Nasopharyngeal Cancer – The Invisible Cancer

Do you know that Malaysia hits the world’s highest incidence of nasopharyngeal cancer (NPC)?

The problem with NPC is it occurs in a place you can’t see: behind the nose. Also, unlike, say, breast cancer, which manifests itself in a lump, nose cancer displays few outward signs. As a result, early detection statistics are very low.

According to data from the NPC tissue databank, collection of cancer tissue was carried out from 6 participating hospitals prior for research purpose, the number of NPC patients detected at stage III and IV in conjunction with this research study – by which the disease is far advanced and untreatable – is as high as 75%.

Dubbed the invisible cancer by local doctors, the scariest thing about NPC is that its symptoms can be easily mistaken for more benign conditions.


That was the case with Wong Foong Khum, 52, who became aware of a nagging “echo” in her ears in 1999, and endured it for a year before seeking specialist treatment.

“It was intermittent and uncomfortable,” she recalled, “but not so bad that it disrupted my daily work as a teacher.”

A general physician prescribed her a slew of medications. After a year of “trial and error” that failed to address the problem, she consulted an ear, nose and throat (ENT) specialist at Hospital Raja Permaisuri Bainun. A battery of tests confirmed a cancerous tumour in the nasopharynx, an area in the back of the nose towards the base of the skull.

At first she was incredulous. There was no family history of cancer as far as she knew. She did, however, adopted an unhealthy diet heavy in fast food and instant noodles when she was posted outstation; some studies attribute a high-salt diet as a contributing factor.

“After the initial shock wore off, I calmed down. In the past, contracting cancer meant almost certain death. But by 2000, advances in medical science and treatment had changed. I was confident if I followed the recommended treatment, I would have a good chance of survival and leading a quality life.”

Fortunately, Wong’s cancer was in Stage 1, so she would not have to go through chemotherapy. At that time, only government hospitals in Kuala Lumpur and Penang offered oncology services in Malaysia, so she opted to get it done in an Ipoh private hospital to be closer to her family.

She went on a 35-week radiotherapy treatment. “I went five days a week for 7 consecutive weeks. When I arrived at the treatment room, I was asked to lie down while the radiotherapist drew markings on my face. I was told that this was to outline the field of radiotherapy. Each radiotherapy session lasted only about a minute and was painless.”

The real hell took place out of the treatment room. “After a session, I could feel heat radiating out within my mouth. It was like my mouth had turned into a volcano.!I was encouraged to eat soft and cool stuff like ice-cream, to soothe the heat.”

Even worse were the mouth ulcers. “I had so many that I couldn’t even swallow. My family had to buy a food processor to blend my food into liquid form. After seven weeks of therapy, I lost 10kg!”


Early detection not only improves the prognosis of the primary cancer, but – perhaps more critically – it prevents the spread to other vital organs like the brain.

“Undetectably, the tumour can spread upwards into the skull and/or nearby tissues and nerves since it is located at the back of the nose. By then, the disease is usually extensive,” says Dr Rekha Balachandran, ENT Surgeon at Hospital Raja Permaisuri Bainun.

“That’s why we hope primary care doctors will refer patients to us as early as possible when they see the signs. Unfortunately, early detection isn’t always possible. In some countries, physicians may only encounter the disease once in their entire lifetime,” says Dr Rekha.

Alif Lam’s (39) story is a classic case. While working in Oman, he detected blood in his saliva and consulted the local physician, who referred him to a specialist. When an X-ray of his lung and chest showed nothing, the specialist put him on a course of antibiotics.

That was the end of the matter. It was only upon his return to Malaysia and the presence of blood in his saliva again prompted him to go for further investigation, which uncovered a one-year-old 4mm tumour.

Within weeks of radiotherapy, the side effects hit him. “I had no saliva,” he recalled. “My ulcers made eating impossible. I also experienced awful headache at night which lasted several hours.”

Dr Rekha explained that the proximity of the radiated area to the skull base may result in headaches, whose severity varies from person to person.

Other common side effects of radiotherapy are lifelong mouth dryness and osteoradiomitosis, loosely defined as trauma or injury caused by  exposure to radiation. “After a patient is diagnosed with nose cancer, we send him to the dentist to make sure there are no outstanding cavities or loose teeth. In the first few years following radiotherapy, it may not heal well. There is no blanket list,” she says.

Despite living with these inconveniences, both Wong and Alif are upbeat about their second chance at life. Alif says, “If you don’t go for treatment, everyday you wake up with the question, “Will I die today?” You don’t have to live with the uncertainties.”

An optimistic outlook, coupled with a supportive family, helped Wong rebound quickly. After post-radiotherapy CT Scan confirmed her cancer was in remission, her doctor gave her three months off. But by the second month, she was already restless, so she cancelled the last month of leave!

“Acceptance is the first step to coping,” she says. “Nothing they say or do will change the fact that I have contracted nose cancer. A positive, honest outlook helps you handle the situation in a practical manner.”

Next month: Find out whether you are at risk and what are the symptoms to look for!

Learn more about Nasal Cancer at, which was set up by Hospital Raja Permaisuri Bainun Hospital to elevate public awareness on NPC and reach out to the younger generation and doctors who do not specialise in ENT.

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