Nasopharyngeal Carcinoma

Knowledge Check

Exam-style MCQs aligned with these notes. Available to Hyperexcision Scholar members.

Last updated: April 28, 2026Bookmark

Nasopharyngeal cancer is a head and neck squamous cell carcinoma (SCC) that commonly arises in the fossa of Rosenmuller. It is strongly associated with the Epstein-Barr virus (especially in endemic regions).

It is the second most common head and neck cancer in Kenya. It peaks between 35 and 50 years, and affects men more than women.

WHO histological classification of nasopharyngeal cancer

WHO Type	Histology	Subtypes
WHO Type I	Keratinizing SCC	Less associated with EBV and has a worse prognosis
WHO Type II	Non-keratinizing SCC	Associated with EBV and has a better prognosis
WHO Type III	Non-keratinizing Undifferentiated SCC	This is the most common type. It is strongly associated with EBV and has the best response to treatment.

Clinical features of nasopharyngeal carcinoma

Category	Clinical features
Nose	Nasal obstruction, epistaxis, rhinorrhoea, and nasal mass
Neck	Painless neck mass
Ear	Ear blockage, fullness, conductive hearing loss, otitis media with effusion, and otalgia
Throat	Oropharyngeal mass, displaced palate, post-nasal drip, hyponasal speech, dysphagia, odynophagia, and airway obstruction
Eye	Proptosis, visual disturbance, and impaired eye movement
Central Nervous System (CNS)	Xerophthalmia (greater superior petrosal nerve), facial pain (trigeminal nerve), diplopia (CN VI), ophthalmoplegia (CN II, IV, VI), horner syndrome (sympathetic trunk), headache, and convulsions

Risk factors
- Male sex
- East Asian or Northern African heritage
- Epstein-Barr Virus (EBV)
- Genetic predisposition (HLA/MHC variants)
- Family history of nasopharyngeal cancer
- Nitrosamines in salted fish and other preserved foods
- Burning of an incense stick and wood
- Cigarette smoking
- Lack of vitamin C
- Alcohol consumption
- Occupational exposure to wood, dust, or smoke
- Polycyclic hydrocarbons
- Chronic nasal infection
- Poor hygiene
- Poor ventilation
- Smoke
Pathophysiology
- EBV infects nasopharyngeal epithelial cells → viral oncogenes (LMP1) activate pathways that force the cells to proliferate uncontrollably → mutations and evasion of the immune system → malignant transformation from a single infected cell (clonal origin)
Signs and symptoms
- Neck mass (70%)
  - Painless
  - This is the most common presentation
- Otitis media with effusion (50%)
  - Secondary to eustachian tube obstruction
  - This is the second most common presentation
- Nasal obstruction
  - Unilateral in early stages
- Cranial nerve palsies
  - Abducens nerve palsy is the most common
  - Eye symptoms occur in advanced disease
- Recurrent epistaxis
- Trismus
- Headache
Differentials
- Benign tumors
  - Angiofibroma
  - Choanal polyp
  - Squamous papilloma
  - Craniopharyngioma
  - Hamartoma
- Malignant
  - Lymphoma
  - Rhabdmyosarcoma
  - Chordoma
  - Plasmacytoma
  - Malignant salivary gland tumor
investigations
- Nasal endoscopy with biopsy for definitive diagnosis
- FNA of enlarged lymph nodes
- CT scan for bone involvement
- PET-CT for metastases
Treatment
- Treatment is mainly non-surgical
- Radiotherapy for stage I-II
  - Radiotherapy to the primary site and bilateral necks, regardless of nodal status
- Chemoradiation for advanced disease
- Neck dissection for post-radiation salvage surgery
- Tracheotomy if there is airway compromise

