Nasopharyngeal carcinoma diagnostic study of choice: Difference between revisions

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== Overview ==
== Overview ==
The staging of [[nasopharyngeal carcinoma]] is based on the [[TNM staging system]].


== Diagnostic Study of Choice ==
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
OR
The following result of [gold standard test] is confirmatory of [disease name]:
* [Result 1]
* [Result 2]
OR
[Name of the investigation] must be performed when:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
OR
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
OR
The diagnostic study of choice for [disease name] is [name of the investigation].
OR
There is no single diagnostic study of choice for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
OR
[Disease name] is primarily diagnosed based on the clinical presentation.
OR
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
=== Name of Diagnostic Criteria ===
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
OR
'''IF there are clear, established diagnostic criteria'''
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
'''IF there are no established diagnostic criteria'''
There are no established criteria for the diagnosis of [disease name].
==Staging==
==Staging==
'''American Joint Committee on Cancer (AJCC) Staging'''
'''American Joint Committee on Cancer (AJCC) Staging'''


The table below summarizes the TNM staging system for the diagnosis of nasopharyngeal carcinoma:
The table below summarizes the [[TNM]] [[Cancer staging|staging]] system for the [[diagnosis]] of nasopharyngeal carcinoma:<ref>{{cite book | last = Amin | first = Mahul | title = AJCC cancer staging manual | publisher = Springer | location = Switzerland | year = 2017 | isbn = 978-3319406176 }}</ref>


{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T0
| style="padding: 5px 5px; background: #DCDCDC;" |T0
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of primary tumor, but EBV-positive cervical node(s) involvement
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of primary [[tumor]], but [[Epstein Barr virus|EBV]]-positive [[cervical]] node(s) involvement
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Tis
| style="padding: 5px 5px; background: #DCDCDC;" |Tis
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T1
| style="padding: 5px 5px; background: #DCDCDC;" |T1
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor confined to nasopharynx, or extension to oropharynx and/or nasal cavity without parapharthe yngeal involvement
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor confined to [[nasopharynx]], or extension to [[oropharynx]] and/or [[nasal cavity]] without paraphartheyngeal involvement
|
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T2
| style="padding: 5px 5px; background: #DCDCDC;" |T2
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor with extension to parapharyngeal space and/or infiltration of the medial pterygoid, lateral pterygoid, and/or prevertebral muscles
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] with [[extension]] to parapharyngeal space and/or [[Infiltration (medical)|infiltration]] of the [[medial pterygoid]], [[Lateral pterygoid muscle|lateral pterygoid]], and/or [[prevertebral muscles]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T3
| style="padding: 5px 5px; background: #DCDCDC;" |T3
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor invades bony structures of skull base cervical vertebra, pterygoid structures, and/or paranasal sinuses
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] invades bony structures of [[skull]] base [[Cervical vertebrae|cervical vertebra]], [[pterygoid]] structures, and/or [[Paranasal sinus|paranasal sinuses]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |T4
| style="padding: 5px 5px; background: #DCDCDC;" |T4
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor with intracranial extension and/or involvement of cranial nerves, hypopharynx, orbit, parotid gland and/or infiltration beyond the lateral surface of the lateral pterygoid muscle
| style="padding: 5px 5px; background: #F5F5F5;" |[[Tumor]] with intracranial extension and/or involvement of [[cranial nerves]], [[hypopharynx]], [[Orbit (anatomy)|orbit]], [[parotid gland]] and/or [[Infiltration (medical)|infiltration]] beyond the [[lateral]] surface of the [[lateral pterygoid muscle]]
|-
|-
| colspan="3" style="padding: 0 5px; background: #4479BA" |{{fontcolor|#FFF| Regional Lymph Nodes}}
| colspan="3" style="padding: 0 5px; background: #4479BA" |{{fontcolor|#FFF| Regional Lymph Nodes}}
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N0
| style="padding: 5px 5px; background: #DCDCDC;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph nodes involved
| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph nodes]] involved
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N1
| style="padding: 5px 5px; background: #DCDCDC;" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |Unilateral metastasis, in cervical lymph node(s), and/or unilateral, or bilateral metastasis in retropharyngeal lymph nodes, 6 cm or less, above the caudal border of Cricoid cartilage
| style="padding: 5px 5px; background: #F5F5F5;" |Unilateral [[metastasis]], in [[Cervical lymph nodes|cervical lymph node]](s), and/or unilateral, or [[bilateral]] [[metastasis]] in [[retropharyngeal]] [[Lymph node|lymph nodes]], 6 cm or less, above the caudal border of [[Cricoid cartilage]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N2
| style="padding: 5px 5px; background: #DCDCDC;" |N2
| style="padding: 5px 5px; background: #F5F5F5;" |Bilateral metastasis in cervical lymph node(s), 6 cm or less above the caudal border of Cricoid cartilage
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bilateral]] [[metastasis]] in [[Cervical lymph nodes|cervical lymph node]](s), 6 cm or less above the caudal border of [[Cricoid cartilage]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |N3
| style="padding: 5px 5px; background: #DCDCDC;" |N3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis in cervical lymph node(s) greater than 6 cm in dimension and/or extension below the caudal border of Cricoid cartilage
| style="padding: 5px 5px; background: #F5F5F5;" |[[Metastasis]] in [[Cervical lymph nodes|cervical lymph node]](s) greater than 6 cm in dimension and/or [[extension]] below the caudal border of [[Cricoid cartilage]]
|- |-
|- |-
| colspan="3" style="padding: 0 5px; background: #4479BA" |{{fontcolor|#FFF| Distant Metastasis}}
| colspan="3" style="padding: 0 5px; background: #4479BA" |{{fontcolor|#FFF| Distant Metastasis}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |M0
| style="padding: 5px 5px; background: #DCDCDC;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant metastasis
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |M1
| style="padding: 5px 5px; background: #DCDCDC;" |M1
| style="padding: 5px 5px; background: #F5F5F5;" |Distant metastasis is present
| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis]] is present
|}
|}


