Cancer Behind the Nose: Why Nasopharyngeal Cancer Often Goes Undetected

By Dr. Rajeev Sharan, HOD Sr Consultant, Head & Neck Oncology, HCG Cancer Hospital, Kolkata
Nasopharyngeal cancer (NPC) arises in the nasopharynx—the upper part of the throat located behind the nose and above the back of the mouth. Though considered rare in India, its subtle onset and nonspecific symptoms make it a diagnostic challenge. In many cases, the disease progresses significantly, before a confirmed diagnosis is made, which can impact both treatment outcomes and long-term survival.

NPC differs from other head and neck cancers in its location, behaviour, and the population it affects. Unlike oral cavity cancers strongly linked to tobacco and alcohol, NPC has a distinct set of risk factors and requires a different approach to detection and management.

Early Signs Are Often Missed

The nasopharynx is not easily visualised during a routine examination, and symptoms often shows common upper respiratory infections or ear-related issues. Patients may report nasal congestion, mild hearing loss, or a blocked ear sensation, particularly on one side. These signs are frequently attributed to allergies or sinus problems, leading to delays in appropriate referrals and investigations.

In some cases, the first visible symptom may be a painless swelling in the neck caused by enlarged lymph nodes. As the disease advances, symptoms may include nosebleeds, headaches, double vision, or facial numbness, depending on the extent of tumour growth and nerve involvement.

Risk Factors

NPC has a multifactorial origin. One of the strongest associations is with Epstein-Barr Virus (EBV) infection. While EBV is common and often harmless, in some individuals it plays a role in triggering malignant changes in the nasopharyngeal tissue. Genetic susceptibility, certain dietary habits—such as consumption of salt-cured fish—and environmental exposures may also contribute.