A Chinese cancer

“Nose” cancer or more accurately termed nasopharyngeal cancer (NPC) has often been called a Chinese cancer because of the high incidence of NPC in Chinese, especially those of Southern Chinese descent, especially among Cantonese. The incidence here is approximately 20 per 100,000 as is as high as 30 to 50 per 100,000 in Guangzhou.

For a long time, it has been among the top 5 cancers in Singapore but recently dropped to number 6 with our ageing population. It however remains the commonest cancer among Chinese men aged 25 to 45 years of age, hitting us in the prime of life! It occurs more than twice as often in men compared to women. Many do not realise that it occurs quite commonly in Malays as well (about a third to a quarter of Chinese incidence) but occurs rarely in Indians (200 times less!)

Patients with NPC often first complain of a neck lump (2/3 of patients). 40% present with blockage and tinnitus (ringing sound) in one ear. About a third of patients complain of blood stains in their nasal mucus and another third with blood stains in their phlegm. Together, blood stained discharge is the presenting symptom in slightly under half of all patients. Frank nose bleeds are actually uncommon. These symptoms unfortunately can appear very innocuous and many Chinese patients think that it is just “heatiness” and ignore their symptoms until their cancer becomes very advanced.