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Sniffing out nose cancers


A large-scale screening research study aims to enhance the detection of early-stage nose cancer, which could significantly improve treatment success and survival rates.
Issue 3 | December 2023

Sniffing out nose cancers

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A painless lump in the neck, persistent ear ringing or unexplained blood in the mucous - such seemingly benign symptoms can sometimes signal a more sinister underlying condition. In Singapore, which has one of the highest incidences of nasopharyngeal cancer, commonly referred to as nose cancer, these signs warrant urgent attention. Every year, about 300 new patients are diagnosed with the disease, making it the third most common cancer among males aged 40 to 49 in the city-state.

Nose cancer is a malignancy in which cancer cells develop in the passageway behind the nose, just above the throat. Unlike other cancers, it doesn't present clear symptoms in its early stages, often leading to delayed diagnosis and treatment. Although factors like diet, smoking and family history play a role in its onset, the predominant association of nose cancer is the Epstein-Barr virus (EBV). The exact nature of this association remains a mystery to the medical community.

Unfolding the unknown

The National University Health System (NUHS) is spearheading an initiative to tackle this challenge head-on. Through an integrated research programme involving the National University Hospital (NUH), National University Polyclinics (NUP) and National University Cancer Institute, Singapore (NCIS), the focus is on enhancing early detection and improving survival rates for nose cancer patients.

Structured as a five-year study, the programme aims to recruit 20,000 participants between the ages of 35 and 60, encompassing a broad demographic including Chinese, Malay or mixed heritage individuals.

Participants undergo a screening process, which includes a blood test to detect the EBV early antigen, a self-collected saliva sample and a questionnaire - all conducted free of charge. Interested participants can register their interest here.

The blood test is crucial in this study, as it seeks out the presence of EBV. "By targeting the early antigen serology marker, we can identify those at high risk for nose cancer, who will then be referred to specialists at the Ear, Nose and Throat (ENT) - Head and Neck Surgery Centre at NUH for further evaluation," says Dr Joshua Tay, a consultant at the Department of Otolaryngology - Head and Neck Surgery, NUH.

The research aims to delve deeper into the nuances of the virus, where some subtypes might be correlated to the development of nose cancer. "Mapping the landscape of EBV subtypes within Singapore's population and linking them to nose cancer cases can help us develop more targeted and effective screening strategies," Dr Tay adds.

Early detection is key

Sniffing out nose cancer in its early stages is a formidable weapon in the fight against nose cancer. This aspect of the research programme is particularly crucial given the nature of the disease, which often remains cloaked in ambiguity until it reaches more advanced stages. Only less than 10% of patients are diagnosed at Stage 1.

"Early detection and treatment for nose cancer is key as it can make a huge difference in patient outcomes," says Associate Professor Thomas Loh, a senior consultant at the Department of Otolaryngology - Head and Neck Surgery, NUH. "Stage 1 patients usually have a 10-year survival rate above 90%, compared to 50-60% for those diagnosed at Stage 4."

A/Prof Loh, who is also Group Chairman of the Medical Board at NUHS, reiterates the broader impact of the study, "By identifying individuals at high risk and intervening as early as possible, we hope to develop an evidence-based, cost-effective screening model to boost the early diagnosis rates of nose cancer."

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National University Health System
  • National University Hospital
  • Ng Teng Fong General Hospital
  • Alexandra Hospital
  • Jurong Community Hospital
  • National University Polyclinics
  • Jurong Medical Centre
  • National University Cancer Institute, Singapore
  • National University Heart Centre, Singapore
  • National University Centre for Oral Health, Singapore
  • NUHS Diagnostics
  • NUHS Pharmacy
  • Yong Loo Lin School of Medicine
  • Faculty of Dentistry
  • Saw Swee Hock School of Public Health
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