Nasopharyngeal Cancer Clinical Presentation

Updated: Nov 17, 2016
  • Author: Arnold C Paulino, MD; Chief Editor: Cameron K Tebbi, MD  more...
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Presentation

History

Nasopharyngeal carcinoma rarely comes to medical attention before it has spread to regional lymph nodes. Enlargement and extension of the tumor in the nasopharynx may result in symptoms of nasal obstruction (eg, congestion, nasal discharge, bleeding), changes in hearing (usually associated with blockage of the eustachian tube, but direct extension into the ear is possible), and cranial nerve palsies (usually associated with extension of the tumor into the base of the skull).

One study indicated the following symptoms [4] :

  • Nasal symptoms: including bleeding, obstruction, and discharge (78%)

  • Ear symptoms: including infection, deafness, and tinnitus (73%)

  • Headaches (61%)

  • Neck swelling (63%)

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Physical

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  • The most common physical finding is a neck mass consisting of painless firm lymph node enlargement (80%).

  • Neck involvement is often bilateral; the most common nodes involved are the jugulodigastric, and upper and middle jugular nodes in the anterior cervical chain.

  • Cranial nerve palsy at initial presentation is observed in 25% of patients.

  • On nasopharyngoscopy, a mass arising in the nasopharynx is often visible. The most frequent site is the fossa of Rosenmüller.

  • A paraneoplastic osteoarthropathy has been described in patients with widespread metastatic or recurrent disease.

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Causes

Viral DNA in nasopharyngeal carcinoma has revealed that Epstein-Barr virus (EBV) can infect epithelial cells and is associated with their transformation to cancer. [1] Genetic and environmental factors have been implicated in the development of this disease. A genetic etiology has been considered due to the higher rates of disease within specific ethnic groups, patients with first-degree relatives with the disease, patients with A2 HLA haplotypes, and cytogenetic abnormalities identified within tumor samples. [5, 6] Environmental causes must be considered due to the geographical distribution of the disease, bimodal age distribution, and association seen in patients who consume a large amount of preserved foods and/or salted fish. [7]

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