Key points for diagnosis
The site of the nasopharynx is concealed. Meanwhile, the early symptoms of nasopharyngeal carcinoma are more complex. Therefore, take care to emphasize the clinical symptoms so that the early discovery and timely treatment are planned.

(1) Swelling of the cervical lymph node: At the early stage, nasopharyngeal carcinoma may transfer to the cervical lymph node and there may exist lumps in the cervical portion. The lumps first occur in the homolateral superior deep cervical lymph nodes and lie in the inferior part of the mastoidale. First, the lumps lie unilaterally. Then they will develop bilaterally. The lumps are of different sizes and several of them may merge together. The lumps are hard, with the rough surface like nodes and poor mobility. At the late stage, swelling may also exist in the middle and inferior deep cervical lymph nodes and emerge into huge lumps.

(2) Nasal bleeding: Nasal bleeding is often the early symptom of nasopharyngeal carcinoma and its quantity is not profuse. The commonly-seen nasal bleeding exists in the post-sucked bloody nasal discharge or the bloody nasal discharge which is discharged when the patient blows his nose. Profuse bleeding may occur at the late stage.

(3) Nasal obstruction.  Nasal obstruction is not marked at the early stage of pathological changes. It worsens gradually with the development of the carcinoma
which blocks the nose, mostly with unilateral onset. Bilateral nasal obstruction will occur if the carcinoma obstructs the bilateral nostrils.

(4) Symptoms of the ears: If the carcinoma obstructs or compresses the auditory tube, it will cause tinnitus, otic occlusion and hypoacusis, or accompanying middle ear effusion.

(5) Symptoms of cranial nerves. When the carcinoma destroys the base of skull or through lacerated foramen to enter the intracranial part, it will often invade cranial nerves, causing headache of the affected side or prosopalgia as well as inability of eyeball abduction, blurred vision, ambiopia, blepharoptosis, even eyeball fixation or blindness. If the metastatic lymph node of deep cervical region compresses cranial nerves, it will result in symptoms of uranoplegia, dysphasia, hoarseness and deviation of tongue extension. Facial paralysis and deafness may occur at the late stage.

(6) Distal metastasis: At the late stage, the carcinoma may transfer to the lung, liver, and skeleton, etc. and local pain is the first symptom of distal metastasis.

(7) The predilection sites of nasopharyngeal carcinoma lie in the pharyngeal crypts and the posterior wall of nasopharyngeal top which can be examined with an indirect nasopharyngoscope or a fiberopfic nasopharyngoscope. At the early stage, the examination may show local roughness of the mucosa as well as the lesser tubercles or granulation-like tumor which will gradually develop into the cauliflower-like shape, nodular shape or ulceration manifested as erosion of mucosa with colour changes or the normal colour and lustre as well as the collapse of nasopharyngeal wall.

(8) The X-ray film of the base of skull helps to understand whether there exists damage of substance of bone or not. CT scan may indicate the change of the nasopharyngeal mucosa, which is helpful for the diagnosis of nasopharyngeal carcinoma at the early stage.

(9) The suspected focus of the nasopharyngeal region can be confirmed by the biopsy and pathological examination. The sampling may be obtained pernasally or perorally.