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Factors contributing to delayed diagnosis in nasopharyngeal carcinoma

Published online by Cambridge University Press:  29 June 2007

Jern-Lin Leong ,
Kam-Weng Fong  and
Wong-Kein Low
Jern-Lin Leong
Affiliation:
Department of Otolaryngology, Singapore General Hospital, Singapore
Kam-Weng Fong
Affiliation:
Department of Therapeutic Radiology, National Cancer Centre, Singapore
Wong-Kein Low*
Affiliation:
Department of Otolaryngology, Singapore General Hospital, Singapore
*
Address for correspondence: Dr Wong-Kein Low, Head of Department and Consultant, Department of Otolaryngology, Singapore General Hospital, Singapore(169608). Fax: (65) 226-2079
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Abstract

Nasopharyngeal carcinoma (NPC) can be difficult to diagnose. Not only is the post-nasal space (PNS) inaccessible to examination, it is frequently occupied by normal lympho-epithelium which can make differentiation from NPC difficult. Together with its frequent atypical presentation, it is not surprising that the diagnosis is missed or delayed. This is undesirable as the treatment of early NPC carries an excellent prognosis. The aim of this study is to ascertain the extent of the problem of missed or delayed diagnosis and to study the factors responsible.

This was a retrospective study of all newly diagnosed patients with NPC from the Singapore General Hospital and treated in the Department of Therapeutic Radiology in the year 1996 (1 January-31 December).

A total of 126 patients were studied. Eighteen patients (14.3 per cent) were found to have delayed diagnosis of more than a month. The delay ranged from 1.2 to 25 months (mean 7.2 months). Factors identified which contributed to delayed diagnosis included i) Clinicians not considering a diagnosis of NPC ii) Clinicians suspecting NPC but misled by the results of investigations iii) Patients refusing investigation or defaulting follow-up.

Nearly a fifth of patients with NPC had delayed diagnosis. Many of the factors responsible for the delays appear to be preventable by better patient education and counselling, doctors having sharper clinical acument and skills in NPC diagnosis and the hospital administration having a system of tracking down high risk patients who default.

Keywords

Nasopharyngeal neoplasmsCarcinomaDiagnosis
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 113 , Issue 7 , July 1999 , pp. 633 - 636
Copyright
Copyright © JLO (1984) Limited 1999

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Footnotes

Presented at the 32nd Singapore-Malaysia Congress of Medicine, Singapore, 13–16 August 1998.

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