Signs and Symptoms of Nasopharyngeal Carcinoma

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Overview:
    • Nasopharyngeal carcinoma (NPC):
      • Typically presents with a painless upper-neck mass plus nasal, aural, and cranial nerve symptoms:
        • Reflecting the tumor’s origin in the fossa of Rosenmüller with lateral (parapharyngeal) and superior (skull base) spread
    • Early symptoms are non-specific:
      • So most patients present at advanced stage (III to IV)
  • Presenting features by mechanism:
    • Neck mass (regional nodal spread):
      • Most common presentation (~75%):
        • Painless enlarged upper cervical node:
          • Often the first / only sign
      • Retropharyngeal and level II nodes:
        • Are first echelons
      • May occur without a visible primary
    • Nasal symptoms (primary tumor):
      • Epistaxis or blood-tinged discharge
      • Unilateral nasal obstruction
      • Rhinorrhea (nasal dysfunction ~73%)
      • “Nasal twang” or voice change with large tumors
    • Aural / eustachian tube dysfunction:
      • Unilateral serous otitis media
      • Conductive hearing loss
      • Tinnitus
      • Aural fullness (~62%):
        • The feeling of pressure, clogging, or fullness inside the ear:
          • Often described as having water or air trapped inside
    • Skull-base / cranial nerve involvement:
      • Headache (~35%)
      • Facial pain / numbness (CN V)
      • Diplopia (~11%, CN VI)
      • Cranial nerve palsy in ~20% of the cases at diagnosis
      • Most affected nerves:
        • CN V and VI, plus III and XII
        • Advanced disease may cause cavernous sinus syndrome and multiple cranial neuropathies
    • Less common findings:
      • Trismus (~3%, pterygoid muscle invasion)
      • Nasal regurgitation (soft-palate paresis)
      • Symptoms of distant metastasis:
        • Bone, lung, liver
      • Anorexia / weight loss uncommon:
        • If present, raise suspicion for distant spread
  • Evaluation:
    • Complete head and neck exam with nasopharyngeal fiberoptic endoscopy; neck palpation
    • EBV testing:
      • Endemic undifferentiated / nonkeratinizing subtypes strongly EBV-associated
    • Biopsy of nasopharyngeal lesion
    • MRI skull base to clavicle
  • References:
    • Wei WI, Sham JS. Nasopharyngeal Carcinoma. Lancet. 2005.
    • Chua MLK, Wee JTS, Hui EP, Chan ATC. Nasopharyngeal Carcinoma. Lancet. 2016.
    • Ayan I, Kaytan E, Ayan N. Childhood Nasopharyngeal Carcinoma: From Biology to Treatment. Lancet Oncol. 2003.
    • Expert Panel on Neurological Imaging, Gule-Monroe MK, Calle S, et al. ACR Appropriateness Criteria® Staging and Post-Therapy Assessment of Head and Neck Cancer. J Am Coll Radiol. 2023.
    • Kumari B, Goyal MK, Lal V. Pearls & Oy-Sters: Bilateral Cavernous Sinus Syndrome as Presenting Manifestation of Nasopharyngeal Carcinoma. Neurology. 2014.
    • Brennan B. Nasopharyngeal Carcinoma. Orphanet J Rare Dis. 2006.
    • Her C. Nasopharyngeal Cancer and the Southeast Asian Patient. Am Fam Physician. 2001.
    • Albilali A, Alotaibi NH, Alfadley A, Alqarni KM, Alhajlah A. Extensive Locally Invasive Nasopharyngeal Carcinoma Involving 10 Cranial Nerves Palsies: An Interesting Case Report. Front Oncol. 2024.
    • Kumari B, Goyal MK, Lal V. Pearls & Oy-Sters: Bilateral Cavernous Sinus Syndrome as Presenting Manifestation of Nasopharyngeal Carcinoma. Neurology. 2014.
    • Kumari B, Goyal MK, Lal V. Pearls & Oy-Sters: Bilateral Cavernous Sinus Syndrome as Presenting Manifestation of Nasopharyngeal Carcinoma. Neurology. 2014.
    • Zhou P, Zhu Y, Xu B, et al. Cavernous Sinus Syndrome in a Patient With Occult Nasopharyngeal Carcinoma: A Diagnostic Challenge. Oral Oncol. 2025.
    • National Comprehensive Cancer Network. Head and Neck Cancers. 2026.
    • Chad Zender. Nasopharynx. Essential Cases in Head and Neck Oncology. 2022.


Unknown's avatar

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Leave a comment