Table of Contents
*Nasopharyngeal cancer mini-files
*Nasopharynx – the cave deep in the nose
*Why do you get nasopharyngeal cancer?
*What are the symptoms of nasopharyngeal cancer?
*How to determine if you have nasopharyngeal cancer
*Types and stages of nasopharyngeal cancer
*Nasopharyngeal cancer mini-files
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The incidence rate is high in China and Southeast Asian countries. The incidence in China is high in the south and low in the north, with high incidence in southern and southwestern provinces, such as Guangdong, Hainan, Hong Kong and Macao, Jiangxi, Fujian, Taiwan, Sichuan, Yunnan and Guizhou, among which the highest incidence is in the Pearl River Delta and the West River Basin.
The preferred age of nasopharyngeal cancer is 40 to 50 years old.
Nasopharyngeal cancer occurs at the place where the nose and the pharynx meet, that is, the back of the nose and the top of the pharynx, which is a hidden area and therefore not easy to be detected.
The symptoms of uNasopharyngeal cancer are easily mistaken for a cold and ignored; unexplained swollen lymph nodes in the neck, nosebleeds, blood in sputum, blood in snot, tinnitus, ear congestion, heavy hearing, nasal congestion or headache are important warning signs.
*Nasopharynx – the deep cavern of the nose
The human nasopharynx is located directly behind the nasal cavity, above the pharynx and directly below the brain. The nasopharynx is a deep cavity surrounded by the base of the skull, the cervical vertebrae, the back of the soft palate and the back of the nasal cavity, with an upper and lower diameter, a left and right diameter of about 3-4 cm each, and an anterior and posterior diameter of about 2-3 cm. Therefore, it is not easy to detect problems in the nasopharynx.
*Why do you get nasopharyngeal cancer?
Although the true causative factors of nasopharyngeal cancer, like most cancers, remain unclear, the medical community believes that several factors may be closely associated with the disease.
? Ethnicity: This is a very important factor because the Chinese have the highest incidence of nasopharyngeal cancer. In addition, if someone in the family has nasopharyngeal cancer, the chances of a close relative getting it are higher than those without such a family history.
What are the causes of nasopharyngeal cancer? Environment and diet: Poor home or work environment, often inhaling irritating gases such as formaldehyde, smoke, dust, wood chips, etc. In addition, smoking, drinking alcohol, or consuming Z products such as salted fish and pickled vegetables since childhood may also be associated with the development of nasopharyngeal cancer.
EBV (Epstein-Barr virus): There is a small segment of EBV gene in nasopharyngeal cancer cells, and the antibody value of EBV in the serum of nasopharyngeal cancer patients is also higher than that of the general population, so it is believed that EBV infection may be closely related to the development of nasopharyngeal cancer.
*What are the symptoms of nasopharyngeal carcinoma?
Due to its location, the symptoms of nasopharyngeal cancer are not specific, so it is not easy to diagnose it early. The only way is to be vigilant and seek examination by a reliable ENT doctor when the following symptoms are present
? Unexplained lump in the neck: This is usually the most common and earliest symptom. This is because the lymph node enlargement caused by lymphatic metastasis occurs early in nasopharyngeal carcinoma, which is usually painless and grows slowly.
What are the symptoms? Blood in the nose, blood in the sputum or repeated nosebleeds: This is because the surface of the tumor is necrotic and causes the blood vessels to break down, resulting in bleeding (usually dark red or with blood clots), which becomes nosebleeds or blood in the nose if it flows directly from the nostrils, and blood in the sputum when it flows backwards into the throat, especially in the morning when you rinse your mouth.
? Stuffy ears, tinnitus, feeling of water flowing in the ear or hearing loss in one ear: If the tumor invades the muscle controlling the opening and closing of the eustachian tube, it will easily cause the symptoms caused by pressure imbalance inside and outside the middle ear cavity and fluid accumulation in the middle ear.
? Unilateral headache: This is because the tumor invades the skull base and presses on the meninges or the tissues in the cranial cavity, resulting in unilateral headache.
? Eye symptoms: such as diplopia (seeing one thing with two shadows), eye movement disorder or facial nerve palsy, which are caused by the tumor invading into the skull and causing cerebral nerve palsy.
