NASOPHARYNGEAL CARCINOMA

BY DR. SARAIZA ABU BAKAR

Pharynx
Panel Members

Chair:

Ng Kok Han (IMR)

Members: Saraiza Abu Bakar (ORL, HKL)

INTRODUCTION
HEAD AND NECK TUMOUR TENDENCY TO SPREAD TO REGIONAL

NECK NODES AND DISTAL ORGANS REMARKABLE RACIAL AND GEOGRAPHICAL DISTRIBUTION. HIGH CHANCE OF CURE IF DETECTED EARLY

Aetiology-Multifactorial
Genetic EBV Environmental

Salted marine fish Cigarette smoking Formaldehyde Herbal medicines Preserved food Salted duck egg Chinese tuber

Strong association Strong association Loose evidence

Armstrong 1998 Chen 1990 Blair 1990 Hirayama & Ito 1981 Ning 1990 Yu 1988 Lee 1994

GENETIC
UNIQUE GEOGRAPHICAL DISTRIBUTIONS

(PRASAD 1996) FAMILIAL CLUSTERING IN LOW-RISK POPULATION (LEVINE 1992) JOINT OCCURRENCE OF HLA-A2& HLA-Bsin2 IN CHINESE (SIMONS 1976) INCREASED RISK HLA AW19,BW46 AND B17 HIGHER RISK WHEREAS HLA A11 LOWER RISK (LIEBOWITZ 1994) IN MALAYS, HLA B17 AND B18 HIGHER RISK (CHAN 1985)

EPSTEIN-BARR VIRUS
Animal evidence: EBV induces tumour in animals. Vaccination protects animal against tumour Laboratory evidence: EBV capable of infecting nasopharyngeal cells. Detected in epithelial tumours tissue of NPC Genes expressed in NPC tissue Epidemiologic evidence Higher anti-EBV Ab titre than normal control EBV-Ab titres increased years before detection of NPC

Presentations
Neck mass

Unilateral Bilateral

43%

36% 7%

Nasal

Blood-stained discharged Unilateral obstruction Bilateral obstruction

31%

18% 5% 5%

Aural

Unilteral deafness Bilateral deafness Tinnitus

17%

12% 1% 3%

Miscellaneous

Headache Throat pain diplopia

9%

5% 1% 1%

Skimmer 1991(Hong Kong)

Complications
Direct:

Anterior Superior Lateral

Hearing impairment Diplopia,numbness and ophtalmolegia Dysphagia,hoarseness

Posterior

Paralysis last 4 cranial nerves

Node of rouviere Upper JG Lower JG Bone: ribs and spine Liver lungs

Lymphatic

Hematogenous

Nasopharyngeal carcinoma
World Health Organization Classification 1983
Keratinizing carcinoma
Non-keratinizing,
transitional cell carcinoma

WHO Type I
(25%) WHO Type II (12%) WHO Type III (63%)

Undifferentiated
Carcinoma
Undifferentiated carcinoma
lymphoepithelioma Anaplastic Carcinoma

Prognosis
Early
5 years survival rate: about
85%.

Late

5 years survival rate: 50%

(Chinese Hong Kong University archives 2001)

Table 2.4.1: Nasopharynx Cancer Incidence per 100,000

population (CR) and Age-standardized incidence (ASR), by sex, Peninsular Malaysia 2002

Sex Male

No. 940

% 70.0

CR 9.5

ASR 11.4

Female
Both

403
1343

30.0
100.0

4.2
6.9

5.0
8.2

Table 2.4.2: Nasopharynx Age specific Cancer Incidence per 100,000 population (CR) by sex, Peninsular Malaysia 2002
Male Female