{|
{|
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Stage grouping
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Stage
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Stage
Line 191: Line 72:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |M
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |M
|-
|-
! style="background: #DCDCDC; color: #FFFFFF; text-align: center;" |0
! style="background: #DCDCDC; color: ; text-align: center;" |0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Tis
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Tis
| style="background: #F5F5F5; padding: 5px; text-align: center;" |N0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |N0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
|-
|-
! style="background: #DCDCDC; color: #FFFFFF; text-align: center;" |I
! style="background: #DCDCDC; color: ; text-align: center;" |I
| style="background: #F5F5F5; padding: 5px; text-align: center;" |T1
| style="background: #F5F5F5; padding: 5px; text-align: center;" |T1
| style="background: #F5F5F5; padding: 5px; text-align: center;" |N0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |N0
|style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
|-
|-
! style="background: #DCDCDC; color: #FFFFFF; text-align: center;" |II
! style="background: #DCDCDC; color: ; text-align: center;" |II
!style="background: #F5F5F5; padding: 5px; text-align: center;" |T1
| style="background: #F5F5F5; padding: 5px; text-align: center;" |T1
!style="background: #F5F5F5; padding: 5px; text-align: center;" |N0,N1
| style="background: #F5F5F5; padding: 5px; text-align: center;" |N0,N1
!style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
|-
|-
!style="background: #DCDCDC; color: #FFFFFF; text-align: center;"|
! style="background: #DCDCDC; color: ; text-align: center;" |
!style="background: #F5F5F5; padding: 5px; text-align: center;" |T2
| style="background: #F5F5F5; padding: 5px; text-align: center;" |T2
!style="background: #F5F5F5; padding: 5px; text-align: center;" |N0,N1
| style="background: #F5F5F5; padding: 5px; text-align: center;" |N0,N1
!style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
|-
|-
! style="background: #DCDCDC; color: #FFFFFF; text-align: center;"|III
! style="background: #DCDCDC; color: ; text-align: center;" |III
!style="background: #F5F5F5; padding: 5px; text-align: center;" |T0, T1, T2
| style="background: #F5F5F5; padding: 5px; text-align: center;" |T0, T1, T2
!style="background: #F5F5F5; padding: 5px; text-align: center;" |N2
| style="background: #F5F5F5; padding: 5px; text-align: center;" |N2
!style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
|-
|-
!style="background: #DCDCDC; color: #FFFFFF; text-align: center;"|
! style="background: #DCDCDC; color: ; text-align: center;" |
!style="background: #F5F5F5; padding: 5px; text-align: center;" |T3
| style="background: #F5F5F5; padding: 5px; text-align: center;" |T3
!style="background: #F5F5F5; padding: 5px; text-align: center;" |N0, N1, N2
| style="background: #F5F5F5; padding: 5px; text-align: center;" |N0, N1, N2
!style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
|-
|-
! style="background: #DCDCDC; color: #FFFFFF; text-align: center;"|IVA
! style="background: #DCDCDC; color: ; text-align: center;" |IVA
!style="background: #F5F5F5; padding: 5px; text-align: center;" |T4
| style="background: #F5F5F5; padding: 5px; text-align: center;" |T4
!style="background: #F5F5F5; padding: 5px; text-align: center;" |N0, N1, N2
| style="background: #F5F5F5; padding: 5px; text-align: center;" |N0, N1, N2
!style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
|-
|-
!style="background: #DCDCDC; color: #FFFFFF; text-align: center;"|
! style="background: #DCDCDC; color: ; text-align: center;" |
!style="background: #F5F5F5; padding: 5px; text-align: center;" |Any T
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Any T
!style="background: #F5F5F5; padding: 5px; text-align: center;" |N3
| style="background: #F5F5F5; padding: 5px; text-align: center;" |N3
!style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
| style="background: #F5F5F5; padding: 5px; text-align: center;" |M0
|-
|-
! style="background: #DCDCDC; color: #FFFFFF; text-align: center;"|IVB
! style="background: #DCDCDC; color: ; text-align: center;" |IVB
!style="background: #F5F5F5; padding: 5px; text-align: center;" |Any T
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Any T
!style="background: #F5F5F5; padding: 5px; text-align: center;" |Any N
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Any N
!style="background: #F5F5F5; padding: 5px; text-align: center;" |M1
| style="background: #F5F5F5; padding: 5px; text-align: center;" |M1
|}
|}


