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Nasopharyngeal carcinoma

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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]Michael Maddaleni, B.S., Faizan Sheraz, M.D. [3]

Synonyms and keywords: Rhinopharyngeal carcinoma, NPC, nasopharynx cancer, nasopharynx carcinoma, nasopharyngeal cancer, cancer of nasopharynx

Overview

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

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. 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

The association between EBV and nasopharyngeal carcinoma was made in1970. In 1970, Zur Hausen and et al, were the first to extract EBV DNA from NPC tumors by using DNA hybridization method. In 1970, Henle and et al, revealed the link between stage of NPC tumors and EBV antibody titer. In 1973, Wolf and et al, found EBV DNA in NPC tumor cells by in situ hybridization methods but not in infiltrating lymphoid cells. Babe Ruth, a famous baseball player suffered from nasopharyngeal cancer.

Classification

World health organization classified nasopharyngeal carcinoma into 3 types keratinizing, nonkeratinizing (differentiated, undifferentiated) and basaloid squamous cell carcinoma.

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 Epstein Barr virus (EBV infection), Human Papillomavirus (HPV infection), and consumption of salted fish as a source of N-nitrosamine.

Differentiating Nasopharyngeal carcinoma from other Diseases

Nasopharyngeal carcinoma must be differentiated from other congenital abnormalities, inflammatory, and malignant lesions of neck.

Epidemiology and Demographics

The incidence of nasopharyngeal carcinoma is different based on the geographic areas. The incidence in the USA is low, in Alaska and Greenland is moderate and the highest incidenceis seen in southeast Asia, North Africa, southern China and middle east. The incidence of this disease increases with increasing age in low- risk population. However, in high-risk populations, the maximum incidence is seen in individuals around ages 50 to 59 and then the incidence decreases by increasing age. Nasopharyngeal carcinoma usually affects individuals of the Asian race, and is more commonly affected by male than female. The majority of nasopharyngeal carcinoma cases are reported in southern China, Southeast Asia, North Africa and also is more seen in Inuit Indians.

Risk Factors

Common risk factors in the development of nasopharyngeal carcinoma include the family history of cancer, smoking, some disease in ear, nose, and throat, inadequate consumption of fresh fruits and vegetables, heavily alcohol consuming, herbal products and exposure to wood dust.

Screening

Screening for nasopharyngeal carcinoma only is done in endemic areas. Different methods, such as measurement the titre of different types of antibodies against EBV and plasma EBV DNA, and endoscopic examination of nasopharynx can be used for screening.

Natural History, Complications and Prognosis

If left untreated nasopharyngeal carcinoma produces few symptoms early in the course of the disease. Non-keratinizing nasopharyngeal carcinoma is associated with a 5 year survival rate of 65%. The common complications of nasopharyngeal carcinoma’s treatment include radiation necrosis of the temporal lobes, cranial nerve palsies, encephalomyelopathy, atrophy and fibrosis of the muscles of mastication, atrophy of salivary glands, hearing loss, and osteoradionecrosis.

Diagnosis

Diagnostic Study of Choice

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

History and Symptoms

Symptoms of nasopharyngeal carcinoma based on the place of involvement are different. Most symptoms are related to existence of mass in nasopharynx, latero-posterior invasion of the tumor to the nasopharyngeal space and dysfunction of eustachian tube, involvement of skull base accompanied by damaging of the 5th and 6th cranial nerves, and neck mass. Most common symptoms are neck mass, nasal symptoms, ear symptoms and headache.

Physical Examination

Patients with nasopharyngeal carcinoma usually appear normal. Physical examination of patients with nasopharyngeal carcinoma is usually remarkable for neck swelling, neck lymphadenopathy, decrease facial sensation, hearing loss and nasal obstruction.

Laboratory Findings

Laboratory findings consistent with the diagnosis of nasopharyngeal carcinoma include an elevated concentration of serum EBV titer. Plasma EBV DNA load, EBV viral capsid antigen, assessment of EBV in the pathologic specimens, Complete blood count, Urea and creatinine, electrolytes, Liver function tests, Calcium and phosphate, and Alkaline phosphatase are the tests which should be done for the diagnosis and assessment of tumor invasion, and differentiation of tumor.

Electrocardiogram

There are no ECG findings associated with nasopharyngeal carcinoma.

X-ray

There are no x-ray findings associated with nasopharyngeal carcinoma. However, it may be helpful for the assessment of metastasis in the chest.

Echocardiography and Ultrasound

There are no ultrasound findings associated with nasopharyngeal carcinoma. However, ultrasonography may be helpful in the assessment of cervical lymph nodes and liver for metastasisevaluation.

CT

CT scan may be helpful in the diagnosis of nasopharyngeal carcinoma and it’s metastasis to the lymph nodes, intracranial space, bone, chest, and liver. Findings on CT scan suggestive of nasopharyngeal carcinoma include soft tissue masses which most commonly centred at the lateral nasopharyngeal recess (fossa of Rosenmüller) and heterogeneous enhancement of the tumor in the CT scan with contrast.

MRI

Head and neck MRI may be helpful in the diagnosis of nasopharyngeal carcinoma. It is especially used for the assessment of tumor invasion in the skull base, parapharyngeal spcae, paranasal sinus, middle ear and cervical lymph nodes.

Other Imaging Findings

Positron emission tomography (PET) scan may be helpful in the diagnosis of nasopharyngeal carcinoma. It is useful in the detection of residual or recurrent tumor after treatment and distant metastasis, prediction of clinical cancer outcome and PET/CT scan is used for NPC staging.

Other Diagnostic Studies

Nasopharyngoscopy may be helpful in the diagnosis of nasopharyngeal carcinoma. It is used for assessment of tumor extension, determination of mucosal surface involvement and biopsy of the primary tumor.

Fine needle aspiration (FNA) for biopsy and histopathological analysis is used for diagnosis of nasopharyngeal carcinoma.

Treatment

Medical Therapy

The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy, supplemented in some cases with chemotherapy. Chemotherapy drugs that are used in treatment of nasopharyngeal carcinoma are vast, but the two ones which are used more include Cisplatin and 5-Fluorouracil.

