Stuffy nose and vision problems for three years reveal rare nasopharyngeal cancer that spread to brainstem

A 37-year-old woman was diagnosed with stage IV nasopharyngeal carcinoma after attributing a three-year history of nasal congestion and other symptoms to allergies and the common cold, doctors reported in a medical journal. Imaging showed an extensive tumor in the nasopharynx that had extended into the brainstem, cerebellum, skull base and upper cervical spine; the physicians described the spread to the brainstem as an "extraordinary clinical manifestation."

The patient sought hospital care after three years of nasal stuffiness, double vision and difficulty processing sounds and language, and nearly a year of left-sided facial numbness and headaches. At presentation clinicians documented slurred speech, hearing loss in both ears, recurrent nosebleeds, facial and nasal numbness and difficulty walking that required wheelchair use. Magnetic resonance imaging (MRI) revealed a large primary tumor in the nasopharynx with extensive intracranial extension.

The woman had been seen previously at multiple hospitals, including a specialized neurosurgical center, and was reportedly diagnosed or suspected to have meningioma or a pituitary tumor on several occasions. The treating team said reliance on those earlier, inaccurate assessments led to delayed definitive management, and that the patient received supportive herbal therapy while her condition worsened.

Nasopharyngeal carcinoma arises in the upper part of the throat behind the nose and is uncommon in the United States. Estimates place annual U.S. cases at roughly 3,300 — about one case per 100,000 people — and the disease accounts for a small share of oral cavity and pharyngeal cancers nationwide. Two-thirds of nasopharyngeal carcinoma cases are diagnosed at late stages (stage III or IV), a pattern often attributed to misdiagnosis because early symptoms can resemble benign conditions such as sinusitis or allergic rhinitis.

Medical literature links nasopharyngeal carcinoma to Epstein-Barr virus (EBV) infection and to environmental factors including exposure to chemicals in steam from cooking salt-cured foods. EBV infects most adults at some point and has also been associated with other lymphomas. Epidemiologic studies have found substantially higher rates of nasopharyngeal carcinoma among people of southern Chinese descent, and one study cited by the authors reported Chinese Americans are about 10 times more likely to be diagnosed with the disease than white Americans.

Typical presenting symptoms include a neck mass from enlarged lymph nodes, nosebleeds, bloody saliva, double vision, ear infections, facial numbness, persistent headaches, hearing loss, nasal obstruction, tinnitus and sore throat. The authors noted that intracranial spread to structures such as the brainstem is exceptionally rare, occurring in fewer than 1 percent of cases.

Clinicians advised surgical removal in this case, but the patient declined because of concerns about surgical risks and quality of life. She underwent multiple courses of radiation therapy instead and, according to the report, achieved complete remission on follow-up imaging.

Survival varies markedly by stage at diagnosis. Five-year survival for early-stage nasopharyngeal carcinoma has been reported at about 81 percent, declining to roughly 46 percent when the disease has distant extension. Broader figures for cancers of the oral cavity and pharynx — a category that includes nasopharyngeal carcinoma — indicate about 60,000 new U.S. diagnoses and roughly 12,770 deaths annually.

The treating team emphasized the diagnostic value of concurrent brain and nasopharyngeal imaging when clinical signs suggest possible skull-base or intracranial involvement. They concluded that comprehensive imaging can help avoid delayed diagnosis and permit more timely, targeted therapy for this uncommon but potentially aggressive cancer.