Because of a documented increased incidence, nasopharyngeal cancer should be considered when signs or symptoms of ear, nose and throat disease are present in patients from southern China (in particular, Hong Kong and the province of Guangdong) or Southeast Asia. Environmental factors, the Epstein-Barr virus and genetic factors have been associated with the development of nasopharyngeal cancer. Patients with this malignancy most often present with a cervical mass from metastatic spread to a lymph node. Other possible presentations include ipsilateral serous otitis, hearing loss, nasal obstruction, frank epistaxis, purulent or bloody rhinorrhea, and facial neuropathy or facial nerve palsies. Radiotherapy is often curative. The addition of chemotherapy has produced high response rates in local and regionally advanced disease. (Am Fam Physician 2001;63:1776-82,1785.)

Although nasopharyngeal cancer is rare in the general U.S. population, it is significantly more likely to occur in refugees from Southeast Asia who have come to the United States in the past 25 years. Once diagnosed, the malignancy has great potential for cure. This article provides a brief overview of nasopharyngeal cancer, with emphasis on its occurrence in patients from Southeast Asia.

Illustrative Case

A 47-year-old Hmong man presented to his family physician with bloody rhinorrhea, epistaxis, right-sided hearing loss and headache of two weeks’ duration. (The Hmong, also known as the Miao or Meo, are mountain-dwelling peoples of China, Vietnam, Laos and Thailand.) The patient’s medical history was remarkable for colon cancer at 36 years of age, which evidently responded to Hmong therapies (nonsurgical). There was no family history of cancer. The patient had never smoked; he used alcohol rarely and did not use illicit drugs. The patient’s family had fled from Laos to the United States in the mid-1970s.

The review of systems was remarkable only for fatigue in the previous few weeks. The physical examination revealed right middle ear effusion, right hemifacial and periauricular hyperesthesia, and a trace of mucoid, bloody discharge in the nares. Neither cervical nor clavicular adenopathy was present.

Subsequent endoscopic biopsy of the right nasopharynx demonstrated mixed keratinizing squamous cell carcinoma and nonkeratinizing squamous cell carcinoma. Magnetic resonance imaging (MRI) showed a right nasopharyngeal mass with erosion into the sphenoid sinus.

Nasopharyngeal cancer was diagnosed and determined to be stage III (T3 N0: tumor invasion into the bony structures and/or paranasal sinuses; no regional lymph node metastasis). The patient underwent concurrent chemotherapy and radiotherapy; he experienced postirradiation headache and facial neuropathy. One year later, follow-up MRI studies showed nearly complete tumor regression.

Epidemiology

Nasopharyngeal cancer accounts for fewer than 1 percent of malignancies in North America, western Europe and Japan, with incidence rates of one to one and one-half cases per 100,000 population per year.(1) This malignancy has an intermediate incidence of five to nine cases per 100,000 population per year in inhabitants of northern China, the Mediterranean basin (southern Italy, Greece and Turkey), North Africa and Southeast Asia (Thailand, Vietnam, Indonesia,…

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