case ca naso dr.Oscar.pptx

8/11/2019 case ca naso dr.Oscar.pptx

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Case Presentation

Supervisor:dr. H. Oscar Djauhari, Sp. THT

Presented by:

FK UAJ and FKUMJ


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Name : Mr. M

Gender : Male

Age : 60 years old

Occupation : Industrial worker Race : Javanese

Address : Sukabumi

Weight : 55 kg

Height : 170 cm


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Chief Complaint : sensation of blocked right nose and

bloody nasal discharge since 7 past days.

Additional Complaint : right ear fullness, hearingloss, neck mass since 2 months ago, weight lost


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A 60-years-old male came to ENT clinic with a chief

complaint of sensation of blocked right nose and bloody

nasal discharge since 7 past days. The bloody discharge

was intermittent and in a small amount. The discharge was

only in the right nose. He also felt right ear fullness andhearing loss.


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He also noticed a mass at his right upper neck since

2 months ago. The mass was single, round, not enlarging

in the past 7 days, and painless. In the past 6 months, he

lost weight dramatically despite of regular meal


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He has a history of hard smoker. History of fever and

malaise was denied. He didnt have any other ear or eye

complaint. There was no ear discharge, ear pain, or

tinnitus. Complaint of swallowing pain and cough were also

denied


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History of Past Illness

History of previous illness was denied

History of Family IllnessHistory of family illness was denied


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General condition : Appear calm

Body weight : 55 kg

Height : 170 cm

Blood pressure : 110/80 mmHg Pulse : 88 beat per minute

Respiratory rate : 20 times per minute

Temperature : 36,9oC


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Ear

Right ear Auricle : normal

External auditory canal:

hyperemic (-), edema (-), mass (-), laceration (-) secretion (-) ,cerumen

Tymphanic membrane: Intact, hyperemic (-),bulging (+), light reflex

Left ear

Auricle : normal

External auditory canal: hyperemic (-), edema (-), mass (-), laceration (-) secretion (-) ,

cerumen (-)

Tymphanic membrane:

Intact, bulging (-), light reflex (+)


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Nose

Right nose

Mucous membrane:

hyperemic (-), edema (-), blood-stained discharge (+),mass (-), laceration (-), crust (-)

Inferior conchae : eurtrophy

Septum : no deviation Air passage : decreased

Left nose

Mucous membrane:

hyperemic (-), edema (-),secretion (-), mass (-), laceration (-),crust (-)

Inferior conchae : eurtrophy

Septum : no deviation

Air passage :normal


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Oropharynx

Posterior pharynx : hyperemic (-)

Palatine tonsils : T1 / T1, hyperemic (-),

detritus (-) Uvula : symmetrical

Dental : no abnormatlities

Maxillofacial: symmetrical

Neck : single right upper jugular

lymphadenopathy, diameter of 2

cm, painless


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Working Diagnosis

Suspect of nasopharyngeal carcinoma

Differential DiagnosisNasal polyp

Turbinate hypertrophy


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Laboratory:

Complete blood count

Liver function test

Head and neck CT-scan Nasopharyngoscopy + biopsy


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Radiotherapy chemotherapy


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NPC is a relatively rare disease in the west, but is

endemic in the Far East

The highest incidence reported is from the Guangdong

Province of Southern China, where it is the third most

common malignancy among men, with an incidence rate

of between 15 to 50 per 100,000

Latent infection by the Ebstein-Barr virus (EBV) is crucial

in the progression to severe dysplasia, and gains on

chromosome 12 and allelic losses on 11q, 13q, and 16qlead eventually to invasive carcinoma


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Dietary factors have focussed mainly on

preserved foods, and salted fish, in

particular, has been found to have a strong

relation to the development of NPC. Thereis also an increased risk with diets deficient

in fresh fruits, carotene, or fiber intake;

vegetables do not provide protectionagainst NPC


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Three histopathologic types are described in the World

Health Organization (WHO) classification:

Type I: Squamous cell carcinoma (SCC) with varying

degrees of

differentiation

Type II: Non keratinizing carcinoma

Type III: Undifferentiated carcinoma

Three histopathologic types are described

in the World Health Organization (WHO)

classification:

Type I: Squamous cell carcinoma (SCC)with varying degrees of

differentiation



Three histopathologic types are described

in the World Health Organization (WHO)

classification:

Type I: Squamous cell carcinoma (SCC)with varying degrees of

differentiation




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Second decade of life

Peaks in the forth and fifth decades of life

Male:female ratio = 3:1

Cervical lymphadenopathy 50% - 90% of patients Blood-stained nasal discharge

Unilateral nasal obstruction

Unilateral hearing loss, although tinnitus and otalgia may

occasionally be present Neurologic symptoms, cranial nerve paralysis &

headaches


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Detailed history and clinical examination

Visualization Nasopharyngoscopy

Biopsy

FNAC (Fine Needle Aspiration Cytology) MRIw/ gadolinium and fat suppression = imaging

modality of choice

CTbetter definition bone involvement & cervical

lymphadenopathy


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Surgery

Chemotherapy

Radiotherapy


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confined to the treatment of residual or recurrent disease

for postradiation residual or recurrent nodal disease

important considerations are tumor extent, access for

exposure, and control of the internal carotid artery


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advanced disease (stage III and IV)

Single and combination chemotherapyadjunct


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inaccessible location

tumor has extended beyond the confines of the

nasopharynx

tumors are particularly radiosensitive

Locoregional recurrences without distant metastases


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case ca naso dr.Oscar.pptx

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