From nosebleeds to a life-changing diagnosis
What began as frequent nosebleeds in November 2024 for a 41-year-old safety manager in Singapore would soon unfold into a life-changing medical journey. A family doctor linked the bleeding to a fever he had, and the episodes recurred during times of stress and exhaustion. When the nosebleeds intensified to nearly every other day, concern grew. In February, he was admitted to Sengkang General Hospital (SKH), where a biopsy confirmed Stage 3 nasopharyngeal cancer (NPC), commonly known as nose cancer.
NPC develops in the nasopharynx, the upper part of the throat behind the nose, and can present with nosebleeds, a painless lump in the neck, and hearing loss. In Singapore, NPC is relatively common, with roughly 300 new cases diagnosed each year. The disease tends to be more prevalent among Chinese men, but it also affects people from other ethnic backgrounds, including Malays who contribute significantly to non-Chinese cases.
What is nasopharyngeal cancer?
Understanding the disease
Nasopharyngeal cancer arises in the tissues of the nasopharynx. It often presents with symptoms such as recurrent nosebleeds, nasal obstruction, and sometimes neck swelling. Early recognition and prompt treatment are crucial for improving outcomes. In Singapore, clinicians routinely tailor treatment plans based on the stage of NPC, the patient’s overall health, and biomarker indicators.
A disease in Singaporean context
NPC remains a notable cancer in Singapore’s medical landscape. While most affected are Chinese men, other ethnic groups are represented as well. Studies have shown that about 80 percent of NPC patients in Singapore are Chinese, and among non-Chinese patients, Malays form a substantial share. The patient’s case also intersected with family dynamics, as a late maternal uncle had NPC, and his wife had recently faced her own health challenges while pregnant with their fourth child.
Treatment journey: chemotherapy and proton therapy
The patient began cancer treatment in March, with chemotherapy starting just a day before his wife gave birth to their fourth child. Despite fatigue and other side effects, he continued with his treatment, supported by a compassionate workplace. He underwent nine chemotherapy sessions and 35 sessions of proton therapy at the National Cancer Centre Singapore (NCCS). Proton therapy, a form of precision radiation, targets cancer cells more accurately, sparering healthy tissue and mitigating some side effects. Side effects included fatigue, nausea, vomiting, and reduced appetite, which raised concerns about his ability to work, but his employers encouraged him to prioritize treatment and well-being.
Relapse risk and a new clinical trial
Six months into treatment, scans revealed no detectable cancer. However, biomarkers told a different story. Persistent Epstein-Barr virus (EBV) DNA, a common indicator in NPC, suggested a higher relapse risk. In light of this, doctors offered a clinical trial combining immunotherapy with two oral chemotherapy drugs. The trial, conducted at NCCS and Tan Tock Seng Hospital, has enrolled several NPC patients with the aim of expanding to a larger cohort. Early results are promising, offering hope in a disease with a notable relapse rate after initial success. The patient has received two trial cycles and has more to go, with potential side effects such as numbness and dry skin noted in some participants.
Support, resilience, and gratitude
Beyond the medical procedures, the journey was shaped by strong family and community support. Siblings and in-laws helped with daily tasks, groceries, and emotional encouragement. The patient, describing his wife as a pillar of strength, found comfort in her steady presence through the toughest days, including periods of severe treatment-related side effects. His medical team, led by an experienced head-and-neck and thoracic oncology director, emphasized compliance and collaborative care as keys to navigating this challenging path.
Looking ahead
As the journey continues, the focus remains on maintaining cancer-free status and exploring advancing therapies through clinical trials. NPC is a disease with a real risk of relapse for those with advanced stages, underscoring the importance of ongoing research and patient-centered care. With robust medical support, a strong support network, and participation in trials, patients like him carry renewed hope for the future.
