Nasopharyngeal Cancer

Nanang Mardiraharjo,dr.,Sp.THT-KL

Nasopharyngeal carcinoma (NPC) Squamous cell carcinoma (SCC)Arising from the epithelialFrequently : at the fossa of RosenmullerRelatively uncommon, incidence less than 1

per 100,000male-to-female ratio was 3:1 median age was 50 years.

More frequently in the Inuits of Alaska and ethnic Chinese in the southern part of China, (province of Guangdong)

causative factors: Salted fishEpstein-Barr virus (EBV)Genetic factor (alterations in multiple

chromosomes: deletion of regions at 14q, 16p, 1p, and amplification of 12q and 4q)

Histopathology

Histologic classification of NPC (WHO, 1978)

Type I: Keratinizing SCCType II: nonkeratinizing epidermoid

carcinomas. Type III: undifferentiated or poorly

differentiated carcinomas.

Clinical Presentations

4 groups of symptomslocation of the primary tumortheir infiltration of structures in the vicinity

of the nasopharynxmetastasis to the cervical lymph nodes.

Nasal obstruction and dischargeEpistaxisDysfunction of the eustachian tube

conductive deafness and other otologic symptoms

Infiltrate the skull baseheadacheAffects the cavernous sinus and its lateral

wall N III, IV, VI diplopia

involve the foramen ovale the N V facial pain and numbness

most frequent presenting symptom :painless neck mass in the upper neck.

Distant metastasis : uncommon (vertebra, liver, and lung)

Diagnosis

physical signs examination of the postnasal space estimation of antibody levels against EBVimaging studiesendoscopic examination biopsy

Serology

EBV-specific antigens : early replicative antigens, latent phase antigens, late antigens

Antibody response to Epstein-Barr virus : IgA anti- early antigen (EA)IgA anti- viral capsid antigen (VCA)

Imaging Studies

Computed tomography (CT)Magnetic resonance imaging (MRI) bone

marrow infiltrationPositron emission tomography (PET)

Computed tomography (axial view) showing tumor in the nasopharynx (T).

A: Axial view of positron emission tomography superimposed with computed tomography image, showing increased activity at the primary site in the nasopharynx signifying presence of tumor (arrow). B: Sagittal view of the same patient.

Endoscopic Examination

The rigid Hopkin telescopes:0°,30° and 70° excellent view of the

nasopharynxdo not have a suction or biopsy channel

Flexible endoscope:has a suction channel biopsy forceps can be inserted through it

Rigid endoscope (0°) inserted through the left nasal cavity and tumor in the nasopharynx is identified (Tumor).

Rigid endoscope (30°) inserted through the left nasal cavity of the same patient and tumor in the nasopharynx identified (Tumor).

The posterior edge of the septum is visible (S).

Rigid endoscope (70°) inserted through the oral cavity, inspecting the nasopharynx from below. Posterior edge of the nasal septum (S) right

eustachian tube orifice (arrow) and nasopharyngeal tumor can be seen extending from the right lateral wall onto the roof of the nasopharynx

(Tumor).

Staging

AMERICAN JOINT COMMITTEE ON CANCER STAGING FOR NASOPHARYNGEAL CANCER

Tumor in nasopharynx (T) T1 Tumor confined to the nasopharynx T2 Tumor extends to soft tissues of oro-pharynx and/or

nasal fossa T2 a without parapharyngeal extension T2 b with parapharyngeal extension

T3 Tumor invades bony structures and/or paranasal sinuses

T4 Tumor with intracranial extension and/or involvement of cranial nerves, infratemporal fossa, hypopharynx, or orbit

Regional Lymph Nodes (N)NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Unilateral metastasis in lymph node(s), 6

cm or less in greatest dimension, above the supraclavicular fossa

N2 Bilateral metastasis in lymph node(s), 6 cm or less in greatest dimension, above the supraclavicular fossa

N3 Metastasis in a lymph node(s)   N3a greater than 6 cm in dimension   N3b extension to the supraclavicular fossa

Distant Metastasis (M) MX Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis

Stage grouping

Treatment

RadiotherapyNPC is radiosensitive radiotherapy :primary

treatment modality for decades.can also produce undesirable complications

ChemotherapyFor NPC cases with advanced locoregional

diseasecombination with radiotherapy (neoadjuvant,

concurrent, and adjuvant chemotherapy)

TerapiRadioterapi dosis : 6600 – 7000 radSitostatika (neoajuvan, konkuren, ajuvan

kemoterapi) mis.: cisplatin, carboplatin, 5 – FU, bleomisin, paclitaxel, docetaxel

Prognosis Stadium dini 5 ysr: 70 – 80 % Stadium lanjut 5 ysr : 15-25%

Thank You