Interventions

The mainstay of treatment for early stages of nasopharyngeal carcinoma is radiotherapy. For the patients in early stages, radiotherapy is used solely most of the time, and in patients with higher stages,it is used in combination with chemotherapy.

Surgery

Surgery is not the first-line treatment option for patients with nasopharyngeal carcinoma.It is used for resistant and locally recurrent types. The methods can be divided into open and minimally invasive nasopharyngectomy.

Primary Prevention

There are no established measures for the primary prevention of nasopharyngeal carcinoma. Although smoking and alcohol cessation may be effective.

Secondary Prevention

Secondary prevention measures of nasopharyneal cancer include routine physical examination and imaging at scheduled intervals after treatment. Dental screening and screening for thyroid cancers are recommended among patients who had received radiation therapy to the oral cavity and cervical region, respectively.

References

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Historical Perspective

Historical Perspective

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

Overview

The association between EBV and nasopharyngeal carcinoma was made in1970. In 1970, Zur Hausen and et al, were the first to extract EBV DNA from NPC tumors by using DNA hybridization method. In 1970, Henle and et al, revealed the link between stage of NPC tumors and EBV antibody titer. In 1973, Wolf and et al, found EBV DNA in NPC tumor cells by in situ hybridization methods but not in infiltrating lymphoid cells. Babe Ruth, a famous baseball player suffered from nasopharyngeal cancer.

Historical Perspective

Discovery

Famous Cases

  • Babe Ruth, a famous baseball player suffered from nasopharyngeal cancer.[5]

References

  1. ↑ H. zur Hausen, H. Schulte-Holthausen, G. Klein, W. Henle, G. Henle, P. Clifford & L. Santesson (1970). “EBV DNA in biopsies of Burkitt tumours and anaplastic carcinomas of the nasopharynx”. Nature. 228 (5276): 1056–1058. PMID 4320657. Unknown parameter |month= ignored (help)
  2. ↑ H. zur Hausen, H. Schulte-Holthausen, G. Klein, W. Henle, G. Henle, P. Clifford & L. Santesson (1970). “EBV DNA in biopsies of Burkitt tumours and anaplastic carcinomas of the nasopharynx”. Nature. 228 (5276): 1056–1058. PMID 4320657. Unknown parameter |month= ignored (help)
  3. ↑ W. Henle, G. Henle, H. C. Ho, P. Burtin, Y. Cachin, P. Clifford, A. de Schryver, G. de-The, V. Diehl & G. Klein (1970). “Antibodies to Epstein-Barr virus in nasopharyngeal carcinoma, other head and neck neoplasms, and control groups”. Journal of the National Cancer Institute. 44 (1): 225–231. PMID 11515035. Unknown parameter |month= ignored (help)
  4. ↑ H. Wolf, H. zur Hausen & V. Becker (1973). “EB viral genomes in epithelial nasopharyngeal carcinoma cells”. Nature: New biology. 244 (138): 245–247. PMID 4353684. Unknown parameter |month= ignored (help)
  5. ↑ “10 Famous People Who Have Suffered from Head and Neck Cancer – Dr. Jeffrey Faulkner, ENT”.


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Classification

Classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

World health organization classified nasopharyngeal carcinoma into 3 types : keratinizing, nonkeratinizing (differentiated, undifferentiated) and basaloid squamous cell carcinoma.

Classification

World Health Organization (WHO) classification (2005) for nasopharyngeal carcinoma (NPC):[1][2]

Classification Former name EBV Prevalence Prognosis
Keratinizing Type 1, squamous cell carcinoma -ve almost 1/4 of NPC cases poor
Nonkeratinizing, differentiated Type 2, transitional carcinoma +ve less than 1/6 of NPC cases good
Nonkeratinizing, undifferentiated Type 3, lymphoepithelial carcinoma +ve most common good
Basaloid squamous cell carcinoma (BSCC) least common poor

References

  1. ↑ Barnes, Leon (2005). Pathology and genetics of head and neck tumours. Lyon: IARC Press. ISBN 978-92-832-2417-4.
  2. ↑ Thompson, Lester (2011). Diagnostic pathology. Salt Lake City, Utah: Amirsys. ISBN 1931884617.


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Pathophysiology

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

On microscopic histopathological analysis, abundant dense eosinophilic cytoplasm and prominent lymphoid component are characteristic findings of nasopharyngeal carcinoma.

Pathophysiology

Genetics

Genes involved in the pathogenesis of nasopharyngeal carcinoma include:

Pathology

Gross Pathology

The tumor arises from epithelial cells on the surface of the nasopharynx.

Microscopic Pathology

Features:[2]

Nasopharyngeal carcinoma


Nasopharyngeal carcinoma may be classified according to microscopic features into 3 subtypes:[3]

  • Undifferentiated nasopharyngeal carcinoma - low power
    Undifferentiated nasopharyngeal carcinoma – low power
  • Undifferentiated nasopharyngeal carcinoma - med. power
    Undifferentiated nasopharyngeal carcinoma – med. power
  • Undifferentiated nasopharyngeal carcinoma - high power
    Undifferentiated nasopharyngeal carcinoma – high power

Immunohistochemistry

Immunohistochemistry stains for nasopharyngeal carcinoma include:

  • EBER positive
  • p16 negative[4]

References

  1. ↑ Abdel Khalek Abdel Razek, A.; King, A. (2012). “MRI and CT of nasopharyngeal carcinoma”. AJR Am J Roentgenol. 198 (1): 11–8. doi:10.2214/AJR.11.6954. PMID 22194474. Unknown parameter |month= ignored (help)
  2. ↑ Nasopharyngeal carcinoma http://librepathology.org/wiki/index.php/Nasopharyngeal_carcinoma
  3. ↑ Richard Cote, Saul Suster, Lawrence Weiss, Noel Weidner (Editor). Modern Surgical Pathology (2 Volume Set). London: W B Saunders. ISBN 0-7216-7253-1.
  4. ↑ Gulley ML, Nicholls JM, Schneider BG, Amin MB, Ro JY, Geradts J (1998). “Nasopharyngeal carcinomas frequently lack the p16/MTS1 tumor suppressor protein but consistently express the retinoblastoma gene product”. Am. J. Pathol. 152 (4): 865–9. PMC 1858242. PMID 9546345. Unknown parameter |month= ignored (help)

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Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

Common causes of nasopharyngeal carcinoma include Epstein Barr virus (EBV infection), Human Papillomavirus (HPV infection), and consumption of salted fish as a source of N-nitrosamine.