AJCC Staging of nasopharyngeal cancer

Tumor

Stage	Definition
Tx	Primary tumor not assessed
T0	No primary tumor
Tis	Carcinoma in situ
T1	Tumor confined to the nasopharynx, or extension to the oropharynx/nasal cavity w/o parapharyngeal involvement
T2	Tumor extends to the parapharyngeal space and/or adjacent soft tissue (pterygoid mm, prevertebral muscles)
T3	Tumor involves bony structures of skull base/cervical vertebrae/pterygoid and/or paranasal sinus
T4	Tumor invades intracranially/cranial nerves/hypopharynx/orbit/parotid gland and/or extensive soft tissue infiltration beyond the lateral surface of the lateral pterygoid

Node

Stage	Definition
Nx	Nodes cannot be assessed
N0	No regional LN metastasis
N1	Unilateral metastasis in cervical LN and/or unilateral or bilateral metastasis in retropharyngeal LNs, ≤ 6 cm above the caudal border of cricoid cartilage
N2	Bilateral metastasis in Cervical LNs, ≤ 6 cm above the caudal border of the cricoid cartilage
N3	Unilateral or bilateral metastasis in cervical LNs >6cm and/or extension below the caudal border of the cricoid cartilage

Metastasis

Stage	Definition
M0	No distant metastasis
M1	Distant metastasis

Reference Intervals ›

Biochemistry

ACTH	P: <80 ng/L
ALT	P: 5–35 U/L
Albumin	P: 35–50 g/L
Aldosterone	P: 100–500 pmol/L
Alk. phosphatase	P: 30–130 U/L
α-Amylase	P: 0–180 IU/dL
α-Fetoprotein	S: <10 kU/L
Angiotensin II	P: 5–35 pmol/L
ADH	P: 0.9–4.6 pmol/L
AST	P: 5–35 U/L
Bicarbonate	P: 24–30 mmol/L
Bilirubin	P: 3–17 μmol/L
BNP	P: <50 ng/L
CRP	P: <10 mg/L
Calcitonin	P: <0.1 mcg/L
Calcium (ionized)	P: 1.0–1.25 mmol/L
Calcium (total)	P: 2.12–2.60 mmol/L
Chloride	P: 95–105 mmol/L
Cholesterol	P: <5.0 mmol/L
VLDL	P: 0.128–0.645 mmol/L
LDL	P: <2.0 mmol/L
HDL	P: 0.9–1.93 mmol/L
Cortisol AM	P: 450–700 nmol/L
Cortisol Midnight	P: 80–280 nmol/L
CK ♂	P: 25–195 U/L
CK ♀	P: 25–170 U/L
Creatinine	P: 70–100 μmol/L
Ferritin	P: 12–200 mcg/L
Folate	S: 2.1 mcg/L
FSH	P: 2–8 U/L ♂; >25 menopause
GGT ♂	P: 11–51 U/L
GGT ♀	P: 7–33 U/L
Glucose (fasting)	P: 3.5–5.5 mmol/L
Growth hormone	P: <20 mu/L
HbA1C (DCCT)	B: 4–6%
HbA1C (IFCC)	B: 20–42 mmol/mol
Iron ♂	S: 14–31 μmol/L
Iron ♀	S: 11–30 μmol/L
Lactate (venous)	P: 0.6–2.4 mmol/L
Lactate (arterial)	P: 0.6–1.8 mmol/L
LDH	P: 70–250 U/L
LH	P: 3–16 U/L
Magnesium	P: 0.75–1.05 mmol/L
Osmolality	P: 278–305 mosmol/kg
PTH	P: 0.8–8.5 pmol/L
Potassium	P: 3.5–5.3 mmol/L
Prolactin ♂	P: <450 U/L
Prolactin ♀	P: <600 U/L
PSA	P: 0–4 mcg/mL
Protein (total)	P: 60–80 g/L
Red cell folate	B: 0.36–1.44 μmol/L
Renin (erect)	P: 2.8–4.5 pmol/mL/h
Renin (recumbent)	P: 1.1–2.7 pmol/mL/h
Sodium	P: 135–145 mmol/L
TBG	P: 7–17 mg/L
TSH	P: 0.5–4.2 mU/L
T4	P: 70–140 nmol/L
Free T4	P: 9–22 pmol/L
TIBC	S: 54–75 μmol/L
Triglycerides	P: 0.50–2.3 mmol/L
T3	P: 1.2–3.0 nmol/L
Troponin T	P: <0.1 mcg/L
Urate ♂	P: 210–480 μmol/L
Urate ♀	P: 150–390 μmol/L
Urea	P: 2.5–6.7 mmol/L
Vitamin B12	S: 0.13–0.68 nmol/L
Vitamin D	S: 50 nmol/L

