Current Detection Methods

Indirect Mirror Examination has been the traditional and simple, albeit highly nonspecific method that can be performed with minimal equipment requirement. Nasopharyngoscopy is at present the most common routine and is considered the standard of practice. However, up to 30% of NPC are sub-mucosal and may not be apparent on endoscopy. EBV serology has been shown to be useful but it lacks sensitivity and specificity, particularly in early stages. Rising titres may be an indication of presence of disease especially in individuals with strong family history of NPC or those with recurrence after radiation. Examination under anesthesia and biopsy is the gold standard for final pathologic diagnosis.

Diagnostic Challenge

• Nasopharynx is a location in the head that is not directly accessible
• Early cancer is inconspicuous and patients have minimal symptoms and therefore lack of general awareness that there may be an issue
• NPC is difficult to detect routinely without special equipment such as endoscope
• Tumors can be submucosal, and therefore not visible on endoscopy
• Most patients present late stage with advanced disease

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