Causes

Common Causes

Common causes of nasopharyngeal carcinoma may include:[1][2][3][4][5][6][7][8][9][10]

References

  1. ↑ Jia, Wei-Hua; Qin, Hai-De (2012). “Non-viral environmental risk factors for nasopharyngeal carcinoma: A systematic review”. Seminars in Cancer Biology. 22 (2): 117–126. doi:10.1016/j.semcancer.2012.01.009. ISSN 1044-579X.
  2. ↑ Jia, Wei-Hua; Luo, Xiang-Yu; Feng, Bing-Jian; Ruan, Hong-Lian; Bei, Jin-Xin; Liu, Wen-Sheng; Qin, Hai-De; Feng, Qi-Sheng; Chen, Li-Zhen; Yao, Shugart Yin; Zeng, Yi-Xin (2010). “Traditional Cantonese diet and nasopharyngeal carcinoma risk: a large-scale case-control study in Guangdong, China”. BMC Cancer. 10 (1). doi:10.1186/1471-2407-10-446. ISSN 1471-2407.
  3. ↑ Guo, Xiuchan; Johnson, Randall C.; Deng, Hong; Liao, Jian; Guan, Li; Nelson, George W.; Tang, Mingzhong; Zheng, Yuming; de The, Guy; O’Brien, Stephen J.; Winkler, Cheryl A.; Zeng, Yi (2009). “Evaluation of nonviral risk factors for nasopharyngeal carcinoma in a high-risk population of Southern China”. International Journal of Cancer. 124 (12): 2942–2947. doi:10.1002/ijc.24293. ISSN 0020-7136.
  4. ↑ Maxwell, Jessica H.; Kumar, Bhavna; Feng, Felix Y.; McHugh, Jonathan B.; Cordell, Kitrina G.; Eisbruch, Avraham; Worden, Francis P.; Wolf, Gregory T.; Prince, Mark E.; Moyer, Jeffrey S.; Teknos, Theodoros N.; Chepeha, Douglas B.; Stoerker, Jay; Walline, Heather; Carey, Thomas E.; Bradford, Carol R. (2009). “HPV-positive/p16-positive/EBV-negative nasopharyngeal carcinoma in white North Americans”. Head & Neck: NA–NA. doi:10.1002/hed.21216. ISSN 1043-3074.
  5. ↑ Chan, Yap-Hang; Lo, Ching-Man; Lau, Hiu-Ying; Lam, Tai-Hing (2014). “Vertically transmitted nasopharyngeal infection of the human papillomavirus: Does it play an aetiological role in nasopharyngeal cancer?”. Oral Oncology. 50 (5): 326–329. doi:10.1016/j.oraloncology.2013.12.025. ISSN 1368-8375.
  6. ↑ Dogan, Snjezana; Hedberg, Matthew L.; Ferris, Robert L.; Rath, Tanya J.; Assaad, Adel M.; Chiosea, Simion I. (2014). “Human papillomavirus and Epstein-Barr virus in nasopharyngeal carcinoma in a low-incidence population”. Head & Neck. 36 (4): 511–516. doi:10.1002/hed.23318. ISSN 1043-3074.
  7. ↑ Stenmark, Matthew H.; McHugh, Jonathan B.; Schipper, Matthew; Walline, Heather M.; Komarck, Christine; Feng, Felix Y.; Worden, Francis P.; Wolf, Gregory T.; Chepeha, Douglas B.; Prince, Mark E.; Bradford, Carol R.; Mukherji, Suresh K.; Eisbruch, Avraham; Carey, Thomas E. (2014). “Nonendemic HPV-Positive Nasopharyngeal Carcinoma: Association With Poor Prognosis”. International Journal of Radiation Oncology*Biology*Physics. 88 (3): 580–588. doi:10.1016/j.ijrobp.2013.11.246. ISSN 0360-3016.
  8. ↑ Radha Raghupathy, Edwin Pun Hui & Anthony Tak Cheung Chan (2014). “Epstein-Barr virus as a paradigm in nasopharyngeal cancer: from lab to clinic”. American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting: 149–153. doi:10.14694/EdBook_AM.2014.34.149. PMID 24857071.
  9. ↑ Pathmanathan, Rajadurai; Prasad, Umapati; Sadler, Robert; Flynn, Kathryn; Raab-Traub, Nancy (1995). “Clonal Proliferations of Cells Infected with Epstein–Barr Virus in Preinvasive Lesions Related to Nasopharyngeal Carcinoma”. New England Journal of Medicine. 333 (11): 693–698. doi:10.1056/NEJM199509143331103. ISSN 0028-4793.
  10. ↑ A. S. Chan, K. F. To, K. W. Lo, K. F. Mak, W. Pak, B. Chiu, G. M. Tse, M. Ding, X. Li, J. C. Lee & D. P. Huang (2000). “High frequency of chromosome 3p deletion in histologically normal nasopharyngeal epithelia from southern Chinese”. Cancer research. 60 (19): 5365–5370. PMID 11034072. Unknown parameter |month= ignored (help)

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Differentiating Nasopharyngeal Carcinoma from other Diseases

Differentiating Nasopharyngeal Carcinoma from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2], Gertrude Djouka, M.D.[3], Qurrat-ul-ain Abid, M.D.[4], Homa Najafi, M.D.[5], Faizan Sheraz, M.D. [6]

Overview

Nasopharyngeal carcinoma must be differentiated from other congenital abnormalities, inflammatory, and malignant lesions of neck.

Differentiating nasopharyngeal carcinoma from other neck masses

Nasopharyngeal carcinoma must be differentiated from other congenital abnormalities, inflammatory, and malignant lesions of neck.

