Nasopharyngeal carcinoma !

A cancer of the upper part of the throat behind the nose, strongly linked to Epstein-Barr virus. A neck lump or fluid in one ear may be the first sign.

Updated 2026-11-01

Structures involved

Tap one to see what it is and open it in 3D.

Microorganisms that cause it

Epstein–Barr virus

Why it happens

What it is

A malignant epithelial tumour of the nasopharynx, usually arising in the lateral recess (fossa of Rosenmüller) near the opening of the auditory tube. Most cases are the non-keratinising type associated with Epstein-Barr virus (EBV).

Who gets it

Endemic in southern China and Southeast Asia, and more common in North Africa and the Arctic; it is uncommon in Colombia and the rest of Latin America, where it is often diagnosed late. It peaks in middle age, with a smaller peak in adolescents, and is more frequent in men.

Causes

Epstein-Barr virus infection, linked to most non-keratinising tumours
Genetic susceptibility and family history
Diet rich in salt-cured fish and preserved meats (nitrosamines), especially in early childhood
Tobacco and heavy alcohol use, linked mainly to the keratinising type

Risk factors

Asian, North African or Arctic ancestry
Family history of nasopharyngeal carcinoma
High antibody titres or plasma DNA of EBV
Smoking and alcohol
Occupational exposure to wood dust and formaldehyde

Pathophysiology

EBV latent proteins in infected epithelial cells drive proliferation and evade immunity. The tumour grows silently in the nasopharynx, blocks the auditory tube (causing serous otitis), spreads early to retropharyngeal and upper deep cervical lymph nodes, and can invade the skull base and cranial nerves, especially V and VI.

Classification

Keratinising squamous cell carcinoma (WHO type I)
Non-keratinising carcinoma, differentiated or undifferentiated (WHO types II and III, EBV-related, the endemic form)
Basaloid squamous cell carcinoma
TNM staging (AJCC)

Symptoms and signs

Painless, firm lump in the upper neck (enlarged lymph node), often the first sign
One-sided hearing loss, ear fullness or tinnitus from serous otitis media
Nasal obstruction, blood-stained nasal discharge or nosebleeds
Headache, facial numbness or double vision with skull base invasion

Diagnosis

Clinical: Nasal endoscopy (nasopharyngoscopy) to see the mass, full neck examination and cranial nerve examination.
Tests: Endoscopic biopsy confirms the diagnosis; EBV markers on the tissue; plasma EBV DNA is a tumour marker for screening in endemic areas, prognosis and follow-up. Fine-needle aspiration of a neck node that shows EBV-positive carcinoma points to a nasopharyngeal primary.
Imaging: MRI of the nasopharynx and neck defines local spread and skull base invasion; CT or PET-CT for staging and distant metastases (bone, lung, liver).

Differential diagnosis

Adenoid hypertrophy (children)
Lymphoma of the nasopharynx or neck
Juvenile nasopharyngeal angiofibroma (adolescent boys with nosebleeds)
Tuberculous cervical lymphadenitis
Other head and neck squamous cell carcinomas with neck metastasis

Goal of treatment

Cure locoregional disease with high-precision radiotherapy, with chemotherapy for advanced stages, while protecting nearby structures and quality of life.

Treatment

Procedure: Radiotherapy, usually intensity-modulated, is the main treatment because the site is hard to reach surgically; early disease is treated with radiotherapy alone to the primary and both sides of the neck.
Medical: Locally advanced disease: concurrent chemoradiotherapy with platinum-based chemotherapy, often with induction or adjuvant chemotherapy; chemotherapy and immunotherapy (PD-1 inhibitors) for metastatic or recurrent disease.
Surgical: Neck dissection for persistent or recurrent neck nodes after radiotherapy; selected local recurrences may be resected.
Follow-up: Follow-up with endoscopy, MRI and plasma EBV DNA; nursing care for mucositis, dry mouth, nutrition, hearing, and thyroid function after neck irradiation.

Complications

Skull base invasion and cranial nerve palsies
Distant metastases to bone, lung and liver
Radiotherapy effects: dry mouth, hearing loss, hypothyroidism, dental caries, trismus, neck fibrosis and osteoradionecrosis
Persistent serous otitis media

Prognosis

Highly sensitive to radiotherapy; early-stage disease has high cure rates, while advanced and metastatic disease does worse. High plasma EBV DNA before or after treatment predicts a poorer outcome.

Prevention

Avoiding tobacco and limiting salt-cured foods
Plasma EBV DNA screening is used in some endemic populations

Test yourself

Think of the answer, then tap the question to see it.

Which virus is strongly associated with nasopharyngeal carcinoma?

Epstein-Barr virus.

Where in the nasopharynx does this cancer usually arise?

In the lateral recess, the fossa of Rosenmüller, near the auditory tube opening.

What ear finding in an adult should raise suspicion of this tumour?

Unilateral serous otitis media (middle ear effusion).

What is the main treatment modality?

Radiotherapy, combined with chemotherapy in locally advanced disease.

Add to my cards (4)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: Nasopharyngeal Carcinoma Treatment (PDQ®)–Health Professional Version (National Cancer Institute (NCI), 2026); Nasopharyngeal Cancer Treatment (PDQ®)–Patient Version (National Cancer Institute (NCI), 2026).

← All conditions

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.

Pharynx highlighted on the Durgical 3D model