The nasopharynx is right behind the nose and above the oropharynx. It cannot be seen directly. It is shaped somewhat like a box. On the sides are the eustachian tubes that adjust the air pressure in our middle ears. At the top is the spheroid sinus.
Cancers of the nasopharynx are different from other head and neck cancers in that there does not appear to be a link with alcohol and tobacco use and they occur 10 to 20 years earlier (one group in young adulthood and another between 50 and 70 years). The Epstein-Barr (EB) virus has been implicated in most patients. Blood tests available for anti-EB virus antibodies aid in diagnosis as well as screening of high-risk groups.
The most common first sign is a mass in the neck (a lymph node metastasis). At least 80 percent of patients will have some evidence of spread to these lymph nodes , some only microscopically. Other symptoms are hearing loss or signs of middle ear infection, nasal obstruction or nosebleeds, ringing in the ears, inability to equalize the air pressure between the ears, and cranial nerve problems.
Evaluation of patients includes a very careful physical examination, as well as endoscopic examinations of the nose and throat. This is the most likely primary site for the "unknown primary" cancer diagnosed in enlarged lymph nodes in the neck. Most of these cancers are the squamous cell type. The diagnosis is best made by biopsy of the primary site in the nasopharynx and not the enlarged neck lymph nodes. If the primary tumor is not seen and random biopsies of the nasopharynx are negative, then a needle biopsy of the enlarged lymph nodes in the neck is done.
