As the most common malignant tumor of the head and neck, nasopharyngeal carcinoma has achieved good efficacy in its comprehensive treatment. Here is a brief summary of the comprehensive treatment of nasopharyngeal carcinoma: 1. For early stage patients (stages I and II), synchronous radiotherapy or concurrent radiotherapy + targeted therapy is the standard treatment plan, in which radiotherapy is recommended to use moderate intensity radiation therapy, synchronous chemotherapy to use cisplatin or nedaplatin, and targeted therapy to use nitrozumab; 2. For intermediate stage patients (stages III and IVa), induction chemotherapy + synchronous radiotherapy ± adjuvant chemotherapy is feasible. The induction chemotherapy is recommended to be TPF (paclitaxel + platinum + 5Fu), generally 2-4 courses, and the synchronous radiotherapy is as mentioned above, and the adjuvant chemotherapy can be TP, generally 2-4 courses, and the total chemotherapy course is controlled to 6 courses; 3, advanced stage patients (stage IVb or relapse), the main program is chemotherapy ± targeted therapy, in which the chemotherapy program is recommended to be TPF (paclitaxel + platinum + 5 Fu) or GP regimen (gemcitabine + platinum), and targeted therapy can be chosen from cetuximab, nitrozumab or Endo, etc.
Preventive care – Prevention of nasopharyngeal carcinoma. The following groups of people can be well prone to nasopharyngeal cancer: those who live in areas with high incidence of nasopharyngeal cancer, such as Guangdong, Guangxi, Fujian, etc., and are over 40 years old; those who are often exposed to some fumes and chemical toxins in life or work, and have the habit of smoking and drinking; those whose family members or relatives have nasopharyngeal cancer patients. If you have the above conditions, please pay attention to the following preventive measures: 1. Avoid eating salted fish, cured meat, pickles and other foods with high nitrite content; 2. Quit smoking and drink less alcohol (no more than 1 tael/week), avoid frequent exposure to occupational fumes, chemical gases, dust, formaldehyde, etc. Wearing masks frequently can effectively prevent nasopharyngeal cancer; 3. Monitor EBV infection and develop good hygiene habits; 4. Susceptibility gene determination.
Early diagnosis of sexual care – early detection and treatment. Be aware of the following symptoms: 1. local symptoms of nasopharyngeal cavity: snotty blood and nasal bleeding, nasal congestion, tinnitus and hearing loss, headache; 2. cranial nerve-related symptoms: blackness, diplopia, drooping eyelids, eye fixation, facial numbness, hoarseness, speech disorders or swallowing difficulties; 3. cervical lymph nodes (with 60-87% chance); 4. age 30 to 50 years old, nasopharyngeal cancer screening can be performed every two years, 50 The screening includes: palpation of cervical lymph nodes, nasopharyngoscopy and EBV testing.
Chemotherapy care – pay attention to chemotherapy-related toxic side effects.
1. Bone marrow suppression: such as low white blood cells and platelets, anemia, etc. A high-protein, high-calorie, high-fiber, low-fat balanced diet is possible. Meat with chicken, fish, eggs, ribs, lean meat, with some soup (high protein-based), the main food is recommended rice based, such as platelet reduction should be supplemented with peanut-coated diet, and eat more fresh vegetables and fruits, avoid fried, pickled, irritating food, remember to quit smoking, less alcohol;
2, liver function damage: pay attention to the hepatitis situation, such as hepatitis, antiviral treatment as soon as possible;,.
3, nausea and vomiting, abdominal pain and diarrhea, constipation: light, fresh and easy to digest diet, drink more water;
4.Cough and fever: observe the change of sputum, keep sputum culture if necessary; keep the mouth clean, gargle and nebulize if necessary;
5, skin pigmentation, limb paralysis: massage the limbs to promote blood circulation, avoid contact with cold objects and excessive heat compresses;
6, allergic reactions: such as allergies need to be fully informed to the doctor, preventive medication treatment;
7, drug-related blood glucose elevation: observation, low sugar food;
8.Drug exudation leads to local damage: use central venous cannula;
9.Hair loss: build self-confidence, hair back to grow back, it is recommended to cut hair as early as possible, get used to combing hair, etc.
Radiotherapy care – pay attention to radiotherapy-related toxic side effects.
1.Protect the skin in the radiation area: (1) prohibit irritating cleansers; (2) avoid exposure to the sun and cold wind as much as possible; (3) prohibit scratching, hot compresses and other physical stimulation, and please seek medical advice promptly if there is a break in the skin to prevent infection. Avoid stimulation by physical and chemical factors and trauma for one year to avoid long-lasting radioactive ulcers.
It is normal to have mild swelling of the face and neck within 6 months after radiation, which may be accompanied by mild hoarseness and laryngeal edema. With the passage of time, this syndrome will disappear in about six months.
2, maintain oral hygiene: (1) rinse your mouth after eating; (2) brush your teeth 2-3 times a day and use fluoride and calcium toothpaste; (3) clean your teeth 1-2 times a year; (4) do not extract teeth within 3 years after radiotherapy, which can lead to non-healing wounds or infection, if you must extract teeth, you should explain the history of radiotherapy to your dentist and use antibiotics as prescribed by your doctor after extraction; (5) if you have oral infection, you need to consult a doctor in time.
3.Prevention of nasal turbinate adhesions: perform nasopharyngeal radiotherapy, wash the nasopharyngeal cavity with light saline daily and use nasal drops, such as naphazoline nasal drops or 1% ephedrine nasal drops, to prevent turbinate adhesions, and return to the hospital for examination and treatment if complete nasal non-ventilation occurs for no more than 3 days.
