Nasopharyngeal carcinoma overview: Difference between revisions
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Revision as of 02:56, 27 November 2017
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Nasopharyngeal carcinoma Microchapters |
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Differentiating Nasopharyngeal carcinoma from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Nasopharyngeal carcinoma overview On the Web |
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American Roentgen Ray Society Images of Nasopharyngeal carcinoma overview |
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Risk calculators and risk factors for Nasopharyngeal carcinoma overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]
Overview
Nasopharyngeal carcinoma (NPC) is a cancer originating in the nasopharynx (the uppermost region of the pharynx), where the nasal passages and auditory tubes join the remainder of the upper respiratory tract. On microscopic histopathological analysis, abundant dense eosinophilic cytoplasm and prominent lymphoid component are characteristic findings of nasopharyngeal carcinoma. Nasopharyngeal carcinoma differs significantly from other cancers of the head and neck in occurrence, causes, clinical behavior, and treatment. Common risk factors in the development of nasopharyngeal carcinoma are Chinese (or Asian) ancestry, Epstein-Barr virus (EBV) exposure, and heavy alcohol intake. Nasopharyngeal carcinoma must be differentiated from normal adenoidal tissue, nasopharyngeal lymphoma and chordoma.[1] It is vastly more common in certain regions of East Asia and Africa than elsewhere, with viral, dietary, and genetic factors implicated in its causation. The prevalence of nasopharyngeal carcinoma is approximately 1 per 100,000 individuals in the USA. Patients of all age groups may develop nasopharyngeal carcinoma. If left untreated nasopharyngeal carcinoma produces few symptoms early in the course of disease. Once the tumor has expanded from its site of origin in the lateral wall of the nasopharynx, it may obstruct the nasal passages and cause nasal discharge or epistaxis. Non-keratinizing nasopharyngeal carcinoma is associated with a 5 year survival rate of 65%. The common complications of nasopharyngeal carcinoma include airway obstruction, dysphagia, and disfigurement of the neck or face. Head and neck MRI may be helpful in the diagnosis of nasopharyngeal carcinoma. The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy. Surgery is not the first-line treatment option for patients with nasopharyngeal carcinoma.
Historical Perspective
Classification
Nasopharyngeal carcinoma may be classified according to microscopic features into 3 subtypes: well-differentiated, moderately-differentiated, and undifferentiated type.
Pathophysiology
On microscopic histopathological analysis, abundant dense eosinophilic cytoplasm and prominent lymphoid component are characteristic findings of nasopharyngeal carcinoma.
Causes
Common causes of nasopharyngeal carcinoma include history ofEpstein-Barr virus (EBV) infection and nitrosamines consumption.
Differentiating Nasopharyngeal carcinoma from other Diseases
Nasopharyngeal carcinoma must be differentiated from normal adenoidal tissue, nasopharyngeal lymphoma and chordoma.[2]
Epidemiology and Demographics
The prevalence of nasopharyngeal carcinoma is approximately 1 per 100,000 individuals in the USA. Patients of all age groups may develop nasopharyngeal carcinoma.
Risk Factors
Common risk factors in the development of nasopharyngeal carcinoma are Chinese (or Asian) ancestry, Epstein-Barr virus (EBV) exposure, cigarette smoking, and heavy alcohol intake.
Screening
According to the America Cancer Society, screening for nasopharyngeal carcinoma is not recommended.[3]
Natural History, Complications and Prognosis
If left untreated nasopharyngeal carcinoma produces few symptoms early in the course of disease. Once the tumor has expanded from its site of origin in the lateral wall of the nasopharynx, it may obstruct the nasal passages and cause nasal discharge or epistaxis. Non-keratinizing nasopharyngeal carcinoma is associated with a 5 year survival rate of 65%. The common complications of nasopharyngeal carcinoma include airway obstruction, dysphagia, and disfigurement of the neck or face.
Staging
The staging of nasopharyngeal carcinoma is based on the TNM staging system.
History and Symptoms
Symptoms of nasopharyngeal carcinoma include swelling in the neck, cough, sore throat and weight loss.[4]
Physical Examination
Patients with nasopharyngeal carcinoma usually appear normal. Physical examination of patients with nasopharyngeal carcinoma is usually remarkable for neck swelling, hearing loss and nasal obstruction.
Laboratory Findings
Laboratory findings consistent with the diagnosis of nasopharyngeal carcinoma include an elevated concentration of serum EBV titer.
CT
On the head and neck CT scan, nasopharyngeal carcinoma is characterized by presence of soft tissue masses most commonly centered at the lateral nasopharyngeal recess (fossa of Rosenmüller).
MRI
Head and neck MRI may be helpful in the diagnosis of nasopharyngeal carcinoma. Findings on MRI suggestive of nasopharyngeal carcinoma include dural thickening and bone marrow infiltration.
Medical Therapy
The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy, supplemented in some cases with chemotherapy.
Surgery
Surgery is not the first-line treatment option for patients with nasopharyngeal carcinoma.
References
- ↑ http://radiopaedia.org/articles/nasopharyngeal-carcinoma
- ↑ http://radiopaedia.org/articles/nasopharyngeal-carcinoma
- ↑ Can nasopharyngeal cancer be found early? American Cancer Society (2015) http://www.cancer.org/cancer/nasopharyngealcancer/detailedguide/nasopharyngeal-cancer-detection Accessed on September, 16 2015
- ↑ Richard Cote, Saul Suster, Lawrence Weiss, Noel Weidner (Editor). Modern Surgical Pathology (2 Volume Set). London: W B Saunders. ISBN 0-7216-7253-1.