Which of the following is the most common presenting symptom of nasopharyngeal carcinoma in adults?

Explanation

## Presenting Symptoms of Nasopharyngeal Carcinoma **Key Point:** Cervical lymphadenopathy is the most frequent initial presentation of nasopharyngeal carcinoma, occurring in 70–80% of patients at diagnosis. Often it is the first symptom that prompts medical evaluation. ### Symptom Frequency at Presentation | Symptom | Frequency | Mechanism | | --- | --- | --- | | **Cervical lymphadenopathy** | 70–80% | Nodal metastasis; often unilateral, firm, non-tender | | Nasal obstruction | 50–60% | Tumor mass effect | | Epistaxis | 20–30% | Tumor necrosis and ulceration | | Otitis media with effusion | 15–20% | Eustachian tube obstruction | | Cranial nerve palsy (CN V, VI, IX–XII) | 5–10% | Skull base invasion | | Hearing loss | 10–15% | Serous otitis media | **High-Yield:** The classic presentation triad is: 1. Cervical lymphadenopathy (most common) 2. Nasal/nasopharyngeal symptoms (obstruction, epistaxis) 3. Otologic symptoms (otalgia, hearing loss, serous otitis) **Clinical Pearl:** A unilateral cervical lymph node in an adult, especially if persistent >3 weeks, warrants nasopharyngoscopy and biopsy to exclude malignancy. Serous otitis media in an adult is nasopharyngeal carcinoma until proven otherwise. **Mnemonic: "CONE" = Cervical nodes (most common), Obstruction/Epistaxis, Neuro symptoms (late), Ear symptoms**