Post nasal space cancer: Treatment, symptoms, advice and help

Definition

At the back of the nose is a cavity called the 'post-nasal space'. Very rarely, in adults, a cancer may grow in this space. Cancer of the this site is very dangerous due it's closeness to the brain.

Incidence/Age

In the western world it is a very rare place for cancer to develop and occurs in adults of young to middle age. It is, however, a very common cancer in people from South China/Hong Kong.

Causes

In the western world there is no obvious cause, however in the South Chinese it is thought to be due to a genetic susceptibility combined with exposure to a type of virus called 'EBV'. It is not tobacco smoking related.

Symptoms/Signs

The skull at the back of the nose has the drainage channel from the ear and the nerves from the brain passing through it. This results in the first signs of the disease being either a blocked ear due to fluid behind the eardrum or double vision, due to invasion of the nerves controlling the eye.

This type of cancer often produces big glands high in the neck.

Tests/Investigations

The crucial test is a biopsy of the cancer - either under a local or general anaesthetic. The next most important investigation is a special X-ray of the sinuses called a 'CT scan' and possibly a 'MRI'.

Treatment

Cancer of the post-nasal space is very dangerous due to its ability to spread into the skull. It is recommend that the cancer is treated with radiotherapy ('radium or X-ray' treatment) and chemotherapy (chemical). If it returns, as half of cases do, then further radiotherapy and chemotherapy is usually recommended. Surgery is only useful for the rare cancer that has returned and can be cut out without too much harm to the patient. If neck glands persist despite radiation treatment then these should be cut out.

The cancer team managing this condition must be experienced and one way to find this out is to ask how many "new head & neck cancers" they treat every year. If they see at least 80 patients a year then they are probably experienced enough. In addition the cancer team should be composed of an Ear, Nose & Throat Surgeon, an Oral-Maxillo-Facial Surgeon, a Plastic & Reconstructive surgeon, a Clinical Oncologist, a Head & Neck Nurse and Head & Neck Dietician. All members of the team should be present at the meeting with you.

Outcome

The aim of the treatment is to destroy all of the cancer; this is ultimately possible in about 50% of patients.