NASOPHARANGEAL CARCINOMA

ANATOMY

 Cancer arising from  Boundaries-

epithelial cells of  Nasopharynx is a large
nasopharynx square like space 4x4x2cm
 Anterior-choanae & nasal
cavity
 Lateral-Eustachian tube &
fossa of
Rosenmullar/Pharyngeal
recess
 Posterior-pharyngeal wall
 Roof-body of
sphenoid/adenoids
 Floor-soft palate
Epidemiology and geographic distribution

 depends on several factors such as genetic susceptibility,

environment, diets and personal habits
 In Kenya hospital based studies (KNH) show majority of patients
come from central and eastern provinces
 Males>females RATIO-2.2:1
 Overally has bimodal age distribution-Kenya first peak between 10-
20 years, second peak between 40 – 60 years.
 most common in China particularly in southern states and Taiwan
 Its incidence in North American whites is 0.25% of all cancers, while
it is 18% in American Chinese-attributed to:-
 uncommon in India and constitutes only 0.41%
AETIOLOGY

Genetic factors
 Chinese have a higher genetic susceptibility to
nasopharyngeal cancer. Moderate incidence in
Kenyans,tunisians,alaskans,other Asians
 Genomic studies have revealed 3HLA LOCUS ;
 B46
 A2
 B17
viral factors

 Epstein–Barr virus-associated With Nx ca It has two important

antigens: viral capsid antigen(VCA) and early antigen (EA). IgA
antibodies of EA are highly specific for nasopharyngeal cancer but
have sensitivity of only 70–80% while IgA antibodies of VCA are
more sensitive but less specific. Ag A antibodies against both EA
and VCA should be done for screening of patients for
nasopharyngeal cancer.

 Environmental factors. Air pollution, smoking of tobacco and

opium, nitrosamines from dry salted fish, smoke from burning of
incense and wood
Spread of Nx ca
Clinical features

 It is mostly seen in 4th and 5th decades of life.Incidence starts

rising from 2nd decade of life.
 M:F-3:1

Local features:
 These tumors may present in three forms:
1. Proliferative: Polypoid tumor fills the nasopharynx and causes nasal
obstruction.
2. Ulcerative: Epistaxis is common.
3. Infiltrative: Growth infiltrates submucosally.
1. Nasal-Nasal obstruction, nasal discharge, denasal
speech(rhinolalia clausa) and epistaxis.

2. Otologic. Due to obstruction of Eustachian tube, there is

conductive hearing loss, serous or suppurative otitis
media. Tinnitus and dizziness may occur.
Clinical features cont..

 3. Ophthalmoneurologic.
 Occurs due to local extension of the tumor superiorly
through the sphenoid bone
 Nearly all the cranial nerves may be involved.
I. Squint and diplopia-CN VI
II. Ophthalmoplegia-CN III, IV and VI
III. facial pain and reduced corneal reflex- CN V through
(foramen lacerum)
IV. Horner syndrome- cervical sympathetic chain
Totters triad-

1. Conductive deafness-Eustachian tube

blockage
2. Ipsilateral temporoparietal neuralgia-CN V
3. palatal paralysis- (CN X)
 4 Cervical nodal metastases.
 This may be the only manifestation of nasopharyngeal cancer.
 seen in 75% of the patients, when first seen, about half of them
with bilateral nodes.
 5 Distant metastases
 involve bone(most common site) followed by lung& liver
 may be present at the time of diagnosis-3-6% of the cases.
Diagnostic evaluation

 History and physical examination

 Palpation of the neck nodes
 Assessment of cranial nerves
 Fiber optic endoscopy examination
 Nasopharyngoscopy and specimen for biopsy
 Otologic assessment
 Inspection of the tympanic membranes
 Baseline audiologic tests
Lab studies
 Baseline tests
 CBC
 LFTS
 EBV-specific serologic test-IgA,antiviral capsule antigen
titres,Serum EBV DNA levels
Imaging studies
 (a)CT scan/MRI of nasopharynx
and neck. High-
resolution,contrast-enhanced CT
of neck and nasopharynx is the
study of choice.
 (b) X-ray/CT chest for mets to the lung.
 (c) CT abdomen or ultrasound abdomen for
secondaries to the liver.
 (d) Positron emission tomography scan. It
is getting popular to show metastases
anywhere in the body.
 3. Biopsy.
 It can be done under local or general anaesthesia
 using endoscopes.
 It is essential to show the exact histology of the
malignancy.
Staging-TNM
Treatment

 Radiotherapy-
 It is the treatment of choice for
nasopharyngeal cancer. Stage I and II are
treated by radiotherapy alone while stage
III and IV require concomitant radiation
and chemotherapy or radiation followed
by chemotherapy.
 Chemotherapy.
 Some stage III and IV cancers of nasopharynx can be
cured by radiotherapy alone but cure rate is doubled
when chemotherapy is combined with radiotherapy.
Chemotherapy can be given concomitantly or post-
radiotherapy.
 Useful in control of the local tumor and treatment of
distant mets.
Treatment of recurrent and
residual (persistent) disease.
 can occur in neck nodes or in the
nasopharynx.
 Positive neck nodes-They require radical
neck dissection with removal of
sternocleidomastoid muscle,CN XI and
internal jugular vein.
 Recurrent or residual (persistent) disease in the
nasopharynx
 First it should be evaluated by CT and MRI to see the size,
location and regional extent or infiltration.
 It can be treated by;
a) Second course of external radiation.
b) Brachytherapy. It can deliver high dose to the tumor with
less radiation to the surrounding structures.
c) Nasopharyngectomy.
Thank you