Have a persistently blocked nose or trouble hearing? These could be signs of nose cancer

Have a persistently blocked nose or trouble hearing? These could be signs of nose cancer

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If you have been following the news, you’d have read about Senior Parliamentary Secretary for Transport Baey Yam Keng’s nose cancer diagnosis in early January. Back in 2018, Malaysian badminton player Lee Chong Wei also had to deal with early-stage nose cancer.

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What exactly is it and what are the symptoms? Nose cancer – or nasopharyngeal cancer (NPC) – affects the nasopharynx, which is the upper part of the pharynx (throat) behind the nose.

“The cancer typically arises from a groove known as the fossa of Rosenmuller, situated at the side of the nasopharynx,” said Dr Lim Keng Hua, an otorhinolaryngologist and ENT specialist at Ear Nose Throat, Head & Neck Surgery at Mount Elizabeth Medical Centre.

While Baey and Lee did not reveal what symptoms they experienced, NPC could start off as a persistently blocked nose. Blowing into a tissue doesn’t help to unblock it and if the patient has been living with it for a few months (and gotten used to breathing through the mouth), he’d have dismissed it as just a “sinus” problem.

But there may be more accompanying signs. The patient might also detect a painless lump on the side of the neck as well as other symptoms such as a blocked ear, blood-stained saliva or phlegm, nose bleeds, frequent headaches or earaches, change in hearing (such as a sudden loss of hearing or ringing in the ear), and/or even double vision.

Baey, a Member of Parliament, is 52 years old, while the three-time Olympic silver medallist was 36 when he was diagnosed. Although we aren’t privy to the details of their lifestyle, both men appear to be healthy and in good shape. So, why did they get it? And are men more prone to NPC?

Certain genetic risk factors are strongly associated with nose cancer, said Associate Professor Melvin Chua Lee Kiang, who is the head and senior consultant at the National Cancer Centre Singapore’s (NCCS) Department of Head & Neck and Thoracic, Division of Radiation Oncology. However, these mutations do not explain why men are more at risk, he added.

Women may be protected from NPC due to their higher oestrogen levels, said Dr Lim, echoing a hypothesis held by some experts. “Others suggest that it could be due to smoking since the habit is more prevalent among men. However, there is no conclusive evidence.”

Baey and Lee aren’t unusual in their age profiles either. Citing the latest Singapore Cancer Registry Annual Report 2018, Assoc Prof Chua highlighted that most of the cases diagnosed between 2014 and 2018 were Chinese males in their 30s to 50s.

“NPC ranks as the third-most common cancer among the 30-to-39-year-old age group, and the second-most common cancer among the 40-to-49-year-old age group. This observation has remained constant over the years,” said Assoc Prof Chua.

According to the five-year report, about 240 patients were diagnosed with NPC in Singapore each year. As comparison, the top cancer among men during the same period was colorectal cancer. It recorded an incidence rate of 6,129, which averages out to about 1,532 cases per year.

Back to the abovementioned Chinese dialect groups that are more prone to NPC. These communities are also more likely to include salted fish and vegetables in their diet – which could explain their high risk of developing the cancer.

Said Dr Lim, citing a 2017 study in the Chinese Journal Of Cancer: “Those who consumed salted meat or vegetables at least once a week was found to have a four-time increased risk of developing NPC compared to those who never or rarely consumed salted food”.

“Salted and preserved foods are high in nitrosamines, which are carcinogenic compounds linked to NPC,” explained Assoc Prof Chua. This link between a high intake of salted food and NPC is also observed anecdotally, he added.

Historically, mothers would flavour porridge with salted fish before feeding it to their babies and children. Since this is now an uncommon practice, he said that it might, in some ways, account for the declining NPC rates.

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