Category Diseases Benign/

Malignant

Clinical manifestation Paraclinical findings Gold standard diagnosis Associated findings
Demography History Symptoms Signs Lab findings Histopathology Imaging
Pain Dysphagia Mass exam Others
Congenital Branchial cleft cyst[1]
  • Age: 1-15 years old
  • Familial occurrence
  • Lateral neck mass
 − ±
  • Solitary
  • Smooth
  • Mobile
  • Well-defined
  • Non-pulsatile
  • Fluctuant
  • A pit at the opening of the cyst
 − −
Thyroglossal duct cyst[2][3]
  • Age: 1-10 years old
  • Midline neck mass
 − − − − − −
Hemangioma[4]
  • Presents with a flat red or purple patch
  • Regress gradually with age
 − −
  • Firm
  • Rubbery
  • Well-demarcated
Vascular malformation[5][6]
  • Incidence: 1 in 2000 to 5000 births
  • Gender: No predilection
 ± −
  • Grow proportionally with age
  • MRI
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Congenital Lymphatic malformation[7][8]
  • Age: Birth-5 years old
  • Gender: No predilection
 − + − −
Laryngocele[9][10][11] − +
  • Soft
  • Reducible
  • Increase in size on valsalva
  • Common in glass blowers and trumpet players
 − −
Ranula[12][13] − −
  • Well circumscribed
  • Fluctuant
  • Soft
 − − − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Congenital Teratoma[14][15]
  • Incidence: 1:4000 births
  • Gender: No predilection
  • Presents as a firm lateral neck mass
 − −
  • Firm
  • Non-tender
 −
  • High ALP levels
 − −
Dermoid cyst[16][17] − −
  • Freely mobile
  • Solitary
  • Rubbery
  • Nonpulsatile
  • Noncompressible
 −
  • Ultrasound: Thin walled, unilocular
  • CT with contrast: Well circumscribed, unilocular, sac-of-marbles appearance due to fatty tissue
 − −
Thymic cyst[18]
  • Presents as a soft mass, gradually enlarging, on left side of the neck (usual)
 − −
  • Soft
  • Compressible
 − − − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Acute sialadenitis[19]
  • Age: Occurs in all age groups
  • Gender: No predilection
 + – −
Chronic sialadenitis[20]
  • Age: Occurs in all age groups
  • Gender: No predilection
  • Presents with an unilateral swelling
  • Recurrent episodes common
 + −
  • Non-tender
  • Firm
  • Smooth
 −
Reactive viral lymphadenopathy CMV[21]
  • Age: 10-35 years old
  • Gender: No predilection
  • Flu-like illness
 − −
  • Non-tender
  • Soft
  • Usually not necessary
 −
EBV[22][23]
  • Age: Mainly adolescents
  • Gender: No predilection
 − −
  • Non-tender
  • Firm
  • Usually not necessary
 −
HIV[24] − −
  • Non-tender mass
  • Usually not necessary
 −
Viral URI[25]
  • Incidence: More in fall & winter
  • Age: Common in elderly and infants
 − −
  • Non-tender
  • No specific findings
 − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Bacterial lymphadenopathy Tularemia[26][27]
  • Age: Affects all age groups
  • Gender: No predilection
 + −
  • No specific findings
 −
Brucellosis[28]
  • Flu-like illness
 + −
  • No specific findings
 −
Cat-scratch disease[29][30]
  • More common in the Southern of U.S among children and young adults
 + − − −
Actinomycosis[31][32]
  • No predilection in race, age
  • [[Male] to female ratio : 1.5 to 3:1
 − −
  • Tender at the beginning
  • Painless
  • Fluctuant
  • Non-tender at late stage
 −
Mycobacterial infections[22][33][34] − − −
Streptococcal infection[21][35] + + −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Parasitic lymphadenopathy Toxoplasma gondii[36][37]
  • 6 years old and older adults are more affected in U.S.
  • Seen in hot climates
 + −
  • Bilateral
  • Non-tender
  • Symmetrical
  • Non-fluctuant
 −
Sarcoidosis[38][19]
  • More common in African American women aged 20-40 years
 − −
Sjögren syndrome[39]
  • Female to male ratio: 9 to 1
  • May happen at any age
  • Mean age: 40-50
 − + −
Castleman disease (angiofollicular lymphoproliferative disease)[40][41]
  • Mean age: 30-40 years
 − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Kikuchi disease (histiocytic necrotizing lymphadenitis)[42]
  • High prevalence in Japan
  • More common in young adults < 30 years old
 + − −
Kimura disease[43]
  • More common in Asian males
 − − −
Rosai-Dorfman disease[44][45] − − − − − −
Kawasaki disease[46][47]
  • More common in children < 5 years old
  • Highest incidence in Japan
  • Most leading cause of acquired heart disease in U.S
 − − − −
Category Diseases Benign or Malignant Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Salivary gland neoplasm Pleomorphic adenoma[48][49] − + − −
  • MRI: Homogenous on T1
  • Abundant myxochondroid stroma on T2
 −
Warthin’s tumor[50][51]
  • Male to female ratio: 4:1
  • More common in people aged 60-70 years old
 − + − − −
Oncocytoma

[52]

  • Race: Caucasian patients predilection
  • Gender: No gender preference
  • Age: 50–70 years
 ± ±
  • CT:
    • Isodense expansive mass
    • Enhancement after intravenous contrast
    • Hypodense areas
  • MRI:
    • Isodensties on T1
    • Mass is hyperintense on T2
    • Enhancement on contrast
 –
Monomorphic adenoma [53][54][55]
  • Age: 26-76 years
  • Rare in children
  • Gender: No predilection
 ± ±
  • Normal
 –
Mucoepidermoid carcinoma

[56]

  • Age: Mean age of 59
  • Female predilection
 ± ± −
  • Cystic and solid component with variable appearance on CT and MRI
  • Association with CMV
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Salivary gland neoplasm Adenoid cystic carcinoma [57]
  • Age: 40s-60s
  • Gender: Female predominance
 ± ± − −
Adenocarcinoma

[58]

  • Age: young age predilection
 − − −
Salivary duct cancer[59][60][61]

