Early Warning Signs of Nasopharyngeal Cancer: A Patient's Concerns

Suspected nasopharyngeal carcinoma?

Hello Doctor, I am 25 years old.
My father passed away from nasopharyngeal carcinoma at the age of 35, and I was born when he was 32.
When I was 9 years old, I had a benign tumor removed from my right neck, possibly due to excessive consumption of fried foods.
At around 18, I first experienced discomfort in my respiratory tract after passing through an industrial area, which caused slight swelling of my lymph nodes.
It took about two days of rest for my body to return to normal.
I tend to feel unwell whenever I come into contact with chemical gases, so I try to avoid them as much as possible.

On January 14, after being exposed to paint for a while, I immediately noticed redness, swelling, fever, and hardness in my neck lymph nodes.
The next day, the doctor diagnosed me with acute lymphadenitis.
Since then, I have had post-nasal drip, and when I inserted tissue into my nostrils, I noticed blood streaks.
This lasted for about 10 days, and my neck felt slightly warm.
I have also experienced tinnitus, particularly in my left ear, which has persisted until now.
There was one instance of facial numbness, and recently I have had swelling and pain in the area below my left eye, feeling tight.
I have consulted doctors at two hospitals, and both said my nasopharynx appears normal.
A biopsy was performed on January 26, but the doctor mentioned that the swelling in the nasopharynx was not obvious, and the person who performed the biopsy was different from the consulting doctor.
The result was negative, and the Epstein-Barr virus test also showed negative.
Currently, there is a softer tumor in my left neck measuring about 2x0.5 cm (which has been there for a long time), and the biopsy result indicated it is thyroid tissue.
After the exposure to paint, I feel that the lymph nodes in my right neck have become harder and more fixed.
1.
Doctor, given that I have been experiencing early warning signs of nasopharyngeal carcinoma, such as tinnitus and facial swelling becoming more frequent, is it possible that I have nasopharyngeal carcinoma?
2.
According to relevant literature, it is possible that the biopsy did not sample the tumor location, or that the tumor is not superficial.
Should I consider undergoing another biopsy? I plan to arrange an MRI at my own expense to check for any abnormalities in the nasopharyngeal area for the doctor’s assessment, so that the biopsy can target the potential location.
3.
Doctor, would performing a biopsy on the harder lymph node in my right neck be more likely to reveal whether it is a malignant tumor?
4.
Given my family history and exposure to carcinogenic substances, along with these early warning signs of nasopharyngeal carcinoma—such as blood streaks, post-nasal drip, facial numbness, unusual sensations in the neck lymph nodes, persistent tinnitus, occasional ear fullness, and slight swelling and tightness in the area below my left eye, as well as some mild abnormalities in the back of my head—I am concerned that I may have nasopharyngeal carcinoma.
I hope to detect it early for treatment.
Since two doctors have not found any abnormalities in my nasopharynx, should I rely on the MRI for further evaluation? Are there any other methods that could help me achieve an early diagnosis and avoid being misdiagnosed with otitis media or sinusitis? I hope to identify and treat any issues as early as possible.
5.
Doctor, after exposure to chemical gases, I experience discomfort in my respiratory tract and lymph nodes.
What could be the reason for this? Regarding carcinogenic substances related to nasopharyngeal carcinoma, such as incense, I am starting to exhibit early symptoms.
Should I also avoid exposure to these substances? Thank you for your patience in reading this.

11, 20~29 year old female. Ask Date: 2016/02/22

Dr. Zheng Jueyi reply Otolaryngology

Hello, if you have already been examined by multiple physicians and no significant abnormalities were found in the nasopharynx, most recommend regular follow-up.
Magnetic resonance imaging (MRI) can provide imaging references; however, the definitive diagnosis still relies on nasopharyngeal biopsy.
As for nasopharyngeal carcinoma, in addition to family history, it is associated with various factors.
It is advisable to avoid potential carcinogens in your environment or lifestyle as much as possible.
Wishing you safety and health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2016/02/22

More Info

Understanding the early warning signs of nasopharyngeal cancer (NPC) is crucial, especially given your family history and the symptoms you've described. Nasopharyngeal cancer is a type of head and neck cancer that can present with various signs and symptoms, some of which you are experiencing. Let's address your concerns one by one.

1. Symptoms and Risk Factors: Your symptoms, including persistent ear ringing (tinnitus), facial swelling, nasal bleeding, and lymph node enlargement, are indeed concerning. While these symptoms can be associated with various conditions, including infections or allergies, they can also be indicative of nasopharyngeal cancer, especially given your family history. NPC is more prevalent in certain populations and is associated with the Epstein-Barr virus (EBV), which you mentioned was negative in your tests. However, the absence of EBV does not entirely rule out the possibility of NPC.

2. Need for Further Biopsy: It is true that biopsies can sometimes miss tumors if they are not located in the sampled area. If your symptoms persist and you continue to feel that something is wrong, it may be reasonable to discuss with your healthcare provider the possibility of a repeat biopsy or a more targeted approach, especially if imaging studies suggest abnormalities. MRI can provide detailed images of soft tissues and may help identify any suspicious areas that warrant further investigation.

3. Lymph Node Assessment: The lymph nodes in your neck, particularly if they are hard and fixed, can be concerning for malignancy. A fine needle aspiration (FNA) of these nodes can provide valuable information. If the right neck lymph node is more prominent and hard, it may indeed be more indicative of a potential malignancy, and a biopsy could yield more definitive results.

4. Imaging Studies: MRI is a good step to take for further evaluation of the nasopharyngeal area. It can help visualize soft tissue structures and identify any masses or abnormalities that may not have been apparent on previous examinations. If there are still concerns after imaging, additional diagnostic procedures, such as a nasopharyngoscopy, may be warranted to directly visualize the nasopharynx and obtain biopsies if necessary.

5. Chemical Exposure and Symptoms: Your reaction to chemical exposure, such as paint fumes, could be due to irritation of the respiratory tract or an allergic response. Chemical irritants can exacerbate underlying conditions or lead to inflammation, which might explain your symptoms of discomfort and lymph node swelling. It is advisable to minimize exposure to such irritants, especially if you have a history of respiratory issues.

6. Lifestyle Considerations: Given your symptoms and family history, it would be prudent to avoid known carcinogens, including smoke from incense or other sources. While the direct link between these exposures and nasopharyngeal cancer is not fully established, minimizing exposure to potential irritants is a sensible precaution.

In summary, while your symptoms could be indicative of nasopharyngeal cancer, they could also be related to other benign conditions. Given your family history and the persistence of your symptoms, it is essential to continue seeking medical advice. A multidisciplinary approach involving an ENT specialist, oncologist, and possibly a pulmonologist may provide the best pathway to diagnosis and treatment. Early detection is key in managing any potential malignancy, and advocating for your health is crucial. If you feel your concerns are not being adequately addressed, seeking a second opinion or further testing is entirely appropriate.

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