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[[Category:Up-To-Date]]
[[Category:Medicine]]
[[Category:Oncology]]
[[Category:Otolaryngology]]

Latest revision as of 22:53, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]

Overview

The staging of nasopharyngeal carcinoma is based on the TNM staging system.

Staging

American Joint Committee on Cancer (AJCC) Staging

The table below summarizes the TNM staging system for the diagnosis of nasopharyngeal carcinoma:[1]

TNM Description
TX The primary tumor cannot be assessed
T0 No evidence of primary tumor, but EBV-positive cervical node(s) involvement
Tis Carcinoma in situ
T1 Tumor confined to nasopharynx, or extension to oropharynx and/or nasal cavity without paraphartheyngeal involvement
T2 Tumor with extension to parapharyngeal space and/or infiltration of the medial pterygoid, lateral pterygoid, and/or prevertebral muscles
T3 Tumor invades bony structures of skull base cervical vertebra, pterygoid structures, and/or paranasal sinuses
T4 Tumor with intracranial extension and/or involvement of cranial nerves, hypopharynx, orbit, parotid gland and/or infiltration beyond the lateral surface of the lateral pterygoid muscle
Regional Lymph Nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph nodes involved
N1 Unilateral metastasis, in cervical lymph node(s), and/or unilateral, or bilateral metastasis in retropharyngeal lymph nodes, 6 cm or less, above the caudal border of Cricoid cartilage
N2 Bilateral metastasis in cervical lymph node(s), 6 cm or less above the caudal border of Cricoid cartilage
N3 Metastasis in cervical lymph node(s) greater than 6 cm in dimension and/or extension below the caudal border of Cricoid cartilage
Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis is present
Stage grouping
Stage T N M
0 Tis N0 M0
I T1 N0 M0
II T1 N0,N1 M0
T2 N0,N1 M0
III T0, T1, T2 N2 M0
T3 N0, N1, N2 M0
IVA T4 N0, N1, N2 M0
Any T N3 M0
IVB Any T Any N M1

References

  1. ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 978-3319406176.

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