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How to Differentiate between Nasopharyngeal Cancer and Allergic Rhinitis

The changing of seasons, especially between spring and summer, is prone to trigger allergic rhinitis, which is also commonly known as nasal allergy. Symptoms such as sneezing, runny nose, and stuffy nose are very common. However, if these symptoms persist for a few months or get worse, you may be at risk of other more serious diseases such as chronic sinusitis and even nasopharyngeal carcinoma.

5 Common symptoms of nasopharyngeal cancer

Is nasopharyngeal carcinoma associated with nasal allergies, chronic sinusitis, and other upper respiratory tract infections? Identify common nasopharyngeal cancer symptoms and do not confuse them with other upper respiratory tract infections.

1. Bloody discharge from your nose

Bloody discharge from your nose is a very common symptom of nasopharyngeal carcinoma, nasal allergies or sinusitis. At the same time, it is also the most easily neglected warning sign of nasopharyngeal cancer. It is not too difficult to find out the “clues” if you look carefully enough. Nasal discharge is usually white in colour and contains transparent mucus with a small amount of blood whereas the nasal discharge of a nasopharyngeal cancer patient might be yellowish. It is possible that the discharge might only contain nasal blood and no mucus.

nose bleed

In addition, if the mucus and nasal discharge are yellow and green, they are more likely to be due to the inflammation of the nasal cavity or sinusitis. In theory, nasopharyngeal carcinoma may also cause inflammation and produce nasal discharges that are darker in colour, but such conditions are relatively rare in clinical cases.

2. Frequent Nasal Pain and stuffiness

Nasal pain, sneezing, and stuffiness is caused by excessive nasal discharge. It is very common in nasopharyngeal cancer and upper respiratory tract infections.

3. Ringing in the ear, pain

Since the area near the nasopharynx is an ear-to-nose conduit, patients with nasopharyngeal carcinoma may experience ringing in the ear or pain, particularly on one side of the ears. However, patients with severe nasal allergies and sinusitis may experience ringing in the ears as well.

4. Swollen Cervical Lymph Nodes

Among nasopharyngeal carcinoma, nasal allergies and sinusitis, only nasopharyngeal carcinoma will cause this symptom. It is possible that the tumor has spread from the nasopharynx to the cervical lymph nodes, which is typical for cases classified as stage 2 or above.

5. Diplopia (Double Vision)

Among nasopharyngeal carcinoma, nasal hypersensitivity and sinusitis, only nasopharyngeal carcinoma will cause this symptom, which is a red flag for nasopharyngeal cancer. At this stage, the tumor may have grown close to the base of the brain, affecting the nervous system that is responsible for controlling eye movements, consequently impairing vision and causing facial paralysis, as well as pain at the top of the skull. This symptom is common in more severe cases of advanced-stage nasopharyngeal carcinoma.

 

Symptoms

Early symptoms of nasopharyngeal carcinoma Upper Respiratory Infections
Nasal allergies Chronic sinusitis
Nasal Discharge
  • Yellowish
  • Possible with nose blood only and no mucus
  • Mainly white and transparent nasal mucus
  • May have a small amount of blood
  • Thick nasal discharge. It could be white, yellow or green.
  • Patients usually have inflamed sinuses, so the mucus is only coming out from one side of the nostril.
Nasal Pain and stuffiness
  • Very Similar
  • Swelling of sinuses
Ringing in the ears, pain
  • Very Similar
Cervical lymph nodes
  • Swollen
  • Usually no effect
Vision
  • Double vision
  • May cause facial paralysis and pain at the top of the skull
  • No effect
  • Does not affect vision
  • Since the sinuses are located near the eyes and nose, patients with sinusitis may suffer from cheek pain, headache, and fatigue
  • Severe cases may lead to fever

Who should be screened for nasopharyngeal cancer?

The early symptoms of nasopharyngeal cancer are very similar to those of upper respiratory infections, making it hard to catch for some patients. At times, these symptoms are “disguised” as nasal allergies. The bloody nasal discharges are often mistaken as a result of dry weather. The ambiguous symptoms give rise to psychological anxiety and put pressure on patients.

In the face of such “sneaky” nasopharyngeal cancer, patients should see a doctor right away as soon as you identify symptoms such as bloody nasal discharge, especially those with a family history of nasopharyngeal carcinoma. A routine nasopharyngeal examination takes about one week to complete. Key procedures include:

  • Nasopharynx endoscopy- Biopsy;
  • Magnetic Resonance Imaging (MRI) – Locating tumors;
  • PET/CT – Positron Emission Tomography- Cases of advanced-stages may need to be examined again to check if the tumor has spread.

The survival rate of early-stage nasopharyngeal carcinoma (Phase 1 to Phase 2) can be up to 90% if discovered via screening and treated early. For Phase 3, the survival rate is around 70%. If found in Phase 4 (including cases of advanced-stage or when the tumor has spread), the survival rate drops to 50% to 60%. Clinical findings show that nearly half of the nasopharyngeal carcinoma patients were diagnosed at stage 2 or stage 3.

Imaging Scan

In addition to regular nasopharyngeal cancer screening, EBV-DNA blood test screening, which has been introduced few years ago, can detect the risk of developing NPC cancer before any symptoms are found. The advantages of EBV-DNA blood testing are that it is non-invasive, inexpensive (about HK$1,000) and provides prompt results (within a few days).

However, there is room for improvement regarding the accuracy of EBV-DNA blood test. As of today, it is not considered as part of the procedure for regular nasopharyngeal carcinoma screening. Only about 10% of all people with abnormal results ended up with NPC cancer. On the contrary, if results are within the normal range, more than 90% of these cases will not be diagnosed with nasopharyngeal cancer . Although the risk of nasopharyngeal cancer cannot be entirely ruled out, for those with a family history of NPC cancer, they can take a weight off their minds for a while. As for the general public, it is not necessary to undergo this screening.

Are nasal allergy patients at high risk?

There is no sufficient evidence of medical authority to show that nasal allergy and nasopharyngeal carcinoma have a cause and effect relationship. Nasal allergy patients are not in the high-risk group of nasopharyngeal carcinoma. In recent years, some studies have tried to figure out the relationship between nasopharyngeal carcinoma and nasal allergy. However, the results and conclusions vary.

Nose Allergy

A large-scale study published in 2014 by Taipei Medical University Hospital suggested that nasal allergy patients should also be alert to nasopharyngeal carcinoma. The research team randomly sampled 1799 cases of nasopharyngeal carcinoma from 2005 to 2011 and analyzed 5397 cases. The results showed that 48.6% of nasopharyngeal carcinoma patients had a history of nasal allergy, which was 19.4% higher than that of the control group without nasopharyngeal carcinoma. The result does not provide a clear explanation of the cause. However, it brings new perspectives regarding the prevention and treatment of nasopharyngeal carcinoma.

If the public awareness of cancer prevention can be elevated, it is undoubtedly good news for doctors. The standard treatment of early-stage nasopharyngeal carcinoma is 7 weeks of electrotherapy, supplemented with 2 months of chemotherapy, to achieve the ideal therapeutic effect. The local recurrence rate after treatment is only about 10% for advanced-stage nasopharyngeal carcinoma, which is a breakthrough. Therefore, discovering NPC cancer as early as possible is a critical step to fight against it.

Dr. Tsang Wai Kong, Maverick

Dr. Tsang Wai Kong, Maverick

SPECIALIST IN CLINICAL ONCOLOGY
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