Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017:21:16-180.
doi: 10.7812/TPP/16-180.

Nasopharyngeal Carcinoma Diagnostic Challenge in a Nonendemic Setting: Our Experience with 101 Patients

Kevin H Wang  1 , Stephanie A Austin  2 , Sonia H Chen  3 , David C Sonne  4 , Deepak Gurushanthaiah  5
Affiliations

Nasopharyngeal Carcinoma Diagnostic Challenge in a Nonendemic Setting: Our Experience with 101 Patients

Kevin H Wang et al. Perm J. 2017.

Abstract

Introduction: We studied the presenting symptoms, time intervals, and workup involved in the diagnosis of nasopharyngeal carcinoma in an integrated health care system.

Methods: A retrospective chart review of all patients with a nasopharyngeal carcinoma diagnosis between 2007 and 2010 at Kaiser Permanente Northern California. Main outcome measures included diagnostic time intervals, presenting symptoms, diagnostic accuracy of nasal endoscopy, imaging, and diagnosis at first otolaryngologist (Oto-HNS) visit.

Results: This study included 101 patients: 70 (70%) were of Chinese or of Southeast Asian descent. The median time intervals along the diagnostic pathway were symptom onset to primary care physician visit, 6.0 weeks; primary care physician to Oto-HNS, 2.4 weeks; Oto-HNS to pathologic diagnosis, 1.1 weeks; and diagnosis to treatment onset, 5.5 weeks. The most common presenting symptoms were otologic issues (41, 41%), neck mass (39, 39%), nasal issues (32, 32%), and headache/cranial neuropathy (16, 16%). A nasopharyngeal lesion was detected in 54 (53%) patients after the first Oto-HNS visit. Among the initial nasal endoscopy reports, 32 (32%) did not reveal a nasopharyngeal lesion; 32 (32%) initial imaging studies also did not reveal a nasopharyngeal lesion. There was no correlation between diagnostic delay and disease stage.

Conclusion: Nasopharyngeal carcinoma presenting symptoms are extremely variable, and initial misdiagnosis is common. Median time from symptom onset to treatment was almost six months among patients studied. Nearly one-third of nasopharyngeal cancers were missed with nasal endoscopy and imaging. An understanding of the risk factors, presenting symptoms, and limitations associated with these diagnostic tests is necessary to support earlier detection of this insidious cancer.

PubMed Disclaimer

Conflict of interest statement

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Median time intervals in weeks (interquartile ranges). Oto-HNS = otolaryngologist; PCP = primary care physician.
Figure 2
Figure 2
Nasopharyngeal carcinoma presenting symptoms.
Figure 3
Figure 3
Initial diagnosis by otolaryngologist.
Figure 4
Figure 4
(A) Example of a T4b nasopharyngeal carcinoma (NPC) with an endoscopic examination that was initially normal. (B) Example of an endophytic NPC initially interpreted as normal on this computed tomography sinus scan without contrast. The arrow points to a tumor in the right parapharyngeal space.
See this image and copyright information in PMC

References

    1. Lee JT, Ko CY. Has survival improved for nasopharyngeal carcinoma in the United States? Otolaryngol Head Neck Surg. 2005 Feb;132(2):303–8. doi: 10.1016/j.otohns.2004.09.018. - DOI - PubMed
    1. Lee AW, Foo W, Law SC, et al. Nasopharyngeal carcinoma: Presenting symptoms and duration before diagnosis. Hong Kong Med J. 1997 Dec;3(4):355–61. - PubMed
    1. August M, Dodson TB, Nastri A, Chuang SK. Nasopharyngeal carcinoma: Clinical assessment and review of 176 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Feb;91(2):205–14. doi: 10.1067/moe.2001.110698. - DOI - PubMed
    1. Chang ET, Adami HO. The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev. 2006 Oct;15(10):1765–77. doi: 10.1158/1055-9965.EPI-06-0353. - DOI - PubMed
    1. Yu WM, Hussain SS. Incidence of nasopharyngeal carcinoma in Chinese immigrants, compared with Chinese in China and South East Asia: Review. J Laryngol Otol. 2009 Oct;123(10):1067–74. doi: 10.1017/s0022215109005623. - DOI - PubMed

MeSH terms

LinkOut - more resources