Dr Nguyễn Thị Minh Tâm*. — Photo courtesy of Family Medical Practice

Dr Nguyễn Thị Minh Tâm*

Globally there are 550,000 cases annually of head and neck cancer including cancer of the ear, nose and throat which is called otorhinolaryngology cancer. One of the most common otorhinolaryngology cancers is nasopharyngeal carcinoma (NPC). It affects about 1/100,000 of the global population and is number one in all kinds of head and neck cancers in Viet Nam. NPC is the fourth most common cancer in Việt Nam.

NPC is a malignant tumour of the nasopharynx epithelium. This cancer usually has early lymph node metastasis, (which means cancer cells are in the lymph nodes) and it closely relates to the Epstein-Barr virus (EPV) infection. This disease may be found at all ages but is most common amongst the 40-60 age group and younger age groups. The male/female ratio of NPC is 2/1. The disease can initially present with ear, nose and throat related symptoms and patients may be diagnosed with rhinitis or otitis before a final referral to the correct department and diagnosis of NPC is made. A late diagnosis of NPC often has consequences on treatment choices and effectiveness; unfortunately, late consultation and diagnosis of NPC at stage 4 and 5 is common. Stage 3 and Stage 4 is where the cancer has spread to other areas of the tissue, bones and organs.

High-risk factors for NPC:

• History of Epstein-Barr virus
• Alcohol
• Smoker or secondary smoker
• Long and frequent intake of smoked, salted and fermented food
• Exposure to certain pressed woods/wood powder and exposure to formaldehyde
• First-generation relative with a history of NPC.

Common symptoms:

(It will depend on the position of the tumour)

• Nose:

+ Appears blocked on one side

+ Runny nose with mucus, pus, blood on one side

+ Possible sinusitis

• Ear:

+ Full feeling and blocked ear

+ Pain, tinnitus

+ Hearing loss

+ Possible otitis

• Eyes:

+ Diplopia (double vision)

+ Esotropia (eyes turning inwards)

+ Blurry vision

• Nervous system:

+ One-sided headache, pain after orbit, temporal

+ Difficulty moving your chin,

+ Difficulty biting tightly due to paralysed chewing tissue, numb face and mouth on one side

+ Difficulty swallowing/choking

+ Hoarseness

• Lymph node:

+ Swollen lymph node on one side of neck, this may be the earliest symptom, hard lymph node with no pain

Investigations for diagnosis:

• ENT endoscopy
• Radiology scans: (CT, MRI, PET)
• Epstein-Barr virus test (once only)

Endoscopy is the simplest, fastest and most effective method, applicable for all ages. If anything suspicious is found by endoscopy a biopsy will be performed to identify the character of the tumour; a normal ENT consultation may miss this tumour. Endoscopy is a non-surgical procedure- passing a flexible tube through the nasal/pharyngeal tract with a camera and light attached.

Preventative actions:

• Maintain a healthy lifestyle; eat a lot of vegetables, fruits and reduce foods that are smoked, salted and fermented
• Avoid alcohol and stop smoking
• Avoid exposure to poisonous chemicals like paint and formaldehyde
• Annual health check by ENT endoscope
• EBV testing

NPC can be cured therefore early diagnosis is the key factor to determine the treatment result. Annual ENT endoscope and if any symptoms present is very necessary in these cases:

• New neck lymph node at male aged 40-60
• Persistent headache on the same side of lymph node
• Persistent tinnitus
• Persistent blocked nose and spitting up of phlegm and blood. — Family Medical Practice

*Dr Nguyễn Thị Minh Tâm holds a bachelor’s degree in general medical practice and a master’s in ENT from Hanoi Medical University. She has completed many training courses with Australian experts focusing on Audiology, and taken part in many courses in other ENT-related fields. She has worked in ENT for more than 20 years.

Dr Tâm can speak fluent Vietnamese and English. Beyond FMP, Dr Tâm enjoys reading, running and spending time with her family.

Family Medical Practice was the first foreign-owned primary healthcare provider in Việt Nam, and has consistently remained at the forefront of international-standard medicine since 1995. It offers extensive healthcare and emergency medical services nationwide to Vietnamese, expatriate and corporate customers.

For more advice on any medical topics, visit Family Medical Practice Hanoi at 298 I Kim Mã, Ba Đình. Tel: (024) 3843 0748.  E: hanoi@vietnammedicalpractice.com.

FMP’s downtown HồChí Minh location is Diamond Plaza, 34 Lê Duẩn, District 1; 95 Thảo Điền, District 2. Tel: (028) 38227848. E: hcmc@vietnammedicalpractice.com.

FMP Đà Nẵng is located at 96-98 Nguyễn Văn Linh, Hải Châu District, Đà Nẵng. Tel: (0236) 3582 699. E: danang@vietnammedicalpractice.com.