symptoms and the results of exams may strongly suggest that nasopharyngeal cancer is present, the actual diagnosis is made by removing cells from an abnormal area and looking at them under a microscope. This is known as a biopsy. Different types of biopsies may be done, depending on where the abnormal area is.

If a suspicious growth is found in the nasopharynx during an exam, the doctor may remove a biopsy sample with small instruments and the aid of a fiber-optic scope. Often, biopsies of the nasopharynx are done in the operating room as an outpatient procedure. The sample is then sent to a lab, where a doctor called a pathologist looks at it under a microscope. If cancer cells are present, the pathologist sends back a report describing the type of the cancer.

In some cases, NPC may not produce any signs of the disease that can be seen. This is because most of the cancer is hidden beneath the surface. If the patient has symptoms suggesting NPC, the doctor may take several samples of normal-looking tissue, which may be found to contain cancer cells when viewed under the microscope.

Fine needle aspiration (FNA) biopsy: An FNA biopsy may be used if you have a suspicious lump in or near your neck. For this procedure, the doctor uses a thin, hollow needle attached to a syringe to aspirate (withdraw) a few drops of fluid containing cells and tiny fragments of tissue. A local anesthetic (numbing medicine) may be used on the skin where the needle will be inserted. In some cases, no anesthetic is needed.

The doctor places the needle directly into the mass for about 10 seconds and withdraws cells and a few drops of fluid. The cells are then looked at under a microscope to see if they are cancerous (malignant).

In patients with an enlarged lymph node in the neck area, an FNA biopsy can help determine if the enlargement is caused by a response to an infection (reactive hyperplasia), the spread of cancer from somewhere else (such as the nasopharynx), or a cancer that begins in lymph nodes called a lymphoma. If a patient already known to have NPC has enlarged neck lymph nodes, FNA can help determine if the spread of NPC caused the lymph node swelling.

Imaging tests

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive particles to create pictures of the inside of your body. Imaging tests may be done for a number of reasons, including to help find a suspicious area that might be cancerous, to learn how far cancer may have spread, and to help determine if treatment has been effective.

Chest x-ray

If you have been diagnosed with NPC, a plain x-ray of your chest will be done to see if the cancer has spread to your lungs. This is very unlikely unless your cancer is far advanced. This x-ray can be done in any outpatient setting. If the results are normal, you probably don't have cancer in your lungs.

Computed tomography (CT) scan

The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these into images of slices of the part of your body that is being studied. Before the scan, you may be asked to drink a contrast solution and/or get an intravenous (IV) injection of a contrast dye that helps better outline abnormal areas in the body.

You may need an IV line for the contrast dye injection. The injection can cause some flushing (redness and warm feeling). Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to a contrast material used for x-rays.

You need to lie still on a table while the scan is being done. During the test, the table moves in and out of the scanner, a ring-shaped machine that completely surrounds the table. You might feel a bit confined by the ring you have to lie in while the pictures are being taken.

In recent years, spiral CT (also known as helical CT) has become available in many medical centers. This type of CT scan uses a faster machine. The scanner part of the machine rotates around the body continuously, allowing doctors to collect the images much more quickly than standard CT. As a result, you do not have to hold your breath for as long while the image is taken. This lowers the chance of blurred images occurring as a result of breathing motion. It also lowers the dose of radiation received during the test. The slices it images are thinner, giving more detailed pictures.

The CT scan can provide information about the size, shape, and position of a tumor and can help find enlarged lymph nodes that might contain cancer. CT scans or MRIs are important in looking for cancer that may have invaded into the bones at the base of the skull. This is a common place for nasopharyngeal cancer to grow. CT scans can also be used to look for tumors in other parts of the body.

Magnetic resonance imaging (MRI) scan

Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into very detailed images of parts of the body. A contrast material called gadolinium is often injected into a vein before the scan to better see details.

MRI scans may be a little more uncomfortable than CT scans. They take longer -- often up to an hour. You may be placed inside a large cylindrical tube, which is confining and can upset people with a fear of enclosed spaces. Newer, "open" MRI machines can help with this if needed. The MRI machine makes buzzing and clicking noises that you may find disturbing. Some places will provide earplugs to help block this noise out.

Like CT scans, MRIs can be used to try to determine if the cancer has invaded structures near the nasopharynx. MRIs are a little better than CT scans at showing the soft tissues in the nose and throat, but they're not quite as good for looking at the bones at the base of the skull, a common place for nasopharyngeal cancer to grow.

Positron emission tomography (PET) scan

For the PET scan, you will receive an injection of glucose (a form of sugar) that contains a radioactive atom. The amount of radioactivity used is very low. Because cancer cells in the body are growing rapidly, they absorb large amounts of the radioactive sugar. A special camera can then be used to create a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your whole body.

Your doctor may use this test to see if the cancer has spread to your lymph nodes. It can also help give the doctor a better idea of whether an abnormal area on your chest x-ray may be cancer. A PET scan can also be useful if your doctor thinks the cancer may have spread but doesn't know where.

Some newer machines are able to perform both a PET and CT scan at the same time (PET/CT scan). This allows the doctor to compare areas of higher radioactivity on the PET with the appearance of that area on the CT.

Blood tests

Routine blood counts and blood chemistry tests

Routine blood tests can help determine a patient's overall health. These tests can help diagnose malnutrition, anemia (low red blood counts), liver disease, and kidney disease. And they may suggest the possibility of spread of the cancer to the liver or bone, which may prompt further testing.

In people getting chemotherapy, these blood tests are important to see if the treatment is damaging the bone marrow (where new blood cells are made), liver, and kidneys.

Epstein-Barr virus (EBV) DNA levels

In some patients, the blood level of EBV DNA before and after treatment may help to show how effective treatment is.

Last Medical Review: 01/21/2009
Last Revised: 01/21/2009