(Highly aggressive)

  • Incidence: 1-3%
  • Gender: Male predilection
  • Mean age: 55-61 years old
  • Rapidly growing mass with jaw involvement
 ± ±
  • Painless
  • Hard
  • Non-compressible mass
 −
Squamous cell carcinoma[62][63]
  • Incidence: rare
  • Age: Old age , 61-68 years
  • Male predilection
  • Present as painful growing mass on jaw
 + −
  • Tumor dimension can be delineated using both CT and MRI
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Hypopharyngeal cancer[64][65][66]
  • More common in males
  • Age: 55-65 years old
  • Incidence: < 1/100,000 in U.S.
  • More common in Japan, India, Iran
 − + − −
Parathyroid cancer[67][68][69]
  • Incidence: Rare
  • Mean age : 44-54 years old
  • Gender: Female predilection
 + +
Carotid body tumors[70][71][72][73]
  • Age: 26-55 years
  • Male predominance
 + − −
Paraganglioma[74][75][76]
  • Age 50-70 years
  • More in females
 − − − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Schwannoma[77][78][79]
  • Rare tumor
  • Incidence: 1-10%
 + ±
  • Multiple
  • Slow growing nodules on the skin
  • May be normal
  • Encapsulated neural tissue growth
Lymphoma [80][81][82][83][84][85]
  • Age: Predilection for older age
  • Mean age: 55
 − ±
  • On complete node analysis four patterns are described:
    • Nodular/follicular
    • Diffuse pattern
    • Transition from a nodular to a diffuse pattern in adjacent nodes
    • Transition from a lower to a higher grade of involvement within a single node
Liposarcoma [86][87][88][89]
  • Rare tumor
  • Age: Relatively in older age
  • Gender: No gender predilection
  • Mobile mass
  • Few symptoms until they grow enough to compress the surrounding structures
  • Symptoms of neural deficit, pain, tingling, or skin changes
 ± −
  • Intact skin and normal color
  • Normal
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Lipoma [90][91][92]
  • One or multiple soft, painless skin nodules
  • May causes pain or compressive symptoms
 ± −
  • Normal
  • Normal
  • Diagnoses is usually clinical
  • Tissue biopsy may show:
    • Bundle of well-demarcated lipocytes
    • Single nuclei aligned to the side
    • Intra-cytoplasimic fat granules
Glomus vagale, glomus jugulare tumors[93][94][95][96][97][98]
  • Rare tumor
  • Painless slowly enlarging mass in the neck
 − ±
  • Normal
 −
Metastatic head and neck cancer[99][100] − ±
  • Vary depending on the underlying cancer
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Other Laryngeal cancer[101][102] Benign/Malignant
  • Older males
  • Younger patients with HPV infection or smoking history
 ± ±

human papillomavirus (HPV) infection

−
Arteriovenous fistula

[103][104]

  • Depends on the risk factors
 − −
  • Varies depending on the etiology
 −
Thyroid nodule/ Goiter

[105][106][107][108]

  • Female predominance
  • Young age (benign causes)
  • Old age (malignant etiology)
 ± ±
  • Painless
  • Non-tender
  • Asymmetrical neck mass in front of neck
  • With smooth overlying skin
  • Nodular surface
  • Depending on the type:
  • Normal to low TSH levels in case of malignancy
  • High TSH levels in case of goiter
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings

References

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  96. ↑ Stein PP, Black HR (January 1991). “A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution’s experience”. Medicine (Baltimore). 70 (1): 46–66. PMID 1988766.
  97. ↑ Sajid MS, Hamilton G, Baker DM (August 2007). “A multicenter review of carotid body tumour management”. Eur J Vasc Endovasc Surg. 34 (2): 127–30. doi:10.1016/j.ejvs.2007.01.015. PMID 17400487.
  98. ↑ Boedeker CC, Ridder GJ, Schipper J (2005). “Paragangliomas of the head and neck: diagnosis and treatment”. Fam. Cancer. 4 (1): 55–9. doi:10.1007/s10689-004-2154-z. PMID 15883711.
  99. ↑ Gluckman JL, Robbins KT, Fried MP (1990). “Cervical metastatic squamous carcinoma of unknown or occult primary source”. Head Neck. 12 (5): 440–3. PMID 2211107.
  100. ↑ Waltonen JD, Ozer E, Hall NC, Schuller DE, Agrawal A (October 2009). “Metastatic carcinoma of the neck of unknown primary origin: evolution and efficacy of the modern workup”. Arch. Otolaryngol. Head Neck Surg. 135 (10): 1024–9. doi:10.1001/archoto.2009.145. PMID 19841343.
  101. ↑ Feldman PS, Kaplan MJ, Johns ME, Cantrell RW (November 1983). “Fine-needle aspiration in squamous cell carcinoma of the head and neck”. Arch Otolaryngol. 109 (11): 735–42. PMID 6639441.
  102. ↑ Grénman R, Koivunen P, Minn H (2015). “[Laryngeal cancer in Finland]”. Duodecim (in Finnish). 131 (4): 331–7. PMID 26237923.
  103. ↑ Guneyli S, Cinar C, Bozkaya H, Korkmaz M, Oran I (September 2016). “Endovascular management of congenital arteriovenous fistulae in the neck”. Diagn Interv Imaging. 97 (9): 871–5. doi:10.1016/j.diii.2015.08.006. PMID 26972281.
  104. ↑ Gobin YP, Garcia de la Fuente JA, Herbreteau D, Houdart E, Merland JJ (November 1993). “Endovascular treatment of external carotid-jugular fistulae in the parotid region”. Neurosurgery. 33 (5): 812–6. PMID 8264877.
  105. ↑ Madjar S, Weissberg D (July 1995). “Retrosternal goiter”. Chest. 108 (1): 78–82. PMID 7606997.
  106. ↑ Hedayati N, McHenry CR (March 2002). “The clinical presentation and operative management of nodular and diffuse substernal thyroid disease”. Am Surg. 68 (3): 245–51, discussion 251–2. PMID 11893102.
  107. ↑ Hughes K, Eastman C (August 2012). “Goitre – causes, investigation and management”. Aust Fam Physician. 41 (8): 572–6. PMID 23145396.
  108. ↑ Hermus AR, Huysmans DA (August 2000). “[Diagnosis and therapy of patients with euthyroid goiter]”. Ned Tijdschr Geneeskd (in Dutch; Flemish). 144 (34): 1623–7. PMID 10972051.