Arterial Blood Gases

pH	7.35–7.45
PaCO₂	4.7–6.0 kPa
PaO₂	>10.6 kPa
Base excess	±2 mmol/L

Urine

Cortisol (free)	<280 nmol/24h
Hydroxyindole acetic acid	16–73 μmol/24h
Hydroxymethylmandelic acid	16–48 μmol/24h
Metanephrines	0.03–0.69 μmol/mmol cr.
Osmolality	350–1000 mosmol/kg
17-Oxogenic steroids ♂	28–30 μmol/24h
17-Oxogenic steroids ♀	21–66 μmol/24h
17-Oxosteroids ♂	17–76 μmol/24h
17-Oxosteroids ♀	14–59 μmol/24h
Phosphate (inorganic)	15–50 mmol/24h
Potassium	14–120 mmol/24h
Protein	<150 mg/24h
Protein/creatinine ratio	<3 mg/mmol
Sodium	100–250 mmol/24h

Haematology

WCC	4.0–11.0 ×10⁹/L
RBC ♂	4.5–6.5 ×10¹²/L
RBC ♀	3.9–5.6 ×10¹²/L
Hb ♂	130–180 g/L
Hb ♀	115–160 g/L
PCV ♂	0.4–0.54 L/L
PCV ♀	0.37–0.47 L/L
MCV	76–96 fL
MCH	27–32 pg
MCHC	300–360 g/L
RDW	11.6–14.6%
Neutrophils	2.0–7.5 ×10⁹/L (40–75%)
Lymphocytes	1.0–4.5 ×10⁹/L (20–45%)
Eosinophils	0.04–0.44 ×10⁹/L (1–6%)
Basophils	0–0.10 ×10⁹/L (0–1%)
Monocytes	0.2–0.8 ×10⁹/L (2–10%)
Platelets	150–400 ×10⁹/L
Reticulocytes	0.8–2.0% / 25–100 ×10⁹/L
Prothrombin time	10–14 s
APTT	35–45 s

Paediatric

Pulse Rate (bpm)
Neonate	140–160
Infant <1yr	120–140
1–5 years	110–130
5–12 years	80–120
>12 years	70–100
Respiratory Rate (tachypnoea)
0–2 months	≥60/min
2–12 months	≥50/min
1–5 years	≥40/min
>5 years	≥30/min
Blood Pressure (mmHg)
Term	65/45
1 year	75/50
4 years	85/60
8 years	95/65
10 years	100/70
Weight Formulas
3–12 months	(a + 9)/2 kg
1–6 years	2a + 8 kg
>6 years	(7a − 5)/2 kg
Haemoglobin (g/dL)
Term newborn	13–20
1 month	11–18
2 months	10–15
1–2 years	10–13
>2 years	11–14
MUAC (6 months–5 years)
Obese	>17.5 cm
Normal	13.5–17.4 cm
At risk	12.5–13.4 cm
Moderate malnutrition	11.5–12.4 cm
Severe malnutrition	<11.5 cm
Developmental Milestones
Social smile	1.5 months
Head control	4 months
Sits unsupported	7 months
Crawls	10 months
Stands unsupported	10–12 months
Walks	12–13 months
Talks	18 months
CSF WBC (/mm³)
Term newborn	0–25
>2 weeks	0–5

Calculator ›

Leave a ReplyCancel Reply