Nasopharyngeal Cancer: The Role of EBV Infection and Genetics

Nasopharyngeal cancer (NPC) is rare, but it hits certain regions, especially Southeast Asia and North Africa. Its biggest drivers are the Epstein–Barr virus (EBV) and specific inherited genetic risks. When both come together, they create the right conditions for the tumor to grow, which is why early detection becomes so important. 

How does the Epstein-Barr virus trigger cancer?

EBV is a herpesvirus associated with the majority of NPC cases. While it usually stays silent or causes mild illness, in NPC, it behaves differently. EBV infects the cells lining the nasopharynx and switches on two key genes, LMP1 and EBNA1. LMP1 acts like a stuck ‘on’ switch, activating pathways like NF-κB and MAPK that help cancer cells grow, invade, and survive. The virus stays in the tissue for years, creating a chronic environment that increases cancer risk.

Family history and susceptible genes

Genetics also play a major role, which explains why only some EBV-infected people develop cancer. A strong family history of NPC raises the risk significantly. Genome-wide studies show that changes in the MHC genes on chromosome 6 make it harder for the immune system to recognize and clear EBV-infected cells. When these infected cells stay in the body longer, the risk of cancer increases. 

EBV and genetics in tumor growth

When EBV infection and genetic susceptibility overlap, the risk multiplies. The virus can damage DNA over time, turning on cancer-promoting genes and switching off protective ones. This combination allows NPC to develop and spread quickly. The interaction of EBV and genetics weakens the immune system and DNA by speeding up the tumor growth. Damages to the cell’s DNA activate cancer-causing gene mutations rather than protective genes. This results in nasopharyngeal cancer, which is very aggressive and quickly spreading. 

Reduction of risks

Prevention focuses on reducing exposure and finding the disease early. The biggest challenge is screening people in high-risk regions. Screening tests look for EBV-specific antibodies and measure cell-free EBV DNA (cfEBV DNA) in the blood. High cfEBV DNA levels can indicate NPC even before symptoms appear. This makes early treatment possible and supports lifestyle changes, such as reducing salted and preserved foods.

NPC develops from a mix of EBV infection and inherited genetic risks. Early detection, along with personalized medicine based on a person’s genetic risk, can slow tumor growth and improve outcomes. Public health campaigns are important to raise awareness in high-risk communities.