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Epidemiology and Demographics

Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

The incidence of nasopharyngeal carcinoma is different based on the geographic areas. The incidence in the USA is low, in Alaska and Greenland is moderate and the highest incidence is seen in southeast Asia, North Africa, southern China and middle east. The incidence of this disease increases with increasing age in low- risk population. However, in high-risk populations, the maximum incidence is seen in individuals around ages 50 to 59 and then the incidence decreases by increasing age. Nasopharyngeal carcinoma usually affects individuals of the Asian race, and is more commonly affected by male than female. The majority of nasopharyngeal carcinoma cases are reported in southern China, Southeast Asia, North Africa and also is more seen in Inuit Indians.

Epidemiology and Demographics

Incidence

  • The incidence of nasopharyngeal carcinoma is different based on the geographic areas. The incidence in the USA is approximately 0.2 to 0.5 per 100,000 individuals, in Alaska and Greenland is 15 to 20 per 100,000 individuals and the highest incidence is seen in southeast Asia, North Africa, southern China and middle east with the incidence of 80 per 100,000 individuals.[1][2]

Case-fatality rate/Mortality rate

  • In 2008 , the incidence of nasopharyngeal carcinoma is approximately 0.84 per 100,000 individuals with mortality rate of 61.13%.[3]

Age

Race

  • Nasopharyngeal carcinoma usually affects individuals of the Asian race.[6]

Gender

Region

  • The majority of nasopharyngeal carcinoma cases are reported in southern China, Southeast Asia, North Africa and also is more seen in Inuit Indians.[8][9]

References

  1. ↑ Caponigro, Francesco; Longo, Francesco; Ionna, Franco; Perri, Francesco (2010). “Treatment approaches to nasopharyngeal carcinoma: a review”. Anti-Cancer Drugs. 21 (5): 471–477. doi:10.1097/CAD.0b013e328337160e. ISSN 0959-4973.
  2. ↑ Lee, Anne W.M.; Ng, W.T.; Chan, Y.H.; Sze, Henry; Chan, Connie; Lam, T.H. (2012). “The battle against nasopharyngeal cancer”. Radiotherapy and Oncology. 104 (3): 272–278. doi:10.1016/j.radonc.2012.08.001. ISSN 0167-8140.
  3. ↑ Jemal, Ahmedin; Bray, Freddie; Center, Melissa M.; Ferlay, Jacques; Ward, Elizabeth; Forman, David (2011). “Global cancer statistics”. CA: A Cancer Journal for Clinicians. 61 (2): 69–90. doi:10.3322/caac.20107. ISSN 0007-9235.
  4. ↑ Lee, Jivianne T.; Ko, Clifford Y. (2016). “Has survival improved for nasopharyngeal carcinoma in the United States?”. Otolaryngology-Head and Neck Surgery. 132 (2): 303–308. doi:10.1016/j.otohns.2004.09.018. ISSN 0194-5998.
  5. ↑ Lee, Anne W.M.; Foo, William; Mang, Oscar; Sze, W.M.; Chappell, Rick; Lau, W.H.; Ko, W.M. (2003). “Changing epidemiology of nasopharyngeal carcinoma in Hong Kong over a 20-year period (1980-99): An encouraging reduction in both incidence and mortality”. International Journal of Cancer. 103 (5): 680–685. doi:10.1002/ijc.10894. ISSN 0020-7136.
  6. ↑ Wang, Yu; Zhang, Yawei; Ma, Shuangge (2013). “Racial differences in nasopharyngeal carcinoma in the United States”. Cancer Epidemiology. 37 (6): 793–802. doi:10.1016/j.canep.2013.08.008. ISSN 1877-7821.
  7. ↑ Jia, Wei-Hua; Qin, Hai-De (2012). “Non-viral environmental risk factors for nasopharyngeal carcinoma: A systematic review”. Seminars in Cancer Biology. 22 (2): 117–126. doi:10.1016/j.semcancer.2012.01.009. ISSN 1044-579X.
  8. ↑ Chang, E. T.; Adami, H.-O. (2006). “The Enigmatic Epidemiology of Nasopharyngeal Carcinoma”. Cancer Epidemiology Biomarkers & Prevention. 15 (10): 1765–1777. doi:10.1158/1055-9965.EPI-06-0353. ISSN 1055-9965.
  9. ↑ Muhyi Al-Sarraf & Maryada S. Reddy (2002). “Nasopharyngeal carcinoma”. Current treatment options in oncology. 3 (1): 21–32. PMID 12057084. Unknown parameter |month= ignored (help)


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Risk Factors

Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

Common risk factors in the development of nasopharyngeal carcinoma include the family history of cancer, smoking, some disease in ear, nose, and throat, inadequate consumption of fresh fruits and vegetables, heavily alcohol consuming, herbal products and exposure to wood dust.

