Frequent nosebleeds may be a sign of nasopharyngeal cancer

While nosebleeds are more common in winter months, they can stem from a more serious problem – nasopharyngeal cancer (NPC). Other typical symptoms of NPC include persistent nosebleeds and lump(s) in the nose and lymph nodes in the neck. NPC is also known as the Guangdong province, given 80% of cases worldwide are originated in southern China. Genetic factors and excessive consumption of diets high in salt cured meats and fish are thought to be linked to NPC. Those who are looking to reduce the risk of developing NPC should consider lifestyle changes, such as reducing the intake of such foods.

Hospital Authority statistics showed that 800 NPC cases are diagnosed each year. In 2016 alone, there were 805 new cases of NPC. Dr. Maverick WK Tsang, an oncologist from Hong Kong Integrated Oncology Centre, explains that NPC is most commonly diagnosed in adults over the age of 50, where men are 3 times more likely than women to develop the condition. Those with a family history of NPC are additionally 4 to 8 times more likely to develop NPC.

Recent research showed that the consumption of preserved foods, including salted fish and cured meats, is one of the primary causes to NPC. These foods are commonly found in high concentrations in Asian diets. Another risk factor for NPC is exposure to the Epstein-Barr virus (EBV), which is regarded as a biomarker for NPC. Finally, tobacco smoking and alcohol intake are also established risk factors for NPC.

The signs and symptoms of NPC resemble those that are caused by other upper respiratory conditions, such as nosebleeds, blood in nasal discharge, blocked nostrils, ringing in the ears as well as earaches. As such, NPC can be hard to detect in the early phases. You should seek medical advice should the described symptoms persist over 1 month.

NPC tumours can be spread to lymph nodes in the neck, causing them to swell. Dr Tsang explains that about 90% of NPC patients experience stiff but painless lumps in the neck area The size of these lumps can range from 3 to 10cm in diameter, and tend to emerge in the back of the neck as well as along the clavicles. He adds that, while it is true that infections can cause swollen lymph nodes, these lumps are usually more tender and cause discomfort and pain. The lumps are also smaller than 1cm in diameter and subside as the infection goes away.

There are several tests that can be done to confirm or rule out NPC. These include nasoendoscopy, biopsy and magnetic resonance imaging (MRI). PET-CT scans may be carried out for those with stage III to IV NPC to determine whether the tumours have spread to other body parts, such as lymph nodes in the chest as well as the lungs.

Fortunately, there are ways to lower the risk of developing NPC. These include avoiding habits that have been associated with the disease, such as eating less preserved foods as well as eliminating smoking and alcohol consumption. Those who present with persisting NPC symptoms should seek medical advice as soon as possible. In addition, those who have a family history of NPC should consider NPC screening. In particular, those that are shown with high levels of EBV antibodies in their blood samples can consider additional testing with nasoendoscopy.

There is growing public awareness towards NPC, especially as Malaysia’s top badminton star Lee Chong Wei was diagnosed with NPC in 2018 and has been responding positively to treatment. Radiotherapy remains as the mainstay treatment modality for NPC, where over 90% of early-stage NPC tumours can be treated.

Radiotherapy can indeed cause multiple side effects. Dr Tsang recalls NPC patients who have initially declined radiotherapy treatment due to fears surrounding radiotherapy. He describes an early-stage NPC patient who initially declined radiotherapy, and came back to us a year later presenting with Stage III NPC. At that point, the patient required both radiotherapy and chemotherapy for tumour control, and had to suffer from side effects induced from both treatment modalities.

Common radiotherapy-induced side effects include appetite loss, mouth sores, redness and blisters in skin as well as changes in taste. Medication can help relieve these side effects. Generally speaking, radiotherapy is the standard treatment modality for early-stage NPC. Chemotherapy is often combined with radiotherapy to treat Stage III and IV NPC tumours. With timely and appropriate treatment, Dr Tsang states the 5-year survival rate for Stage I NPC is as high as 90%; whereas the figure drops to 70% for Stage III patients. For Stage IV cases, the 5-year morality rate is at 40-50%.

Symptoms of NPC include:

  • Nose bleeds and blood found in mucous
  • Blocked nose
  • Swollen lymph nodes in the neck
  • Earache
  • Ringing in ears (tinnitus)
  • Hearing loss


  • Reduce intake of salted and fermented foods
  • Avoid smoking tobacco and alcohol consumption
  • Seek professional advice should the above symptoms worsen over time
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Dr. Tsang Wai Kong, Maverick