Health Tips

Why are cantonese people more prone to Nasopharyngeal Cancer (NPC)?

You might or might not have heard of the statement above but it is TRUE. If you descend from that family line, you will naturally be inclined to wonder why so? Studies have shown that some diseases are more prone to occur in certain ethnicity, groups, family line and regions. And there are  reasons behind it. So, today we will focus on NPC! 

What is NPC?

What is nasopharyngeal? This word comes from a combination of 2 words naso (nose) and pharynx (throat). So, nasopharyngeal is the upper part of the throat, right behind the nose. NPC is the cancer that grows in this particular location. 

Why are cantonese people more susceptible to it?

Cantonese people are said to be more susceptible due to our ancestors who stay in the southern region of China (nearer to the sea) and used to consume a lot of salted fish and salted products. Those days, that was a known preservative method and it was used for weaning therefore introducing early childhood exposure to salted fish. It is said that these salt-cured food releases volatile nitrosamines. 

Being a canton does not naturally mean that you will get NPC, so do not fret! What is important however is to know the symptoms and risk factors so that you can avoid the risks and seek help ASAP when you sense something is amiss. 

What are the risks?

• Epstein-Barr Virus (EBV) infection

• Drinking large amounts of alcohol

• Fermented or salted food diet that is high in nitrosamine 

• Chinese (Cantonese people in particular)/ Asian ancestry

What are the symptoms?

• Trouble breathing, speaking, hearing

• Lump in nose or throat

• Nosebleeds 

• Headaches 

• Pain or ringing in ears 

What is the Prognosis?

Prognosis or chances of recovery depends on:

• Size of the tumor

• Invasion of tumor to other areas or organs (cancer stage)

• A high level of EBV antibodies and EBV-DNA markers in the blood before and after treatment.

Other factors that may affect prognosis include:

• Age.

• Long period of time between biopsy and start of radiation therapy.

• Family history.

• Tobacco smoking.

• Salted fish in the diet.

Treatment options

After NPC has been diagnosed, your physician will determine which stage it is and how far it has spread within the nasopharynx or to other parts of the body in order to plan the treatment.

Stages of NPC:

Stage 0 - known as carcinoma in situ. Where there are abnormal cells found on the nasopharynx lining. These cells may become cancer and spread to normal tissue. 

Stage 1 - cancer found in the nasopharynx only

Stage 2 - Either one of the below :

• • Cancer has spread to one or more lymph nodes on one side of the neck and/or to one or more lymph nodes on one or both sides of the back of the throat. The affected lymph nodes are 6 centimeters or smaller. Cancer is found:

  • in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity; or

  • only in the lymph nodes in the neck. The cancer cells in the lymph nodes are infected with Epstein-Barr virus (a virus linked to nasopharyngeal cancer).

  • Cancer has spread to the parapharyngeal space and/or nearby muscles. Cancer may have also spread to one or more lymph nodes on one side of the neck and/or to one or more lymph nodes on one or both sides of the back of the throat. The affected lymph nodes are 6 centimeters or smaller.

Stage 3 - Either one of the below :

• Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller. Cancer is found:

  • in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity; or

  • only in the lymph nodes in the neck. The cancer cells in the lymph nodes are infected with Epstein-Barr virus (a virus linked to nasopharyngeal cancer).

• Cancer has spread to the parapharyngeal space and/or nearby muscles. Cancer has also spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller.

• Cancer has spread to the bones at the bottom of the skull, the bones in the neck, jaw muscles, and/or the sinuses around the nose and eyes. Cancer may have also spread to one or more lymph nodes on one or both sides of the neck and/or the back of the throat. The affected lymph nodes are 6 centimeters or smaller.

Stage 4 - Divided into stages IVA and IVB.

• In stage IVA:

  • Cancer has spread to the brain, the cranial nerves, the hypopharynx, the salivary gland in the front of the ear, the bone around the eye, and/or the soft tissues of the jaw. Cancer may have also spread to one or more lymph nodes on one or both sides of the neck and/or the back of the throat. The affected lymph nodes are 6 centimeters or smaller; or

  • Cancer has spread to one or more lymph nodes on one or both sides of the neck. The affected lymph nodes are larger than 6 centimeters and/or are found in the lowest part of the neck.

• In stage IVB: Cancer has spread beyond the lymph nodes in the neck to distant lymph nodes, such as those between the lungs, below the collarbone, or in the armpit or groin, or to other parts of the body, such as the lung, bone, or liver.

There are 3 main treatment options for NPC: radiation, chemotherapy or surgery or a combination. 

Radiation Therapy (RT) 

Nasopharyngeal carcinoma has traditionally been treated with radiation therapy (RT) because it is a radiosensitive tumor and because its anatomic location limits a surgical approach; RT remains the mainstay of treatment for nasopharyngeal cancer.

Chemotherapy 

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. The way the chemotherapy is given depends on the type and stage of the cancer being treated and there are 2 main ways:

• systemic chemotherapy - Drug taken by mouth or injected into a vein or muscle where the drugs enter the bloodstream and can reach cancer cells throughout the body

• regional chemotherapy - When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas . 

* Chemotherapy may be given after radiation therapy to kill any cancer cells that are left. Treatment given after radiation therapy, to lower the risk that the cancer will come back, is called adjuvant therapy.

Surgery

Surgery removes cancer from the body, or to repair a body part. It is sometimes used for nasopharyngeal cancer that does not respond to radiation therapy. If cancer has spread to the lymph nodes, the doctor may remove lymph nodes and other tissues in the neck.

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Reference: 

1. https://www.cancer.gov/types/head-and-neck/patient/adult/nasopharyngeal-treatment-pdq

2. https://www.uptodate.com/contents/treatment-of-early-and-locoregionally-advanced-nasopharyngeal-carcinoma

3. https://www.uptodate.com/contents/epidemiology-etiology-and-diagnosis-of-nasopharyngeal-carcinoma?search=nasopharyngeal%20carcinoma&source=search_result&selectedTitle=1~76&usage_type=default&display_rank=1#H3

Picture credit: 

1. https://newsnetwork.mayoclinic.org/discussion/hold-for-620-needs-image-text-review-mayo-clinic-q-and-a-symptoms-of-throat-cancer-depend-on-which-throat-structures-are-affected/

2. https://www.unlockfood.ca/en/Articles/Alcohol-and-smoking/Alcohol-and-Nutrition.aspx

3. https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/external-beam

4. https://www.webmd.com/cancer/how-chemo-works#1

Written by

Dr. Jessamine Chong Sze Lynn