Is NPC more common among Chinese, Malay or Indian Malaysians?

There is a significant ethnic difference in Malaysia.

 

​​​​​​​​​Among the three major ethnic groups in Malaysia:

Chinese Malaysians have the highest incidence, followed by Malays, while the incidence among Indians is substantially lower.

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It is worth noting that some Other Bumiputera populations also have relatively high NPC incidence, with a male age-standardised incidence rate of approximately 8.9 per 100,000 in the same registry period.

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Ethnicity represents a population-level risk and should never be used on its own to determine whether an individual has NPC.

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Can NPC occur in children?

Yes, but nasopharyngeal carcinoma in children is rare.

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NPC can technically occur at almost any age.

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In endemic regions such as Southeast Asia, patients can develop NPC at a younger age than is typically seen in countries where the disease is uncommon.

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Children and teenagers can develop NPC, although this represents only a small proportion of overall cases. EBV is also strongly associated with many cases of childhood NPC.

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Symptoms in children may include persistent neck swelling, nasal obstruction, nosebleeds, hearing problems, headaches or other unexplained ENT symptoms.

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A persistent neck mass in a child should therefore be properly assessed rather than assumed to be harmless.

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How is nasopharyngeal carcinoma diagnosed?

If NPC is suspected, assessment usually includes an ENT examination.

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1. Nasal endoscopy

A thin flexible or rigid endoscope is passed through the nose so that the ENT specialist can directly examine the nasopharynx.

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A suspicious tumour may appear as an irregular growth, ulcerated area or abnormal soft-tissue mass.

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2. Biopsy

A tissue sample is taken from the abnormal area.

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The diagnosis of NPC must ultimately be confirmed by histopathological examination of the biopsy specimen.

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3. Imaging

Once NPC is confirmed, imaging may include:

• MRI of the nasopharynx and neck

• CT scan

• PET-CT in selected patients

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These investigations determine the size and local extent of the tumour, lymph-node involvement and whether there is distant spread.

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4. EBV-related blood tests

Plasma EBV DNA may be used as an additional marker in appropriate patients.

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Together, these investigations allow the cancer to be staged accurately and treatment to be planned.

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How is NPC treated?

Treatment depends on the stage of the disease.

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Unlike many other head and neck cancers, surgery is usually not the primary treatment for newly diagnosed NPC.

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The nasopharynx is located deep behind the nose and close to several important structures. At the same time, NPC tends to respond very well to radiotherapy.

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For this reason, radiotherapy — often combined with chemotherapy — forms the backbone of curative NPC treatment.

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What is IMRT?

IMRT stands for Intensity-Modulated Radiation Therapy.

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IMRT is now a major radiotherapy technique used for nasopharyngeal carcinoma.

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Instead of delivering the same dose of radiation uniformly across a large area, IMRT allows radiation oncologists to shape radiation more precisely around the tumour.

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This is particularly important in NPC because the nasopharynx lies close to structures such as the:

• Brainstem

• Spinal cord

• Salivary glands

• Eyes

• Optic nerves

• Temporal lobes

• Inner ears

 

IMRT allows a high therapeutic radiation dose to be delivered to the cancer while helping reduce unnecessary radiation exposure to surrounding normal tissues.

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For appropriately selected patients with early or lower-risk disease, radiotherapy may be sufficient. For more advanced NPC, radiotherapy is usually combined with chemotherapy.

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Chemotherapy for NPC

Chemotherapy is commonly combined with radiotherapy for more advanced stages of nasopharyngeal carcinoma.

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Cisplatin remains one of the most important chemotherapy drugs used in curative treatment.

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For some patients with locally advanced NPC, chemotherapy may also be given before chemoradiotherapy, known as induction chemotherapy.

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Regimens containing gemcitabine and cisplatin, for example, have demonstrated improved long-term outcomes in appropriately selected patients with locally advanced NPC.

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What is the latest treatment for NPC? What about immunotherapy?

One of the most important developments in recent years has been immunotherapy.

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Immunotherapy helps the patient's own immune system recognise and attack cancer cells.

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In NPC, particular attention has focused on drugs targeting the PD-1/PD-L1 immune checkpoint pathway.