Risk Factors

Common Risk Factors

References

  1. ↑ Chang, E. T.; Adami, H.-O. (2006). “The Enigmatic Epidemiology of Nasopharyngeal Carcinoma”. Cancer Epidemiology Biomarkers & Prevention. 15 (10): 1765–1777. doi:10.1158/1055-9965.EPI-06-0353. ISSN 1055-9965.
  2. ↑ Friborg, Jeppe; Wohlfahrt, Jan; Koch, Anders; Storm, Hans; Olsen, Ove R.; Melbye, Mads (2005). “Cancer Susceptibility in Nasopharyngeal Carcinoma Families—A Population-Based Cohort Study”. Cancer Research. 65 (18): 8567–8572. doi:10.1158/0008-5472.CAN-04-4208. ISSN 0008-5472.
  3. ↑ Guo, Xiuchan; Johnson, Randall C.; Deng, Hong; Liao, Jian; Guan, Li; Nelson, George W.; Tang, Mingzhong; Zheng, Yuming; de The, Guy; O’Brien, Stephen J.; Winkler, Cheryl A.; Zeng, Yi (2009). “Evaluation of nonviral risk factors for nasopharyngeal carcinoma in a high-risk population of Southern China”. International Journal of Cancer. 124 (12): 2942–2947. doi:10.1002/ijc.24293. ISSN 0020-7136.
  4. ↑ Ji, Xuemei; Zhang, Weidong; Xie, Conghua; Wang, Bicheng; Zhang, Gong; Zhou, Fuxiang (2011). “Nasopharyngeal carcinoma risk by histologic type in central China: Impact of smoking, alcohol and family history”. International Journal of Cancer. 129 (3): 724–732. doi:10.1002/ijc.25696. ISSN 0020-7136.
  5. ↑ J. M. Yuan, X. L. Wang, Y. B. Xiang, Y. T. Gao, R. K. Ross & M. C. Yu (2000). “Non-dietary risk factors for nasopharyngeal carcinoma in Shanghai, China”. International journal of cancer. 85 (3): 364–369. PMID 10652428. Unknown parameter |month= ignored (help)
  6. ↑ Wiwat Ekburanawat, Chatchai Ekpanyaskul, Paul Brennan, Chaiyaporn Kanka, Kitisak Tepsuwan, Somnuk Temiyastith, Tawin Klinvimol, Surathat Pongnikorn & Suleeporn Sangrajrang (2010). “Evaluation of non-viral risk factors for nasopharyngeal carcinoma in Thailand: results from a case-control study”. Asian Pacific journal of cancer prevention : APJCP. 11 (4): 929–932. PMID 21133603.
  7. ↑ Marron, M.; Boffetta, P.; Zhang, Z.-F.; Zaridze, D.; Wunsch-Filho, V.; Winn, D. M; Wei, Q.; Talamini, R.; Szeszenia-Dabrowska, N.; Sturgis, E. M; Smith, E.; Schwartz, S. M; Rudnai, P.; Purdue, M. P; Olshan, A. F; Eluf-Neto, J.; Muscat, J.; Morgenstern, H.; Menezes, A.; McClean, M.; Matos, E.; Mates, I. N.; Lissowska, J.; Levi, F.; Lazarus, P.; Vecchia, C. L.; Koifman, S.; Kelsey, K.; Herrero, R.; Hayes, R. B; Franceschi, S.; Fernandez, L.; Fabianova, E.; Daudt, A. W; Maso, L. D.; Curado, M. P.; Cadoni, G.; Chen, C.; Castellsague, X.; Boccia, S.; Benhamou, S.; Ferro, G.; Berthiller, J.; Brennan, P.; Moller, H.; Hashibe, M. (2009). “Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk”. International Journal of Epidemiology. 39 (1): 182–196. doi:10.1093/ije/dyp291. ISSN 0300-5771.
  8. ↑ A. Hildesheim, S. West, E. DeVeyra, M. F. De Guzman, A. Jurado, C. Jones, J. Imai & Y. Hinuma (1992). “Herbal medicine use, Epstein-Barr virus, and risk of nasopharyngeal carcinoma”. Cancer research. 52 (11): 3048–3051. PMID 1317256. Unknown parameter |month= ignored (help)
  9. ↑ S. West, A. Hildesheim & M. Dosemeci (1993). “Non-viral risk factors for nasopharyngeal carcinoma in the Philippines: results from a case-control study”. International journal of cancer. 55 (5): 722–727. PMID 7503957. Unknown parameter |month= ignored (help)
  10. ↑ Hsu, W.-L.; Chen, J.-Y.; Chien, Y.-C.; Liu, M.-Y.; You, S.-L.; Hsu, M.-M.; Yang, C.-S.; Chen, C.-J. (2009). “Independent Effect of EBV and Cigarette Smoking on Nasopharyngeal Carcinoma: A 20-Year Follow-Up Study on 9,622 Males without Family History in Taiwan”. Cancer Epidemiology Biomarkers & Prevention. 18 (4): 1218–1226. doi:10.1158/1055-9965.EPI-08-1175. ISSN 1055-9965.
  11. ↑ M. C. Yu, D. H. Garabrant, T. B. Huang & B. E. Henderson (1990). “Occupational and other non-dietary risk factors for nasopharyngeal carcinoma in Guangzhou, China”. International journal of cancer. 45 (6): 1033–1039. PMID 2351484. Unknown parameter |month= ignored (help)
  12. ↑ R. W. Armstrong, P. B. Imrey, M. S. Lye, M. J. Armstrong, M. C. Yu & S. Sani (2000). “Nasopharyngeal carcinoma in Malaysian Chinese: occupational exposures to particles, formaldehyde and heat”. International journal of epidemiology. 29 (6): 991–998. PMID 11101539. Unknown parameter |month= ignored (help)
  13. ↑ Yang, X.(R. (2005). “Evaluation of Risk Factors for Nasopharyngeal Carcinoma in High-Risk Nasopharyngeal Carcinoma Families in Taiwan”. Cancer Epidemiology Biomarkers & Prevention. 14 (4): 900–905. doi:10.1158/1055-9965.EPI-04-0680. ISSN 1055-9965.
  14. ↑ A. Hildesheim, M. Dosemeci, C. C. Chan, C. J. Chen, Y. J. Cheng, M. M. Hsu, I. H. Chen, B. F. Mittl, B. Sun, P. H. Levine, J. Y. Chen, L. A. Brinton & C. S. Yang (2001). “Occupational exposure to wood, formaldehyde, and solvents and risk of nasopharyngeal carcinoma”. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 10 (11): 1145–1153. PMID 11700262. Unknown parameter |month= ignored (help)


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Screening

Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

Screening for nasopharyngeal carcinoma only is done in endemic areas. Different methods, such as measurement the titre of different types of antibodies against EBV and plasma EBV DNA, and endoscopic examination of nasopharynx can be used for screening.