? Nasal symptoms: such as nasal congestion and pus nasal discharge. When the tumor invades into the nasal cavity and blocks the opening of the sinus, it causes sinusitis and leads to pus nasal discharge or nasal congestion.
*How to determine the presence of nasopharyngeal cancer?
Primary diagnosis
Tumor biopsy is the only qualitative means to confirm the diagnosis of nasopharyngeal carcinoma and cannot be replaced by other clinical examinations.
The diagnosis of nasopharyngeal cancer mainly relies on the otolaryngologist to perform nasopharyngeal biopsy, which is called nasopharyngeal endoscopic histopathological examination.
Auxiliary diagnosis
CT or magnetic resonance examination: It is used to determine the size, location and local invasion of the tumor.
CT or MRI: used to determine the size, location and local invasion of tumor. Skeletal isotope scan, liver ultrasonography, chest X-ray: used to determine whether distal metastasis has occurred, because bones, liver, lung and brain are the sites where nasopharyngeal cancer is likely to metastasize.
Serological examination of EBV: It can be used as a reference for diagnosis and treatment.
PET-CT scan: Integrating CT and PET, CT provides precise anatomical positioning of lesions, while PET provides detailed molecular information on function and metabolism of lesions, which is sensitive, accurate, specific and precise in positioning. It can help to detect tumor lesions at an early stage and determine the treatment plan of tumor more accurately.
*Types and stages of nasopharyngeal carcinoma
Cytopathological classification
The World Health Organization (WHO) has classified the pathological tissue of nasopharyngeal carcinoma as WHO types I, II and III (WHO type I, II and III). Despite this, some controversies still exist.
WHO type I, squamous cell carcinoma (keratinized).
WHO type II, Squamous Cell Carcinoma (non-keratinizing).
WHO type III, Squamous Cell Carcinoma, undifferentiated.
WHO type III is most closely related to EBV, followed by type II, while type I is not related to EBV. Most of the cases in China are presented as WHO type III.
Clinical Staging
The cancer stage (TNM) of nasopharyngeal cancer can be divided into four stages. It includes the extent of tumor invasion of tissues near the nasopharynx (T), whether the lymph nodes in the neck are invaded (N), and whether there are distant metastases (M).
According to the TNM classification recommended by the American Cancer Society (AJCC) 7th edition in 2010, nasopharyngeal cancer is classified into stages I-IV based on the extent of primary tumor, metastatic lymph nodes in the neck and the presence of systemic metastasis.
T-stage: Primary tumor
Tx Primary tumor cannot be estimated
T0 No evidence of primary tumor
Tis carcinoma in situ
T1 Tumor limited to nasopharynx, or tumor extending to oropharynx and/or nasal cavity but no parapharyngeal invasion
T2 Tumor invasion of the parapharynx
T3 Tumor invading bony structures at the base of the skull and/or sinuses
T4 Tumor invasion of intracranial and/or cranial nerves, hypopharynx, orbit or masticatory muscle space
N stage: regional lymph nodes
Nx No assessment of regional lymph node metastasis
N0 No regional lymph node metastasis
N1 Unilateral cervical lymph node metastasis with a maximum diameter ≤ 6 cm above the supraclavicular fossa
Unilateral and/or bilateral retropharyngeal lymph node metastasis with a maximum diameter ≤ 6 cm above the supraclavicular fossa*
N2 Bilateral cervical lymph node metastases ≤6 cm in diameter, above the supraclavicular fossa*
N3 One or more cervical lymph node metastases >6 cm in maximum diameter* and/or lymph node metastases in the supraclavicular fossa
N3a Lymph node metastasis with a maximum diameter >6cm
N3b Lymph node metastasis in the supraclavicular fossa
M stage: systemic metastasis
Mx Cannot assess for distant metastases
M0 No distant metastasis
M1 with distant metastases
Clinical staging
Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage II T1 N1 M0
T2 N0 M0
T2 N1 M0
Phase III T1 N2 M0
T2 N2 M0
T3 N0 M0
T3 N2 M0
T3 N3 M0
Phase IVA T4 N0 M0
T4 N1 M0
T4 N2 M0
Phase IVB Any T N3 M0
Stage IVC Any T Any N M1