General Information

Most cases of NPC are detected late

What Is Cancer
Generally cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of out-of-control cell growth.

Nasopharyngeal Tumors and NPC
Several types of tumors can develop in the nasopharynx, an area in the back of the nose toward the base of skull. Some of these tumors are benign (non-cancerous), while others are malignant (cancerous). Nasopharyngeal carcinoma (NPC) is one type of cancer that develops in the nasopharynx and is the most common malignant tumor of the nasopharynx. Reseachers have found in the high-risk population (ethnic Chinese) virtually 100% of malignancies are Type III, NPC. A carcinoma is a cancer that starts in cells lining the internal and external surfaces of the body.

There are 3 types of NPC:
    · Type I, keratinizing squamous cell carcinoma (well differentiated)
    · Type II, non-keratinizing carcinoma (moderately differentiated)
    · Type III, undifferentiated carcinoma

Each of these NPC types is more common in some areas of the world than others. While rare, most NPC in Caucasions is the keratinizing Type I. In Southeast Asia, where NPC is much more common, most cases are the undifferentiated Type III.

Symptoms and Signs of NPC
During the early stages, nasopharyngeal carcinoma is usually asymptomatic (no overt symptoms). Most people seek medical attention when NPC is in the advanced stages with noticeable symptoms which may include:
    ·   A lump in your neck caused by a swollen lymph node
    ·   Bloody discharge from your nose
    ·   Nasal congestion on one or both sides of your nose
    ·   Hearing loss in one ear
    ·   Frequent ear infections
    ·   Headaches
    ·   Double vision
    ·   Face and neck pain

What Causes NPC And Risk Factors
NPC arises in the surface lining of the nasopharynx. Cancer begins when one or more genetic (DNA) mutations cause normal cells to replicate out of control, invade surrounding anatomic structures and eventually spread (metastasize) to other parts of the body.

Studies have shown that NPC is associated with a combination of one or more risk factors which include acquired infection by the Epstein-Barr virus (EBV), dietary habits and inherited characteristics. Multiple EBV DNA copies are found in almost every nasopharyngeal carcinoma tumor cell (up to 150 copies per cell), in comparison there are zero EBV DNA copies in healthy nasopharyngeal cells. Having a family member with nasopharyngeal carcinoma increases your risk for the disease.

How Common Is NPC
Nasopharyngeal carcinoma incidence rates are less than 1 per 100,000 in most populations. In ethnic Chinese, these rates are much higher, with elevated incidence rates in southern China (30 to 50 per 100,000). Men are twice as likely to develop nasopharyngeal carcinoma as women. Incidence rates progressively increase in the 20 to 60 years of age range, peaking at about 54 years of age. Emigrants relocating from endemic areas to non endemic areas such as United States and Canada maintain their elevated risk status. In North America, Chinese-Americans/Canadians comprise the majority of NPC patients.

How Is NPC Diagnosed
NPC may be diagnosed when a patient complains of symptoms or finds a lump in the neck or if a screening test such as nasopharyngoscopy or NP Screen® produces suspicious findings. The doctor will obtain a sample of nasopharyngeal tissue (biopsy). The tissue is sent to a laboratory where a pathologist (a doctor specializing in laboratory diagnosis of diseases) examines the tissue and confirms (or does not confirm) diagnosis of cancer.

Protecting Yourself Through Routine Screening

Less than 10% of patients are diagnosed during the early, more treatable, stages of the disease. Survival rate for early diagnosis can exceed 90%. In contrast less than half of those diagnosed with advanced stage NPC survive. During the early and intermediate stages there are few, if any, symptoms making effective screening tools essential to surviving NPC. There is, unfortunately, no accepted or widely promoted population based NPC screening program such a those in place for cervical or colon cancer. Most patients seek medical attention at the advanced stage when the disease becomes symptomatic. Ten year survival rates for tumor stages I, II, III and IV are estimated to be 90%, 70%, 50% and 40% respectively indicating better outcomes through early diagnosis and treatment.

The nasopharynx is located deep inside the head and not easily visualized. Special techniques are needed to screen this area. Doctors use indirect and direct nasopharyngoscopy instruments to examine the nasopharynx. These instruments allow the doctor to look inside the nasopharynx for abnormal growths, asymmetries, bleeding, or other signs of disease. However a significant number of early NPC cases remain hidden under the lining of the nasopharynx and evade detection.

New molecular screening tests such as NP Screen® assay are designed to detect NPC early. The test uses a simple, patient friendly trans-oral swab to collect cells from the area of the nasopharynx where NPC first forms. DNA is extracted from these cells and if abnormalities are detected at elevated levels then your risk for NPC is considerted to be very high.

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