Understanding nasopharyngeal cancer
Nasopharyngeal cancer (NPC) is a cancer that originates in the nasopharynx, the upper part of the throat behind the nose. In Singapore, NPC remains one of the more common cancers, with roughly 300 new cases diagnosed each year. While NPC is more prevalent among Chinese men in this country, it does occur across other ethnic groups. A 2015 study by the NUS Yong Loo Lin School of Medicine found that about 80% of NPC patients in Singapore are Chinese, with Malays accounting for a sizeable portion of non-Chinese cases.
Common symptoms include nosebleeds, a painless lump in the neck, and hearing loss. These signs can be subtle early on, which is why timely evaluation by medical professionals is crucial when unusual nasal bleeding or throat symptoms appear.
From nosebleeds to diagnosis
Mr Mohamed Farhain Mohamed Pawsie, a 41-year-old safety manager in Singapore, began experiencing nosebleeds in November 2024. A family doctor linked the bleeding to a fever, and Farhain noted that stress or exhaustion had previously been associated with nosebleeds for him. When the episodes escalated to nearly every other day, concern grew. In February, he was admitted to Sengkang General Hospital, where a biopsy confirmed Stage 3 NPC.
Farhain recalls how the diagnosis devastated his family circumstances at the time. His late maternal uncle had NPC, his wife Nurislamiyah Ithsnen was heavily pregnant with their fourth child, and her mother had died of pancreatic cancer less than a year earlier. Still, the couple pressed on, guided by a physician who emphasized support and compliance with treatment plans.
Treatment at NCCS: chemotherapy, proton therapy, and resilience
Farhain began cancer treatment in March, with his first chemotherapy session occurring just one day before his wife gave birth. Despite fatigue and the burden of treatment, he remained present for the birth of their child, a testament to the family’s resolve. His clinicians, including Associate Professor Melvin Chua at the National Cancer Centre Singapore (NCCS), underscored the importance of compliance and steady progress: “From the first time I met him, he told me, ‘I do not need anything else from you except for compliance. I’ll make sure you get well.’”
Over the course of treatment, Farhain underwent nine cycles of chemotherapy and 35 sessions of proton therapy. Proton therapy is a type of radiation treatment that uses protons to target cancer cells with high precision, sparing surrounding healthy tissue and potentially reducing side effects. While chemotherapy and radiation can take a toll, the goal was clear: shrink the tumor and eradicate visible disease.
Fatigue, nausea, and reduced appetite were among the common side effects. Yet, his employers were supportive, reinforcing that treatment should come first. “As long as you’re able to continue your treatment, you do it,” they told him, a reminder of the supportive work environment that helped many patients during long treatment journeys.
After six months of therapy, scans showed no detectable cancer. Yet the medical team remained vigilant because NPC can recur, especially in advanced stages and when viral biomarkers persist.
Clinical trial and ongoing vigilance
Despite a favorable response, Farhain persistently tested positive for Epstein-Barr virus (EBV) DNA, a biomarker linked to NPC and a predictor of relapse risk when detected after induction chemotherapy. Professor Chua notes that relapse risk remains high for those with advanced NPC, underscoring the need for innovative approaches beyond conventional therapy.
To address this risk, Farhain enrolled in a clinical trial at NCCS and Tan Tock Seng Hospital. The trial combines immunotherapy with two oral chemotherapy drugs, tislelizmab and metronomic capecitabine. Early results from the trial are promising, with 18 patients enrolled so far and a plan to recruit 69 NPC patients overall. Farhain has already completed two treatment cycles and has 15 more to go. Reported side effects include numbness in the limbs and dry skin and mouth, but the potential for long-term cancer remission drives continued participation.
Beyond the medical interventions, Farhain credits the support network around him — his siblings and his wife’s family — for helping with daily tasks such as grocery shopping while he focused on treatment. He also highlights his wife as a “pillar of strength,” especially during the toughest days when side effects were most challenging.
Hope, perseverance, and the road ahead
Farhain’s journey from recurring nosebleeds to a Stage 3 NPC diagnosis illustrates the impact of early evaluation and multidisciplinary care. His experience reflects how Singapore’s healthcare system combines cutting-edge therapies with patient-centered support to improve outcomes for NPC patients. While the risk of relapse remains a reality for many NPC patients, participation in clinical trials offers hope for more durable remissions and a better understanding of how best to tailor treatment to individual patients. Farhain’s determination, the support of his family, and the expertise of his medical team together form a narrative of resilience in the face of a challenging cancer journey.
