Nasal Issues: Polyp Concerns and Cancer Screening

Nasal issues

Hello Dr.
Hong,
My husband underwent a health check-up at a health examination center in July this year, and he has some issues related to his nose, including: 1.
Nasopharyngoscopy: bilateral nasal polyps (which have been present for over twenty years; he feels like his nose is almost completely blocked).
2.
Post-nasal drip.
3.
Non-specific screening for nasopharyngeal carcinoma (EBIgA): the reference value is approximately 0.8, and the test result is 1.6 ng/ml.
Recently, he has experienced occasional headaches and had one instance of nosebleed.
He is currently taking traditional Chinese medicine to see if it can help reduce the nasal polyps.
He also has several red flags in his cardiovascular disease risk factor assessment.

I would like to ask: 1.
Regarding the non-specific screening for nasopharyngeal carcinoma with a value of 1.6, the health examination center mentioned that it could be elevated due to inflammation elsewhere in the body and advised us to improve his diet and exercise for a few months before retesting.
I am concerned whether we should urgently go to the hospital for a biopsy.
What is the likelihood of having nasopharyngeal carcinoma? 2.
Could his headaches and nosebleeds be caused by nasopharyngeal carcinoma, or could they possibly be related to cardiovascular issues? Thank you for your response!

Niming, 30~39 year old female. Ask Date: 2008/07/29

Dr. Hong Guangliang reply Otolaryngology

Hello, based on what you mentioned, a nasopharyngoscopy has already been performed, and I believe there are no obvious tumors in the nasopharynx.
The nasopharyngeal carcinoma (NPC) markers are reference indicators, but the most important factor is still the clinical findings.
Typically, in cases with a high suspicion of nasopharyngeal carcinoma, we would recommend a biopsy.
Therefore, for your husband's situation, we suggest consulting with an otolaryngologist to decide on the necessity of a biopsy based on clinical findings.
Additionally, while headaches and nosebleeds are symptoms of nasopharyngeal carcinoma, they are not definitive.
As you mentioned, cardiovascular issues could also be a possibility; however, I believe that nasal polyps may be the most significant concern.
I hope this information is helpful to you!

Reply Date: 2008/07/29

More Info

Understanding nasal issues, particularly concerning nasal polyps and the potential risk of nasopharyngeal cancer, is crucial for effective management and peace of mind. Your husband's situation, as described, involves several factors that warrant careful consideration.

1. Nasopharyngeal Cancer Screening and EBIgA Levels
The non-specific screening for nasopharyngeal cancer using the EBIgA (Epstein-Barr virus IgA) test shows a level of 1.6 ng/ml, which is above the reference value of ~0.8 ng/ml. While elevated EBIgA levels can be associated with nasopharyngeal cancer, they can also indicate other conditions, such as infections or inflammatory processes. The recommendation from the health check center to monitor his condition through dietary and lifestyle changes before repeating the blood test is reasonable.
It is essential to understand that while elevated EBIgA levels can raise suspicion for nasopharyngeal cancer, they are not definitive. The incidence of nasopharyngeal cancer varies by geographic region and population, with higher rates observed in certain areas, particularly in Southeast Asia. However, in general, the risk remains relatively low for most individuals, especially if there are no significant clinical symptoms or findings on physical examination.

If your husband has a history of nasal polyps, which he has had for over twenty years, it is crucial to manage these appropriately. Chronic nasal obstruction and sinus issues can lead to complications, including infections, but they do not necessarily indicate cancer.

2. Symptoms: Headaches and Nosebleeds
Regarding your husband's symptoms of headaches and occasional nosebleeds, these can be attributed to several causes. While they can be associated with nasopharyngeal cancer, they are more commonly linked to other conditions, such as:
- Nasal Polyps: These can cause obstruction, leading to sinus pressure and headaches. They can also lead to nasal bleeding, especially if they become irritated or inflamed.

- Sinusitis: Chronic sinus infections can cause headaches and nasal bleeding due to inflammation of the nasal mucosa.

- Allergies: Allergic rhinitis can lead to nasal congestion, post-nasal drip, and headaches.

- Cardiovascular Issues: While less common, headaches can also be a symptom of hypertension or other cardiovascular conditions.

Given the complexity of symptoms, it is advisable for your husband to consult an ear, nose, and throat (ENT) specialist for a thorough evaluation. The ENT can perform a nasal endoscopy to assess the nasal passages and sinuses directly, which can provide more information about the status of the polyps and any other abnormalities.

Conclusion and Recommendations
In summary, while the elevated EBIgA level and symptoms warrant attention, they do not immediately indicate a high risk of nasopharyngeal cancer. It is essential to follow up with the recommended lifestyle changes and repeat the blood test as advised. Additionally, a consultation with an ENT specialist is crucial for a comprehensive evaluation of the nasal polyps and associated symptoms.
Regular monitoring and management of nasal polyps, along with addressing any cardiovascular risk factors, will be vital in ensuring your husband's overall health and well-being. If there are any significant changes in symptoms or new concerns arise, seeking immediate medical attention is always the best course of action.

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