4, functional exercise: (1) mouth opening training: ① persistent mouth opening, mouth with 3-125px diameter wooden openers, 2-4 times a day, 10-30 minutes each time, if at the beginning that there is a certain degree of difficulty in opening the mouth, it is appropriate to use cone (or wedge) shaped wooden plugs, daily record the dental seal, in order to know the effect of their own exercise; ② short time sexual exercise, the mouth slowly a closed, a total of 200 times / time. More than 3 times a day. (2) Neck exercise: nodding and head turning exercise in sitting position, the movement should be gentle and the amplitude should not be too large. Functional exercise should be persistent in order to maintain its exercise effect.
Work and life after treatment
1, work, exercise, life: if the condition is stable, according to their own situation can be rested for a period of time (at least six months) to carry out normal work, remember to avoid the work before the disease strenuous stay up late. Suitable and appropriate amount of exercise can promote the recovery of the disease and enhance physical fitness, but the intensity of physical exercise should not be too large. Normal sexual life will not have a negative impact on health, and female patients should avoid pregnancy. It is recommended that childbirth can be considered after three years of cure. Maintain optimism, pay attention to rest and labor intensity, in order not to fatigue.
2, health education: develop good health habits, avoid digging nose with hands, blowing nose and coughing hard, pay attention to keep warm, prevent cold, pharyngitis, otitis media, etc., so as not to induce acute cellulitis of the head and neck and rhinorrhea, etc. The air in the living room should be fresh.
3, dietary guidance: after radiotherapy, dry mouth, taste changes, decreased appetite, nausea, vomiting, sore throat, eating difficulties and malnutrition often occur, so you should try to increase your appetite. The general principle is: eat whatever you want; eat several times if you want. Pay attention to the color, aroma and taste, eat less food and drinks that are irritating to the mouth and pharynx, such as dry, hard, sour, numb and spicy food, avoid smoking and alcohol, reduce various factors that cause irritation to the mucous membrane of the oropharynx, treat the dietary contraindications correctly, it is advisable to eat high protein, high calorie, high vitamin, low fat, easily digestible food, such as eggs, dairy, fish, turtles, lean animal meat, vegetables and fruits, etc. Drink more water to prevent blind tonic or taboo.
4, appears dry mouth: to often prepare water, drinking water should be slow, adhere to the meal, keep the mouth clean, drink nourishing and moistening food (sugar cane juice, pear juice, orange juice, etc.).
5.If there is difficulty in opening the mouth, use a wooden plug to assist in opening the mouth and keep the incisor distance above 75px.
6.Visit indications should be promptly when discomfort occurs: bone pain after treatment, headache, nasal congestion, neck lump, tinnitus, deafness, facial numbness, diplopia, electric shock sensation in both lower extremities with low head, rapid memory loss, and obvious vision loss should be promptly contacted with the doctor or department.
Cold weather and strong cold wind can easily lead to nasal bleeding, oral infection, difficulty in opening the mouth, neck ankylosis, soft tissue cellulitis and other reactions. Thus, it is particularly important to know how to “winterize” the following points: (1) regular rest and exercise, avoid staying up late, get up at night and put on warm clothes before getting out of bed; physical exercise should not be too strong (walking, etc., mainly once a day, each time should not exceed 40 minutes); (2) should wear a mask when going out. This can effectively form the nasopharynx, nasal cavity, oral cavity local moist environment, conducive to the prevention of nasopharynx, nasal cavity, oral cavity dry bleeding and other reactions; especially in the deteriorating air quality, wearing a mask can also prevent respiratory diseases; (3) out should wear a scarf to avoid blowing cold wind (such as a motorcycle and other transport prone to cold wind, you need to wear a full helmet), which can protect the skin of the face and neck, to prevent the occurrence of facial cellulitis. Prevent the occurrence of facial and neck cellulitis and avoid the occurrence or aggravation of facial and neck tissue fibrosis; (4) use a relatively professional nasal flush to rinse the nasopharyngeal cavity regularly. This can prevent dryness and bleeding in the nasopharyngeal cavity and remove impure nasopharyngeal and nasal secretions; (5) insist on neck exercise and mouth opening exercise.
Follow-up review: follow the doctor’s instructions and review regularly. In general, review every 3 months for 2 years after the end of treatment, every 6 months for 3-5 years, and once a year after 5 years. If needed, you can visit the doctor at any time. The review includes: nasopharyngeal physical examination or nasopharyngoscopy, enhanced CT or MRI of the head and neck, frontal and lateral chest films, ultrasound of the neck and abdomen, routine blood, EBV antibodies, etc. or as prescribed by the doctor (e.g. PET-CT examination, etc.).
Psychological support: Reduce psychological burden by improving bad mood, regulating diet and rest, promoting more daily activities, improving self-image, family support, etc.; improve sleep through appropriate physical exercise, psychological relaxation, and methods to nourish and calm the mind. You can choose to join some legal rehabilitation organizations.
”Since 2006, the World Health Organization (WHO) and other international authorities have redefined malignant tumor as an incurable disease into a chronic disease that can be treated, controlled and even cured. Academician Sun Yan, a senior medical oncology authority of the Chinese Academy of Medical Sciences, has clearly pointed out that “in fact, for ordinary people, there will be more and more cancers in the future. Cancer may be just like diabetes, just a chronic disease that is no longer common. As long as prevention is strengthened, timely detection, early treatment and standardized recovery, cancer is not that terrible”.