Ear, Nose & Throat

What are the first symptoms of nasopharyngeal cancer (nose cancer)?

The first signs of nasopharyngeal cancer (nose cancer) can be subtle and painless, which is why it is difficult to detect in the early stages.

Lisa Twang

Published on November 7, 2020

This article has been verified medically by Dr Samuel Yeak, otorhinolaryngologist and ENT specialist at Amandela ENT Head And Neck Centre Singapore, Mount Elizabeth Novena Hospital (Singapore).
About the Doctor

Nasopharyngeal cancer (nose cancer) affects the nasopharynx, which is the area connecting the nose to the throat. Nasopharyngeal cancer is associated with infection by the Epstein-Barr Virus (EB virus). It first develops in cells of the lining of the nasopharynx, and forms a cancerous lump. This can spread to the lymph glands in the neck and eventually to the lungs, liver and bones if left untreated.

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In its early stages, nasopharyngeal cancer is curable but difficult to diagnose. As it occurs so far back in the deeper part of the nose, patients usually show few symptoms until it has reached an advanced stage.

Symptoms of nose cancer

Neck lump	A painless neck lump is the most common symptom of nose cancer. It is seen in two out of three patients. It means their nose cancer has already spread to the lymph nodes in their neck, causing swelling.
Hearing issues	Nose cancer may spread locally to block the tube connecting to the ear. Fluid builds up in the ear, causing a blocked ear and tinnitus (ringing in the ears). Around half of patients have these symptoms.
Blood in mucus and phlegm	Rather than nosebleeds, about one third of patients have blood in their mucus (nasal discharge). Another third may cough up blood-tinged phlegm. Together, blood-tinged mucus and blood-tinged phlegm are seen in about half of patients.

Among Chinese patients, these symptoms are often interpreted as signs of “heatiness”. This is another reason why patients with nasopharyngeal cancer tend to ignore the symptoms, and delay seeing a medical doctor until their cancer has already advanced. There is a need for the public to be more aware of nasopharyngeal cancer symptoms, so they can seek early treatment.

Who is at risk for nasopharyngeal cancer?

You are more likely to have nasopharyngeal cancer if you are:

Male (it is the eighth most common cancer in Singaporean men, and the most common cancer in young Singaporean men)
Chinese (it is 20 to 30 times more common among Chinese than other ethnicities)
Found to have a family history of the disease
Consuming high amounts of preserved foods, such as salted fish and vegetables

Most early cases of nasopharyngeal cancer are found through EB virus antibody screening. However, routine screening for nasopharyngeal cancer is generally not done. The incidence of nasopharyngeal cancer, even in a positive EB virus test, is very low. If a person has a strong family history of nasopharyngeal cancer or has some symptoms, he or she can consider a blood test for the EB virus and start a discussion with a specialist.