Overview.
Nasopharyngeal carcinoma is the most common malignant tumor of the head and neck in southern China. Epidemiological survey shows that Guangdong is a high incidence area of nasopharyngeal cancer, so nasopharyngeal cancer is also called “Guangdong tumor”. There are obvious regional differences in the distribution of nasopharyngeal carcinoma in China, with Zhaoqing, Foshan, Guangzhou and Wuzhou in central Guangdong and eastern Guangxi as the centers of high incidence, and gradually decreasing in the surrounding areas. The incidence rate of male is about 2~3 times that of female, and the age of 40~50 is the high incidence age.
Nasopharyngeal cancer accounts for about 30.97% of systemic malignant tumors, 78.08% of head and neck tumors, and 92.99% of upper respiratory tract tumors.
Etiology.
1, genetic factors
2.Viral infection: closely related to EBV.
3.Environmental factors.
4.Dietary factors: salted fish, pickled products, etc.
5, trace elements: high content of nickel elements.
Clinical manifestations.
1.Blood in nasal aspiration: Since nasopharynx is located at the back of nasal cavity and upper part of oropharynx, the location is more hidden and not easy to find, early appearance of blood in nasal aspiration or blood in sputum should be consulted as early as possible.
2.Ear symptoms: Tumor located in nasopharynx can compress Eustachian tube orifice and lead to negative pressure in tympanic chamber, resulting in exudative otitis media and causing tinnitus and hearing loss.
3.Nasal congestion: The tumor can block the posterior nostril and cause nasal congestion.
4.Headache: Tumor invasion or compression of skull base will lead to intractable headache.
5.Cervical lymph node enlargement: The rate of nasopharyngeal cancer metastasis in the neck is high, and the first symptom of cervical lymph node enlargement is 60%.
6.Cerebral nerve symptoms: facial numbness, restricted eye abduction, ptosis, even soft palate paralysis, recoil, hoarseness, tongue extension deviation, etc.
7, dermatomyositis: the skin appears erythematous at the beginning, and may be desquamated after a little while, which will be complicated by muscle weakness, muscle pain and pressure pain or even various motor disorders such as reduced grip strength, walking difficulty, swallowing difficulty, and breathing difficulty.
8.Distant metastasis: late stage nasopharyngeal carcinoma may appear bone, lung and liver metastasis.
Examination.
1.Indirect nasopharyngoscopy: It is a simple and direct method, but some patients cannot tolerate it.
2.Cervical palpation: pay attention to the presence of enlarged lymph nodes.
3.Electronic fiberoptic nasopharyngoscopy or fiberoptic nasopharyngoscopy or nasal endoscopy: it can visually and clearly examine the nasopharynx.
4.Serological examination of EBV: as an auxiliary diagnostic indicator.
5.Imaging examination: CT or MRI examination is beneficial to understand the scope of tumor invasion and the degree of destruction.
Diagnosis.
Medical history, indirect nasopharyngoscopy, fiberoptic nasopharyngoscopy, nasopharyngeal biopsy, EBV serological examination and imaging examination are beneficial for clear diagnosis and clinical staging. Negative nasopharyngeal biopsy or normal appearance of nasopharyngeal mucosa cannot exclude nasopharyngeal cancer. Patients should be closely followed up and this biopsy should be done when necessary.
Treatment.
Most of nasopharyngeal carcinoma is low-differentiated squamous carcinoma (98%), and radiation therapy is preferred, i.e. using radiation to kill the tumor.
Early stage nasopharyngeal carcinoma: radiation therapy alone can cure it. The treatment course takes about 7 weeks. Radiation therapy can also damage normal tissues and cause some complications while killing the tumor, but with the improvement of radiation technology, the complications have been significantly reduced.
Middle and late stage nasopharyngeal cancer: The recurrence rate of radiotherapy alone is high, therefore, adjuvant chemotherapy is very necessary, which can be given before or after radiotherapy, or at the same time. Chemotherapy, i.e. drug therapy, has toxic effects on normal organism while killing tumor, but it is still an indispensable adjuvant in comprehensive tumor treatment.
Surgery for nasopharyngeal carcinoma: Surgery is not the first choice for nasopharyngeal carcinoma, but it is a remedy for uncontrolled or recurrence after radiotherapy.
The surgical solutions for nasopharyngeal cancer recurrence after radiotherapy are
1.Rescuing surgery after the first radiotherapy failure is the last time. The lesions of recurrence after the second course of radiotherapy or multiple courses of radiotherapy are more extensive, with heavy local and neck soft tissue trauma, often accompanied by bone necrosis, making surgery difficult.
2.Nasopharyngeal carcinoma should be operated according to different parts and scope of lesions, so as to eradicate the tumor as much as possible with the smallest operation.
3.If the lymph nodes in the neck do not subside within 3 months after radiotherapy, surgery should be performed.
4.After the relief surgery, depending on the specific situation, decide whether to have radiotherapy again.
Surgical treatment of post-radiotherapy complications of nasopharyngeal carcinoma: nasal adhesions, posterior nostril atresia, secretory otitis media, radiation sinusitis, radiation osteonecrosis, radiation skin ulcers, radiation secondary carcinoma and other complications after radiotherapy of nasopharyngeal carcinoma can be treated surgically and the quality of life improved.
Prognosis.
The 5-year survival rate of stage I nasopharyngeal carcinoma can reach 90%, and for patients with advanced stage, the prognosis is poor.