Age, year
0-9 10-19 20-29 30-39 40-49 50-59 60-69

No.
2 8 33 148 298 251 154

%
0.2 0.9 3.5 15.7 31.7 26.7 16.4

CR
0.1 0.4 2.0 10.1 25.3 34.4 39.4

No.
1 15 10 74 107 102 71

%
0.2 3.7 2.5 18.4 26.6 25.3 17.6

CR
0.0 0.8 0.6 5.2 9.4 14.9 17.4

70+

46

4.9

21.0

23

5.7

8.5

Nasopharynx Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2002

Male

Female

Age specific Cancer Incidence per 100000 population

39.4

0.0 0-9 10-19 20-29 30-39 40-49 Age group 50-59 60-69 70+

Table 2.4.3: Nasopharynx Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity and sex, Peninsular Malaysia 2002

Male
Ethnic group Malay No. 241 % 26.6 CR 4.2 ASR 5.6 No. 105 % 27.0

Female
CR 1.8 ASR 2.3

Chinese

641

70.8

24.7

23.0

272

69.9

10.9

10.3

Indian

23

2.5

2.6

4.0

12

3.1

1.4

1.7

Table 2.4.4: Nasopharynx Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2002
Age groups, year 0-9 Male Malay Chinese Indian 0.0 0.4 0.0 1019 0.5 0.4 0.0 2029 1.9 2.9 0.7 3039 3.9 27.8 0.7 4049 13.2 54.6 4.3 5059 16.1 69.7 7.7 6069 17.3 68.0 26.4 70+ 12.0 36.7 18.8 Cum R 0.6 2.4 0.5

Female

Malay
Chinese Indian

0.0
0.2 0.0

0.9
0.0 1.2

0.3
1.8 0.0

2.7
12.5 0.7

4.4
21.2 2.6

6.4
31.0 3.1

7.1
32.9 11.2

3.5
17.7 0.0

0.2
1.1 0.2

Nasopharynx International comparisons [6] - Age standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2002
Male
Australia, NSW China, Hong Kong China, Shanghai Columbia, Cali Denmark India, Madras Singapore, Chinese Singapore, Indian Singapore, Malay UK, Birmingham US, LA, Black US, LA, Chinese US, LA, Non-Hispanic W hite Malaysia, Malay Malaysia, Chinese Malaysia, Indian 0
0.9 24.3 4.5 0.3 0.3 0.9 18.5 0.5 6.5 0.4 1.0 9.8 0.5 5.6 23.0 4.0

10 15 20 Age standardized Incidence

25

Female
Australia, NSW China, Hong Kong China, Shanghai Columbia, Cali Denmark India, Madras Singapore, Chinese Singapore, Indian Singapore, Malay UK, Birmingham US, LA, Black US, LA, Chinese US, LA, Non-Hispanic W hite Malaysia, Malay Malaysia, Chinese Malaysia, Indian 0
0.3 9.5 1.8 0.2 0.2 0.3 7.3 0.5 2.0 0.2 0.2 2.8 0.2 2.3 10.3 1.7

10 15 20 Age standardized Incidence

25

Comparing the Malaysian and Singaporean

age standardized incidence per 100,000 population

Male
Chinese 23.3 Malaysian 18.5 Singapore Malay 5.7 Malaysian 6.5 Singapore Indian 4 Malaysian 5 Singapore

Female Chinese 10.3 Malaysian 7.3 Singapore

Malay 2.4 Malaysian 2 Singapore Indian 1.5 Malaysian 5 Singapore

Conclusion
NPC is a common cancer among Chinese in Malaysia. The incidence of male is much higher in the male than in
female population. Malaysian Chinese female ranks higher than Hong Kong Chinese female hence considered highest in the world

Future research
Environmental
:
Lab work to systematically search
for the carcinogen in NPCassociated food.

Genetic Virus

: :

genetic studies of HLA and other

Analytical studies :

systems in Chinese as well as other population. studies being done to develop adoptive immunotherapy for NPC(Hong Kong University in collaboration with xiamen
U China)

to better quantify the exposure-

disease- relationship to understand the susceptibility high risk group

Thank you