Nasopharyngeal Carcinoma
Nasopharyngeal carcinoma is distinct from other head and neck cancers in aetiology, geography and biology. Its strong Epstein–Barr virus association makes plasma EBV DNA one of the more established circulating biomarkers in solid oncology.
Disease categories
Major disease categories
- Keratinising squamous cell carcinoma
- Non-keratinising carcinoma
- Basaloid squamous cell carcinoma
Molecular
Molecular considerations
Epstein–Barr virus association is characteristic of non-keratinising disease. Alterations in NF-κB pathway genes and CDKN2A are described. PD-L1 expression is commonly assessed in recurrent disease.
Markers commonly discussed in nasopharyngeal carcinoma
- Plasma EBV DNA
- EBER in situ hybridisation
- PD-L1
- CDKN2A
Not exhaustive, and not every marker is assessed in every patient. Which of these is relevant depends on the individual case and should be discussed with the treating team.
Testing
Genomic testing considerations
EBV assessment is central; broader profiling is discussed in recurrent and metastatic disease.
Germline
Germline considerations
Familial clustering is described in endemic regions; germline assessment is considered where family history is strong.
Molecular monitoring
ctDNA and liquid biopsy considerations
Plasma EBV DNA is used in research and practice discussion for monitoring and for assessing residual disease, and is among the better-established circulating markers in solid tumours.
Single-cell & computation
Single-cell and algorithmic approaches
Single-cell sequencing in head and neck cancer is used to characterise immune exclusion and the stromal compartment, both of which vary substantially between tumours that look similar histologically. Single-cell DNA analysis contributes to field-change questions — whether a second lesion is a recurrence or an independent primary, which clonal analysis can often settle. Algorithm work includes HPV integration site analysis, deconvolution of immune composition from bulk expression, and viral circulating-DNA trajectory modelling.
Decisions
Treatment decision questions
Questions worth raising with a treating team when a decision is being made:
- Has EBV status been established?
- Is plasma EBV DNA being measured where available?
- Is the histological subtype documented?
Resistance
Resistance and recurrence questions
- Has plasma EBV DNA been retested at suspected relapse?
Trials
Clinical trial considerations
EBV status and prior therapy shape eligibility.
When a precision oncology review may help
A review is most useful where the standard pathway has been exhausted or where the picture is more complicated than a protocol accounts for — rare presentations, treatment resistance, complex or apparently contradictory molecular findings, or a decision between several defensible options.
The output is a structured analysis and a set of questions for the treating team. It is not treatment, and it does not replace the treating oncologist.