BEAT IT! … before it beats you


Cancer is daunting. However, if it is discovered sooner, the survival rate may increase. The same goes for nose cancer, as Dr S Ram Kumar Sharma, Consultant Ear, Nose, Throat, Head & Neck Surgeon, advises individuals who show concerning signs and symptoms to see their doctor as soon as possible.

Be more vigilant in fight against nose cancer

A scare in life can take many different forms. Among the many is receiving news from the doctor about a potentially life-threatening condition.

Life is fragile and delicate, like a feather. Therefore, it can be frightening to get such unexpected news.

Dr S Ram

However, Consultant Ear, Nose, Throat, Head & Neck Surgeon (ENT surgeon) Dr S Ram Kumar Sharma emphasised in an interview that it’s important to always be vigilant for any changes in the body and to get them diagnosed as soon as possible.

Nasopharyngeal carcinoma (NPC), commonly known as nose cancer, is a disease that, like all cancers, has a higher chance of survival the sooner it is detected and treated, Dr S Ram said.

NPC is the third most common cancer among Malaysian men and the fourth most prevalent cancer nationwide.

The prevalence increases with age and Asians are more likely to be affected than Caucasians. NPC is also prevalent among the Bidayuh in Sarawak and the Chinese in Malaysia.

Dr S Ram, who is currently working in a hospital in Malacca, said that there are numerous factors that contribute to nose cancer.

“NPC is not caused by just one thing. Genetics accounts for 30 to 40 per cent of the cause. The environment may also be involved — whether you are subjected to any chemicals or contaminants. Furthermore, a person’s lifestyle could be the cause — drinking alcohol and smoking are both risk factors.”

The ENT surgeon went on to say that there are two types of risk factors: non-modifying risk factors and modifying risk factors.

Age, gender, and genetic make-up are examples of the former and are referred to be non-modifying risk factors because they cannot be changed.

While the moderating risk factor could be something like a person’s occupation, dietary lifestyle, or personal habits.

“Therefore, nose cancer is more common in patients who are male, Chinese, and have a family history of the disease. The youngest patient I have seen thus far is 12 years old. However, according to the national census, nose cancer typically affects people between the ages of 20 and 60,” the doctor said.

Diagnosing nose cancer

Cancer occurs when a normal cell transforms into an abnormal cell. When cancer is triggered by the risk factors, it is presented to the human body as a warning signal to address a problem that has surfaced.

There will be initial signs and symptoms, much like with many other cancers. When asked what the warning indications are, Dr S Ram said that NPC arises in places where it is difficult to detect.

“NPC occurs in an area where important structures are present. It is close to the nose, ears, and eyeballs. And we have important lymph nodes in the surrounding head and neck region that act as ‘policemen’ in our head and neck region. So, whenever there is an infection or cancer, the lymph nodes become triggered and swollen,” he said.

Dr S Ram went on to say that 70 per cent of patients come in with one-sided or both-sided neck swelling. “Although the neck swelling is not painful, it increases in size over time.”

About 50 per cent of patients will come in with a one-sided blocked nose or bloodstain nasal discharge.

“As previously stated, there are important structures quite near to the junction of the nose and the mouth. Some individuals also come in with a one-sided ear block or a one-sided buzzing sound. Some patients come in with one-sided facial pain and one-sided eye swelling, and if the disease progresses, it can spread to the liver,” he added.

Photo: Top Doctors

The ENT doctor noted that bloodstain nasal discharge, nose block, and one-sided or both-sided neck swelling are the most common symptoms.

Dr S Ram typically asks patients about their symptoms and medical history to diagnose NPC at his clinic.

“Once the facts have been noted, we will utilise a scope — a tiny camera that is inserted through the nose — to gain access to the behind. We can determine the structure’s normalcy or abnormality from this approach.”

According to him, an abnormal structure will develop into cancer at the back of the nose. After being examined, Dr S Ram said that a quick biopsy is performed to determine the diagnosis.

“Once NPC is confirmed, the patient will be subjected to scans to determine the extent of the cancer and whether it has spread to other organs,” he added.

Following the determination of the depth of the nose cancer, a tumour board comprised of ENT surgeons, radiation oncologists, radiologists, and pathologists will usually meet to discuss the best treatment option for the patient. Chemotherapy and radiotherapy are common treatment options.

Always be vigilant

As an ENT surgeon, having received countless cases regarding nose cancer, Dr S Ram lamented the fact that 60 per cent of his patients usually come in late.

He advised everyone to be vigilant in recognising the warning signs and symptoms he had mentioned.

“Delayed presentation is common since it is on a side that you cannot see. You would seek medical attention right away if you had a visible growth on your fingers. NPC, on the other hand, grows behind the nose. And in late diagnosis, I frequently notice them spreading to the surrounding structures,” said the doctor.

Dr S Ram gives the example of a late presentation by imagining himself as a factory worker who works 12 hours a day for minimal salary.

“And if I, as the worker, have a swelling but it does not bother me, why should I seek treatment? Only when it has spread elsewhere will I likely go to the doctor.”

Having said that, Dr S Ram hopes that many people would become aware and seek therapy at an early stage.

“Early detection results in a positive survival outcome. Almost 90 per cent has a three-year survival rate. On the other hand, early detection requires active screening or early admission.” At the end of the day, the timeline for the next step is critical. “Because the survival chances will be affected once this particular swelling becomes bigger and spreads to other areas,” said the ENT surgeon.

Photo: MAKNA (National Cancer Council)
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