Nasopharyngeal carcinoma (NPC)
Introduction
Nasopharyngeal carcinoma is an uncommon head and neck cancer in the UK but an important diagnostic consideration in emergency practice because it often presents with non‑specific ENT symptoms to the emergency department (ED) or urgent care.
NPC differs from other head & neck cancers by its epidemiology (strong Epstein-Barr virus association in endemic areas), frequent early cervical nodal metastasis and a radiotherapy‑based curative approach.
Emergency clinicians need to recognise typical presentations and red flags, stabilise acute problems, avoid inappropriate procedures and trigger urgent specialist referral (see NICE NG12, NG36).
Epidemiology and risk factors
- Rare in the UK; much higher incidence in parts of Southeast Asia.
- Strong association with Epstein-Barr virus (EBV) in endemic populations.
- Most commonly affects people aged approximately 40-70 years.
- Despite low prevalence in non‑endemic areas, persistent unilateral ENT symptoms or an unexplained neck lump warrant prompt investigation.
Typical presentation NPC commonly presents to ENT/ED with the following (approximate frequencies from case series and guideline summaries):
- Cervical neck lump (~80%) - often the first sign; typically upper jugular chain lymphadenopathy.
- Unilateral nasal obstruction (~60%).
- Unilateral conductive hearing loss or serous otitis media (~50%) due to eustachian tube obstruction.