But in some cases, these very symptoms may signal nasopharyngeal cancer (NPC) – a disease that develops in a concealed area behind the nose and frequently escapes early detection.
In Malaysia, NPC remains one of the more common cancers among men. Cancer-related deaths accounted for 14.3% of all deaths in 2024, up from 13.8% in 2023.
Consultant clinical oncologist Dr Hafizah Zaharah Ahmad said early detection is crucial, with survival rates exceeding 90% when the disease is diagnosed at an early stage.
“Many symptoms are initially treated as sinusitis, allergies or ear infections,” she said, stressing that persistent or unusual symptoms should prompt further investigation.
Hidden location, delayed diagnosis
NPC arises from the nasopharynx – the area behind the nose and above the back of the throat. Because of its deep anatomical position, early tumours are difficult to detect during routine examinations, allowing the disease to progress quietly.
Consultant ear, nose, throat and head and neck surgeon Dr David Yee Leong Wai said many patients only seek medical attention after noticing painless neck swellings caused by enlarged lymph nodes.
“As these swellings do not cause discomfort, they are often overlooked or assumed to be harmless,” he said.
Risk factors include Epstein-Barr virus infection, smoking, family history, genetic susceptibility and diets high in preserved or salted foods. The disease is diagnosed more frequently in men aged between 40 and 60 and is more prevalent among individuals of Asian descent.
Recognising the symptoms
According to Hafizah, NPC symptoms often reflect the tumour’s location and spread.
Persistent nasal blockage, nosebleeds or unusual nasal discharge may occur when the tumour develops within the nasopharynx.
If the tumour affects the Eustachian tube – which connects the middle ear to the nasopharynx – fluid can accumulate in the middle ear. This may result in one-sided hearing loss, ear fullness, ringing in the ears or ear pain, symptoms commonly mistaken for routine ear conditions.
As the disease spreads, patients may experience headaches, double vision or facial numbness. Painless neck lumps caused by lymph node spread remain a common presenting feature.
Because early symptoms are non-specific, accurate diagnosis requires structured assessment. Nasoendoscopy allows doctors to directly visualise the nasopharynx and detect abnormalities not visible during routine examinations.
Imaging with MRI or CT scans is then used to assess tumour size and spread. MRI is particularly valuable for evaluating soft tissue involvement and skull base extension, while CT scans are widely used due to accessibility and suitability for patients who cannot undergo MRI.
“A biopsy is mandatory to confirm the diagnosis and determine the cancer type,” said Yee. “It allows us to grade the NPC using World Health Organisation classification, which is important in predicting prognosis and guiding treatment.”
Treatment and recovery
Treatment depends largely on the stage of disease. Hafizah explained that early-stage NPC may be treated with radiotherapy alone, while locally advanced cases typically require combined chemotherapy and radiotherapy.
Radiotherapy remains the cornerstone of treatment because the tumour is highly sensitive to radiation.
Modern techniques such as Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy enable more precise targeting of tumours while minimising damage to nearby critical structures, including the brainstem, nerves and salivary glands.
Surgery is not commonly used as a primary treatment but may be considered in selected cases, particularly for residual or recurrent disease after radiochemotherapy.
Advances in endoscopic techniques now allow surgeons to access the nasopharynx through the nasal passages, reducing trauma and supporting improved recovery and quality of life.
During treatment, patients may experience fatigue, nausea, reduced appetite, skin reactions and oral ulcers. These side effects are managed with supportive medication, nutritional support and close monitoring.
After treatment, regular follow-up with ENT specialists and oncologists is essential to monitor recovery and detect recurrence early.
With improved awareness, accurate diagnosis and advances in treatment, outcomes for NPC continue to improve. As with many cancers, early recognition and timely intervention remain the most effective tools in preserving survival and quality of life.