Common features of nasopharyngeal carcinoma are:
- bilateral cervical node enlargement - in one third of cases
- nasal voice, epistaxis, possibly, nasal obstruction - in one third of cases
- deafness from Eustachian tube involvement - in one fifth of cases
The exact presentation however, depends on the location and spread of the tumour. They may be grouped as:
- features of local disease:
- nasal - postnasal obstruction; unilateral or bilateral nasal obstruction; loss of smell; epistaxis; blood stained nasal discharge
- aural - secretory or less commonly, suppurative otitis media; deafness; otalgia; tinnitus; rarely, ear discharge
- orbital - proptosis; restricted eye movement; diplopia; impaired vision; rarely, blindness
- pharyngeal - difficulty in speaking; dysphagia; excessive salivation; airway obstruction
- neurologic - cranial nerve involvement at the skull base. Most commonly, III, IV and VI, and IX, X, XI and XII with trigeminal involvement
- neck metastases - unilateral or bilateral, often asymmetrical, enlargement of the upper deep cervical lymph nodes
Constitutional features suggest advanced disease - pain; headache; nausea; vomiting; anorexia; and loss of body weight; in severe cases, cachexia