Clinical features

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