Persistent Positive EBV IGA After Benign Nasopharyngeal Tumor Removal: Next Steps?

EBV IgA has consistently tested positive, but the biopsy of the completely resected nasopharyngeal tumor was benign?

Hello Doctor: In early July of this year, I visited an ENT specialist at a local hospital due to mild tinnitus and some hearing impairment.
The doctor found a small tumor in my nose and immediately arranged for a blood test for EBV IgA, which resulted in a positive reading of 1.1.
Since the lesion was located deeper, the doctor promptly scheduled surgery to remove the entire tumor for further examination, which turned out to be a benign lymphoproliferative tumor.
After the tumor was removed, my ear discomfort also disappeared.
However, when I returned for a follow-up blood test to check if the EBV IgA had turned negative, unfortunately, the result was still 1.1 positive.
I continued to follow up with the doctor, who suggested I get another blood test after some time.
About three weeks later, I caught a viral cold and had a sore throat for a week.
After visiting the clinic, I recovered and then went to get the HPV vaccine.
A week after receiving the vaccine, I had another blood test, and this time the EBV IgA level increased to 1.6.
I have issues with dysautonomia and anxiety, and although the tumor was completely removed and the pathology report was benign, the doctor did not see any new lesions during the last nasopharyngoscopy.
What should I do? It seems that my EBV IgA cannot turn negative no matter how many tests I take.
I have not noticed any lumps in my neck, nor do I have symptoms like tinnitus, nasal congestion, or nosebleeds.
Do I need to undergo another biopsy to confirm that I do not have nasopharyngeal cancer? The repeated visits to the hospital for blood tests are exhausting; it has been three months from July to October.
How can this virus turn negative? I also wonder if the repeated blood tests are wasting medical resources.

Jul, 20~29 year old female. Ask Date: 2023/10/09

Dr. Zheng Jueyi reply Otolaryngology

Hello, there are many factors that can affect EBA IgA levels.
If the nasopharyngeal tumor has been surgically removed and the pathology results are benign, it indicates that there is currently no nasopharyngeal carcinoma.
Therefore, regular outpatient follow-up is recommended.
As for the blood test results, they are for the physician's reference; in addition to the values themselves, it is important to observe the trend of changes.
It is not necessary for the results to be negative to be considered normal.

Reply Date: 2023/10/09

More Info

Persistent positive EBV IgA levels after the removal of a benign nasopharyngeal tumor can understandably cause anxiety and concern about potential malignancy, especially given the association between Epstein-Barr Virus (EBV) and nasopharyngeal carcinoma (NPC). However, it is essential to interpret these results in the context of your overall clinical picture and the benign nature of your previous tumor.

Firstly, EBV is a common virus that can remain dormant in the body after initial infection. The presence of EBV IgA antibodies, particularly in the context of nasopharyngeal tumors, can be a marker for malignancy. However, it is crucial to note that elevated EBV IgA levels do not definitively indicate cancer, especially if there are no other clinical signs or symptoms of malignancy. In your case, the tumor was confirmed to be a benign lymphoproliferative lesion, and subsequent examinations did not reveal any new growths or abnormalities.

The increase in your EBV IgA levels from 1.1 to 1.6 could be influenced by various factors, including recent infections (like your viral upper respiratory infection), vaccinations (such as the HPV vaccine), or even stress and anxiety, which can affect immune responses. It is not uncommon for EBV antibody levels to fluctuate, and a single elevated reading does not warrant immediate concern for cancer recurrence.

Regarding your question about whether further biopsies are necessary, it is essential to consider the recommendations of your healthcare provider. If your doctor performed a thorough examination and did not find any new lesions or concerning signs, it may not be necessary to repeat a biopsy at this time. Continuous monitoring and follow-up blood tests can provide more information about the trend of your EBV IgA levels. If they remain elevated or if new symptoms arise, further investigation may be warranted.

In terms of managing your anxiety and the feeling of being overwhelmed by frequent medical visits, it may be beneficial to discuss your concerns with your healthcare provider. They can help you establish a follow-up plan that balances the need for monitoring with your emotional well-being. Regular follow-ups are essential, but they should also be manageable for you.
In conclusion, while persistent positive EBV IgA levels can be concerning, in the context of your benign tumor and absence of new symptoms, it is likely that close monitoring is the best approach. Continue to communicate openly with your healthcare team about your concerns, and consider seeking support for managing anxiety related to your health. Regular check-ups and a clear follow-up plan can help alleviate some of the stress associated with your condition.

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