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REFERAT

“NASOPHARYNGEAL CARCINOMA”
S H E A N Y L E S TAT I L A
(406152017)

ANATOMY

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frequently seen in the pharyngeal recess (Rosenmuller’s fossa). posteromedial to the medial crura of the Eustachian tube opening in the nasopharynx. • Incidence: High among Chinese people who have emigrated to Southeast Asia or North America. but is lower among Chinese people born in North America than in those born in Southern China. .  Genetic & Enviromental factors. • Varying degrees. INTRODUCTION • Nasopharyngeal carcinoma (NPC) is a nonlymphomatous squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx.

with an incidence of between 50 per 100. and the Middle East/North Africa.000 in the Guangdong Province of Southern China. . including Southern China. EPIDEMIOLOGY • Endemic in many geographical regions. Southeast Asia. Japan. • NPC is the third most common malignancy among men.

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ETIOLOGY • NPC presents as a complex disease caused by an interaction between: chronic infection EBV. • It is transmitted by saliva. . environmental and genetic factors involving a multistep carcinogenic process. followed by a latent infection of B lymphocytes. primary infection occurs during childhood with replication of the virus in the oropharyngeal lining cells.

Studies: -Weekly or no/rare consumption generally ranged 1. .4 to 3.8 to 7. allowing fish and other foods to become partially putrefied. accumulates nitrosamines  carcinogens.000 -Daily consumption 1.5 per 100.2 per 100. Nonviral exposure: consumption of salt-preserved fish. Result.000  The process of salt preservation is inefficient.

PATHOLOGY WHO classification: • Squamous cell carcinoma (keratinizing squamous cell carcinoma. type 1 of the former classification) • Nonkeratinizing carcinoma (types 2 and 3 of the former classification) -subdivided into differentiated and undifferentiated carcinomas .

T2 N0-N1 M0 Stadium III : T1 – T3 M2 N0 Stadium IV : T4 N0 – N2 M0 // T1 – T4 N2. STAGING TNM staging system Stadium I : T1 N0 M0 Stadium II : T1 .N3 M0 // T1 – T4 N0 – N3 M1 .

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prophylactic neck radiation is recommended even in N0 cases. .Patients treated with radiation alone had a significantly lower 3-year survival rate. . TREATMENT • Radiotherapy is the mainstay of treatment for NPC.They reported a definite improvement of the 5-year survival rate due to the addition of chemotherapy (56% with radiotherapy alone versus 62% with chemoradiotherapy) • High incidence of occult cervical node metastasis. • Recent studies have suggested that addition of chemotherapy to radiotherapy improves the treatment results. Studies  .

diplopia. nasal obstruction. facial pain. and numbness) (4)Neck masses (70%) . and discharge) (2)Symptoms associated with dysfunction of the Eustachian tube (hearing loss) (3)Symptoms associated with the superior extension of tumor (headache. EARLY DETECTION  Symptomps: (1)Symptoms caused by the presence of a tumor mass in the nasopharynx (epistaxis.

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Endoscopic biopsy: definitive diagnosis.  MRI  Superior to PET for the assesment of locoregional invasion and retropharyngeal nodal metastasis. skull erosion.  CT – scan : determine tumor extent. .  Endoscopy plays a key role in detecting the early NPC lesions. Serologic screening Immunofluorescent assays  Individuals with acquired immunodeficiency syndrome (AIDS)  increased risk of NPC: The most common presenting complaint is a painless upper neck mass or masses. cervical lymphadenopathy.

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• EBV-related serologic tests are used as screening tools in high-risk populations. • MRI seems suitable for the detection of early lesions. and the routine use of PET for the initial diagnosis of NPC does not seem to be justified. CONCLUSIONS • NPC detection in the early stage is often difficult because the symptoms are not specific. • PET is useful in distinguishing recurrent NPC regions if MRI findings are not definitive. .