Babe Ruth and Nasopharyngeal Cancer: A Story That Touched Cancer Research

A hoarse voice in the fall of 1946

PBS NewsHour records that Babe Ruth's voice grew increasingly hoarse in late 1946, followed by severe pain behind his left eye. An x-ray showed a large tumor at the base of the skull.

A report in Mayo Clinic Proceedings describes the diagnosis as nasopharyngeal carcinoma that had already reached nearby lymph nodes. It also records something that would be unthinkable now: Ruth was never told he had cancer.

In early 1947 he became one of the first people to receive an experimental anticancer drug, under Dr. Richard Lewisohn at Mount Sinai Hospital in New York. The drug was teropterin, a folate analogue made by Lederle Laboratories and a forerunner of methotrexate. He was treated daily for six weeks. The response was striking at first, with his enlarged nodes shrinking and his symptoms easing, and PBS notes he regained some of the roughly 80 pounds he had lost. Radiation followed and did little.

The cancer returned. He died on August 16, 1948, at the age of 53, at Memorial Hospital in New York, of pneumonia and metastatic cancer.

Teropterin itself went nowhere, quickly set aside for the more potent aminopterin. But the trial he joined sits near the start of the line that leads to modern chemotherapy.

What nasopharyngeal cancer is

The nasopharynx is the space at the very top of the throat, directly behind the nose and above the soft palate. It is not somewhere anyone can see or feel, which is why tumors there grow quietly.

The disease is rare. NCI reports that fewer than one person per 100,000 worldwide is diagnosed with it each year. It is far more common in southern China, Southeast Asia, North Africa, and the Arctic, and men are affected more often than women.

There are two broad forms. The keratinizing type accounts for under 20 percent of US cases and is linked to heavy smoking and alcohol. The nonkeratinizing types make up most cases worldwide and are strongly associated with Epstein-Barr virus, the virus that also causes mononucleosis.

NCI lists the risk factors as Epstein-Barr virus infection, ancestry or residence in those regions, a family member with the disease, tobacco use or secondhand smoke, heavy alcohol use, and a diet high in salt-cured fish and meats.

How it shows itself

The single most common presenting sign is a lump in the neck. NCI reports enlarged neck nodes in about 75 percent of patients, because the nasopharynx drains readily into them.

Early signs NCI lists are:

• A lump in the neck.
• Pain, pulsing, or ringing in the ear.
• Trouble hearing.
• A sore throat.
• A blocked or stuffy nose.
• Nosebleeds.

The ear symptoms deserve emphasis. A tumor sitting beside the opening of the Eustachian tube, which drains the middle ear, can cause fluid to build up behind one eardrum. An adult with fluid behind one ear and no cold to explain it needs the nasopharynx examined.

As disease advances, cranial nerves near the skull base become involved. That produces headaches, double vision, eyes that no longer line up, and numbness or weakness of the face.

When to get checked

Ask for an examination if:

• A neck lump has been present for more than three weeks, especially if it is painless and firm.
• One ear feels blocked, or hearing has dropped on one side, and there is no infection to explain it. In an adult, one-sided middle ear fluid is a red flag.
• Nosebleeds keep recurring from the same side, or blood-streaked mucus appears when clearing the throat.
• A blocked nostril has not cleared in several weeks, especially on one side only.
• A sore throat has lasted more than three weeks.
• Any facial numbness, double vision, or persistent headache appears, which needs prompt assessment.

There is no routine screening for this cancer in the general United States population. In high-incidence regions, blood testing for Epstein-Barr virus DNA is used, and NCI reports it performs with 96 percent sensitivity and 93 percent specificity.

Diagnosis and staging

The examination is done through the nose. Nasopharyngoscopy passes a thin scope to view the nasopharynx directly and take a biopsy, which is what makes the diagnosis.

Imaging follows. MRI is preferred for assessing the skull base, with CT and PET-CT used to map spread. NCI also lists Epstein-Barr virus testing, HPV testing, a neurological examination, hearing tests, and blood work.

Staging runs from stage 0 through stage IV, subdivided into IVA and IVB, based on tumor size and reach, lymph node involvement, and distant spread.

Treatment today

Surgery plays a small role here, because the nasopharynx is hard to reach and sits among critical structures. Radiation is the mainstay.

For stage I disease, NCI describes radiation therapy alone. For stages II through IV, the standard is concurrent chemoradiation, meaning radiation and chemotherapy given together, sometimes with additional chemotherapy before or after. Immunotherapy is an option in some situations.

The results bear no resemblance to 1948. NCI cites recent trial data showing five-year overall survival of roughly 78 to 88 percent with combined chemoradiation approaches, including in advanced disease.

Those are trial populations, selected and treated under protocol, and they describe groups rather than individuals. Stage, virus status, and general health all move an individual picture. What the figures do show is the distance traveled since a hoarse voice sent Babe Ruth to an x-ray.

Sources

• https://www.cancer.gov/types/head-and-neck/hp/adult/nasopharyngeal-treatment-pdq
• https://www.cancer.gov/types/head-and-neck/patient/adult/nasopharyngeal-treatment-pdq
• https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet
• https://www.pbs.org/newshour/health/august-16-1948-babe-ruth-americas-greatest-baseball-star-pioneer-modern-treatment-cancer-dies
• https://www.mayoclinicproceedings.org/article/S0025-6196(11)60644-7/fulltext