Overview.
1.One of the highly prevalent tumors in China, especially in Guangdong, Guangxi, Hunan, Fujian and other provinces (autonomous regions) with high incidence;
2, Guangdong Sihui City, for example, ranks first in the world;
3. The incidence rate of men is about 2-3 times that of women;
4, 40-50 years old is the high incidence age group.
Etiology: (currently believed to have three)
1, genetic factors.
Racial susceptibility, family aggregation, certain genetic factors of human leukocyte antigen (HLA).
2, EBV
3, Environmental factors.
Nickel can promote nitrosamines to induce nasopharyngeal carcinoma.
Pathology.
98% of low-differentiated squamous carcinoma, highly differentiated squamous carcinoma, adenocarcinoma, vesicular nucleated cells, etc. are rare.
Clinical manifestations.
1. Nasal symptoms: retracted snot with blood in it; nasal congestion-unilateral → bilateral.
2.Ear symptoms: tinnitus, stuffy ears, hearing loss.
3.Cervical lymph node enlargement: the first symptom is 60%, starting unilaterally → bilaterally.
4.Brain nerve symptoms: Involvement of V and VI brain nerves → headache, restricted abduction; involvement of IV, III and II → diplopia, blurred vision, eye fixation or blindness; direct invasion of tumor or metastatic lymph node compression may result in damage to IX, X and VIII brain nerves, soft palate paralysis, recoil, hoarseness, tongue extension and obliquity.
5.Distant metastasis: lung, liver and bone metastasis may appear in advanced stage.
Examination.
1, posterior nostril examination.
The anterior wall of nasopharyngeal apex and pharyngeal crypt is the preferred site of nasopharyngeal cancer. Visible to the naked eye: rough and uneven mucosa, small nodules, granuloma-like masses, and typically cauliflower-like.
Attention.
Submucosal type – easy to miss the diagnosis, CT scan is needed for suspected tumor. Visually: one side of the pharyngeal crypt is fuller.
2. Neck palpation.
Hard, fixed, painless mass (enlarged lymph nodes) in the deep upper neck.
3.Electronic fiberoptic nasopharyngoscopy, nasal endoscopy
4.EB virus serological examination.
EB virus capsid antigen-immunoglobulin A (EB, VCA-IgA)
EB virus nuclear antigen-immunoglobulin A (EB, NA- IgA)
EBV-Specific DNase (EBV-Specific DNase) antibody
Imaging tests.
CT and MRI : Extent of tumor invasion, degree of bone destruction at the skull base.
Diagnosis.
1.History: ear and nose symptoms
2.Examination: nasopharyngoscopy, EBV serology, imaging
3.Confirmation of diagnosis: biopsy
Differential diagnosis.
1.Cervical lymphatic tuberculosis
2, Hodgkin’s disease (Hodgkin’s disease)
Treatment.
Hypofractionated squamous carcinoma – radiation therapy mainly Cobalt 60, local residual foci or recurrence even after three months of TCM immunoradiotherapy, light radiation or surgery can be used.
Prognosis.
The 5-year survival rate after radiotherapy is about 45%, and local recurrence and metastasis are the main causes of death.