What is nasopharyngeal cancer (NPC)?
Nasopharyngeal cancer (NPC) is a malignancy that develops in the nasopharynx, the upper part of the throat behind the nose. It can present with nosebleeds, a painless lump in the neck, hearing loss, and sometimes facial discomfort. In Singapore, NPC remains one of the more frequently diagnosed cancers, with roughly 300 new cases each year. While it is historically more common among Chinese men, the disease also appears in people of other ethnic backgrounds, including Malays, making NPC a public health concern that touches many families.
A difficult diagnosis in Singapore
Mr Farhain Mohamed Pawsie, a 41-year-old safety manager, began experiencing frequent nosebleeds in November 2024. A family doctor attributed the bleeds to a fever and stress, as nosebleeds can occur during tiring periods. When the bleeding intensified to near-daily episodes, he sought further evaluation. In February, a biopsy at Sengkang General Hospital confirmed Stage 3 NPC, a condition that demands aggressive treatment and close monitoring. The news was especially devastating given his family circumstances: his late maternal uncle had NPC, his wife was pregnant with their fourth child, and she had recently left her job to focus on the family, leaving him as the primary breadwinner.
The treatment journey
Mr Farhain’s care team at the National Cancer Centre Singapore (NCCS) emphasized the core principle of treatment: compliance with the plan to achieve the best possible outcome. The head, neck, and thoracic oncology team, led by Professor Melvin Chua, outlined a multi-modality approach that began in March. He underwent nine chemotherapy cycles and 35 sessions of proton therapy, a precise form of radiation that uses proton beams to target cancer cells while sparing healthy tissue. The journey was taxing—fatigue, nausea, vomiting, and appetite loss were all part of the experience—but his employers offered unwavering support, saying their primary concern was that he could continue his treatment and recover.
After six months of therapy, imaging scans showed no detectable cancer, a moment of relief for Mr Farhain and his family. Yet, the road ahead remained cautious. NPC relapse risk can be high, particularly when Epstein-Barr virus DNA remains detectable after induction chemotherapy. This biomarker guided his next step: a clinical trial exploring an immunotherapy regimen combined with oral chemotherapy.
The clinical trial: A new line of hope
The decision to enroll Mr Farhain in a trial at NCCS and Tan Tock Seng Hospital reflects a growing effort to improve NPC outcomes for patients at high risk of relapse. The study pairs immunotherapy with two oral chemotherapy drugs, tislelizumab and metronomic capecitabine. The trial has enrolled 18 NPC patients to date, with plans to recruit 69 in Singapore. Early results are promising, offering a glimmer of hope for patients like Mr Farhain who are confronting the dual challenge of cancer and the possibility of recurrence. So far, he has completed two cycles of treatment in the trial, with 15 cycles to go. Side effects reported include numbness in the limbs and dry skin and mouth, but the family remains hopeful about long-term remission.
Resilience, support, and the road ahead
Beyond the medical interventions, Mr Farhain’s story underscores the power of family and community. He credits his wife and siblings for handling daily tasks and errands during treatment, allowing him to focus on his health. He recalls the hospital moments when his wife, heavily pregnant and in the midst of a challenging season, found strength in his steadfast presence and calm reassurance. For many NPC patients, the path to recovery is not just a medical journey but a social one—where support networks become part of the healing process.
Looking forward
The NPC landscape in Singapore continues to evolve with advances in radiation techniques, chemotherapy, and immunotherapy, offering new options for patients at every stage of the disease. Mr Farhain’s journey—from nosebleeds to a cancer diagnosis, through intense treatment, and into a hopeful trial—highlights both the challenges and the resilience that define this battle. Early detection and treatment remain critical, and stories like his remind us of the importance of paying attention to persistent symptoms and seeking timely medical care.
