Nasopharyngeal carcinoma is one of the common malignant tumors in China. The disease is most common in five provinces in south central China, but the incidence rate in northern China is also increasing in recent years. About 90% of nasopharyngeal carcinomas are low-differentiated squamous carcinomas, followed by highly differentiated squamous carcinomas and undifferentiated carcinomas, while adenocarcinomas and cystic adenocarcinomas are rare. Because of its pathological characteristics of poorly differentiated carcinoma, the chance of cervical lymph node metastasis is high, and about 80% of patients have cervical lymph node enlargement at the time of consultation.
Diagnosis of nasopharyngeal carcinoma requires the collection of the following materials, including history taking, physical examination, imaging examination, adjuvant examination and pathological diagnosis, etc.
1. history taking: history taking mainly includes first symptoms/main symptoms and signs, duration, development process, diagnosis and treatment, main negative signs, etc.
2. Clinical symptoms: bloody nose, nasal congestion, tinnitus, deafness, hearing loss, headache, facial numbness and diplopia are the most common symptoms of nasopharyngeal cancer.
3. Clinical examination: nasopharyngeal examination is the key point. It is required to master the method of postnasal rhinoscopy or nasopharyngeal fiberoptic examination to clarify the shape of the tumor and the extent of invasion. Routine whole body physical examination is required. They should know the location of the 12 pairs of cranial nerves, their main branches and their course, their innervation range and function, and the clinical symptoms that appear after injury. To master several major syndromes after cranial nerve injury such as orbital apical syndrome, cavernous sinus syndrome, rockfly syndrome, jugular foramen syndrome, etc. 4. Imaging examination: enhanced CT or MRI scan is required for visualization of nasopharyngeal tumor and adjacent structures invasion or skull base bone destruction, cervical lymph node metastasis, etc. All patients are required to have one of the two. For patients treated with intensity-modulated radiation therapy, MRI examination of nasopharyngeal skull base is preferable. The imaging of the normal anatomical structures of the nasopharyngeal skull base, as well as its destruction, is required. Chest radiograph, cervical lymph nodes and abdominal ultrasound are mandatory, and bone scan is also required for advanced patients .
5. Serological examination: positive test of EBV antibody has certain reference value for the diagnosis of nasopharyngeal carcinoma, among which the positive reaction of EA/IGA has its specificity.
6. Pathological examination: taking nasopharyngeal tumor tissue through nasal or oral cavity for pathological examination is the most reliable basis for diagnosis. If it is difficult to obtain pathological specimens of nasopharynx, cervical lymph node biopsy can be considered and cervical lymph node excision biopsy can be avoided as much as possible.
7. Other ancillary tests: blood picture, liver and kidney function, electrolytes, etiology and antibody indicators for hepatitis B, AIDS, syphilis, etc. Pituitary/thyroid function tests.