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At present, immunotherapy has an established role particularly in recurrent or metastatic NPC.

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For example, the PD-1 inhibitor toripalimab, combined with gemcitabine and cisplatin, has demonstrated improved outcomes in first-line recurrent or metastatic NPC and received specific regulatory approval for this indication.

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Another PD-1 inhibitor, penpulimab, was approved by the US FDA in 2025 in combination with platinum chemotherapy and gemcitabine for first-line recurrent or metastatic non-keratinising NPC.

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Research continues into how immunotherapy can be integrated earlier into treatment for high-risk, non-metastatic NPC.

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The best treatment therefore depends on the disease stage, previous treatment, EBV status, overall medical condition and the treatment protocols available locally.

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What is the role of surgery in NPC?

Surgery has a much smaller role in NPC than in cancers of areas such as the tongue, oral cavity or thyroid.

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For newly diagnosed NPC, treatment is generally centred around radiotherapy and chemotherapy.​

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• Surgery may nevertheless be useful in selected situations, particularly:

• Diagnosis – obtaining a biopsy.

• Persistent or recurrent lymph nodes – selected patients may require neck dissection.

• Local recurrence – selected recurrent tumours confined to the nasopharynx may sometimes be treated using salvage nasopharyngectomy.

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Because recurrent disease can be complex, these decisions require multidisciplinary assessment involving ENT/head and neck surgeons, radiation oncologists, medical oncologists and radiologists.

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Can NPC come back after treatment?

Yes. Like other cancers, nasopharyngeal carcinoma can recur after apparently successful treatment.

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Recurrence may occur:

• At the original nasopharyngeal site

• In lymph nodes in the neck

• In distant organs

 

Common sites of distant metastasis include the lungs, bones and liver.

 

This is why follow-up after treatment is important.

 

Follow-up may involve clinical examination, nasal endoscopy, imaging and, in selected patients, monitoring of plasma EBV DNA.

 

If NPC recurs, treatment depends on the location of recurrence, previous radiation dose, time since initial treatment and whether distant metastases are present.

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Possible treatments include re-irradiation, surgery in selected patients, chemotherapy and immunotherapy.

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Are there foods to avoid if you are worried about NPC?

Diet alone does not cause NPC, and there is no single food that can either prevent or cure nasopharyngeal cancer.

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However, long-term consumption of large amounts of salt-cured or heavily preserved fish and meat has been associated with an increased risk of NPC.

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These foods may contain nitrosamines and other compounds that have been linked to carcinogenesis.

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A sensible long-term diet should emphasise fresh foods, including vegetables, fruits, legumes and other minimally processed foods.

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Smoking should also be avoided, and heavy alcohol consumption should be reduced.

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What should I eat during NPC treatment?

There is no special “NPC diet” proven to destroy cancer.

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The priority during radiotherapy and chemotherapy is usually to maintain adequate:

• Calories

• Protein

• Fluid intake

• Body weight

• Nutrition

 

Radiotherapy involving the nasopharynx and neck may temporarily cause sore throat, mouth ulcers, altered taste, dry mouth or difficulty swallowing.

 

During this period, softer and more moist foods are often easier to tolerate.

Very spicy, acidic, extremely hot or hard foods may need to be temporarily avoided if they cause pain.

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Patients who are losing significant weight or having difficulty swallowing should discuss this early with their oncology team or dietitian.

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Unproven supplements or traditional medicines should also be discussed with the treating oncologist because some products can interact with chemotherapy or other medications.

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When should I see an ENT specialist?

Most nosebleeds, blocked noses, ear problems and neck swellings are not caused by nasopharyngeal cancer.

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However, further assessment should be considered when symptoms are persistent, unexplained or predominantly affect one side.

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Particular warning signs include:

• Persistent neck lump

• Recurrent blood-stained nasal mucus

• Repeated nosebleeds from one side

• Persistent one-sided nasal blockage

• New unexplained hearing loss in one ear

• Persistent middle-ear fluid in an adult

• Persistent headaches together with other nose or ear symptoms

• Double vision or facial numbness

 

An examination with nasal endoscopy can allow the nasopharynx to be directly inspected.

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