Collaborative breakthroughs in precision diagnosis and treatment of nasopharyngeal cancer: Biomarker‑driven screening and endoscopic minimally invasive surgery reshape the new paradigm of early intervention (Review)

The management of nasopharyngeal carcinoma (NPC), a malignancy with pronounced geographic prevalence in Southeast Asia, is undergoing a paradigm shift toward precision medicine driven by innovations in early detection and minimally invasive therapy. Breakthroughs in Epstein‑Barr virus (EBV)‑based screening, such as CRISPR‑associated protein 12a (Cas12a) amplification‑free assays, P85 antibody profiling and T‑cell receptor sequencing, now achieve 97.9% sensitivity and 99.3% specificity, enabling ultra‑early risk prediction 6‑12 months before clinical diagnosis. These advances synergise with multimodal imaging techniques such as narrow‑band imaging and I‑scan virtual chromoendoscopy, which detect sub‑5 mm lesions with 90% sensitivity, revolutionizing screening protocols. Therapeutically, endoscopic nasopharyngectomy (ENPG) exemplifies precision oncology, achieving ≥90% negative resection margins and a 92.1% 5‑year survival rate in early‑stage NPC while preserving key functions (such as swallowing and hearing) and reducing radiotherapy‑related morbidity. Yet, it should be regarded as an indication‑bounded option for carefully selected T1‑T2 disease in experienced centers and does not constitute a universal substitute for radiotherapy. Persistent challenges, including tumor heterogeneity, limited access to advanced technologies in resource‑constrained regions and restrictive ENPG eligibility, underscore the need for artificial intelligence‑driven multi‑omics risk models, portable diagnostic tools and multinational trials to validate long‑term outcomes. By integrating surgical‑immune synergy (such as neoadjuvant programmed cell death protein 1 inhibitors) and equitable implementation strategies, NPC care is transitioning from empirical approaches to a precision framework targeting >80% early diagnosis and >90% functional preservation, offering a roadmap to mitigate the global burden of this regionally concentrated cancer.