Screening

Screening for nasopharyngeal carcinoma only is done in endemic areas, the screening methods which can be used are:[1][2][3][4][5][6][7][8]

References

  1. ↑ Altun, M.; Fandi, A.; Dupuis, O.; Cvitkovic, E.; Krajina, Z.; Eschwege, F. (1995). “Undifferentiated nasopharyngeal cancer (UCNT): Current diagnostic and therapeutic aspects”. International Journal of Radiation Oncology*Biology*Physics. 32 (3): 859–877. doi:10.1016/0360-3016(95)00516-2. ISSN 0360-3016.
  2. ↑ Wang, W.-Y.; Twu, C.-W.; Chen, H.-H.; Jan, J.-S.; Jiang, R.-S.; Chao, J. Y.C.; Liang, K.-L.; Chen, K.-W.; Wu, C.-T.; Lin, J.-C. (2010). “Plasma EBV DNA Clearance Rate as a Novel Prognostic Marker for Metastatic/Recurrent Nasopharyngeal Carcinoma”. Clinical Cancer Research. 16 (3): 1016–1024. doi:10.1158/1078-0432.CCR-09-2796. ISSN 1078-0432.
  3. ↑ Y. Zeng, L. G. Zhang, Y. C. Wu, Y. S. Huang, N. Q. Huang, J. Y. Li, Y. B. Wang, M. K. Jiang, Z. Fang & N. N. Meng (1985). “Prospective studies on nasopharyngeal carcinoma in Epstein-Barr virus IgA/VCA antibody-positive persons in Wuzhou City, China”. International journal of cancer. 36 (5): 545–547. PMID 4055129. Unknown parameter |month= ignored (help)
  4. ↑ Y. S. Zong, J. S. Sham, M. H. Ng, X. T. Ou, Y. Q. Guo, S. A. Zheng, J. S. Liang & H. Qiu (1992). “Immunoglobulin A against viral capsid antigen of Epstein-Barr virus and indirect mirror examination of the nasopharynx in the detection of asymptomatic nasopharyngeal carcinoma”. Cancer. 69 (1): 3–7. PMID 1309307. Unknown parameter |month= ignored (help)
  5. ↑ Wei-min Cheng, Kwok Hung Chan, Hong-lin Chen, Rui-xian Luo, S. Park Ng, Winsie Luk, Bo-jian Zheng, Ming-fang Ji, Jin-sheng Liang, Jonathan S. T. Sham, De-Kun Wang, Yong-sheng Zong & Mun Hon Ng (2002). “Assessing the risk of nasopharyngeal carcinoma on the basis of EBV antibody spectrum”. International journal of cancer. 97 (4): 489–492. PMID 11802211. Unknown parameter |month= ignored (help)
  6. ↑ Chien, Yin-Chu; Chen, Jen-Yang; Liu, Mei-Ying; Yang, Hwai-I; Hsu, Mow-Ming; Chen, Chien-Jen; Yang, Czau-Siung (2001). “Serologic Markers of Epstein–Barr Virus Infection and Nasopharyngeal Carcinoma in Taiwanese Men”. New England Journal of Medicine. 345 (26): 1877–1882. doi:10.1056/NEJMoa011610. ISSN 0028-4793.
  7. ↑ Yu, K. J.; Hsu, W.-L.; Pfeiffer, R. M.; Chiang, C.-J.; Wang, C.-P.; Lou, P.-J.; Cheng, Y.-J.; Gravitt, P.; Diehl, S. R.; Goldstein, A. M.; Chen, C.-J.; Hildesheim, A. (2011). “Prognostic Utility of Anti-EBV Antibody Testing for Defining NPC Risk among Individuals from High-Risk NPC Families”. Clinical Cancer Research. 17 (7): 1906–1914. doi:10.1158/1078-0432.CCR-10-1681. ISSN 1078-0432.
  8. ↑ Leung, S.-f. (2004). “Improved Accuracy of Detection of Nasopharyngeal Carcinoma by Combined Application of Circulating Epstein-Barr Virus DNA and Anti-Epstein-Barr Viral Capsid Antigen IgA Antibody”. Clinical Chemistry. 50 (2): 339–345. doi:10.1373/clinchem.2003.022426. ISSN 0009-9147.


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Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

If left untreated nasopharyngeal carcinoma produces few symptoms early in the course of the disease. Non-keratinizing nasopharyngeal carcinoma is associated with a 5 year survival rate of 65%. The common complications of nasopharyngeal carcinoma’s treatment include Radiation necrosis of the temporal lobes, Cranial nerve palsies, encephalomyelopathy, Atrophy and fibrosis of the muscles of mastication, atrophy of salivary glands, hearing loss, and osteoradionecrosis.

Natural History

Complications

Complications of radiotherapy include:[2][3][4][5][6][7]

Complications of chemotherapy include:[8]

Prognosis

Prognosis of nasopharyngeal carcinoma is influenced by tumor type:[9][10]

  • Type I: Keratinizing squamous cell carcinoma – 42% 5 year survival
  • Type II: Non-keratinizing squamous cell carcinoma – 65% 5 year survival
  • Type III: Undifferentiated carcinoma – 14% 5 year survival

References

  1. ↑ Petersson, Fredrik (2015). “Nasopharyngeal carcinoma: A review”. Seminars in Diagnostic Pathology. 32 (1): 54–73. doi:10.1053/j.semdp.2015.02.021. ISSN 0740-2570.
  2. ↑ A. W. Lee, S. C. Law, S. H. Ng, D. K. Chan, Y. F. Poon, W. Foo, S. Y. Tung, F. K. Cheung & J. H. Ho (1992). “Retrospective analysis of nasopharyngeal carcinoma treated during 1976-1985: late complications following megavoltage irradiation”. The British journal of radiology. 65 (778): 918–928. doi:10.1259/0007-1285-65-778-918. PMID 1422667. Unknown parameter |month= ignored (help)
  3. ↑ A. W. Lee, S. H. Ng, J. H. Ho, V. K. Tse, Y. F. Poon, C. C. Tse, G. K. Au, S. K. O, W. H. Lau & W. W. Foo (1988). “Clinical diagnosis of late temporal lobe necrosis following radiation therapy for nasopharyngeal carcinoma”. Cancer. 61 (8): 1535–1542. PMID 3349419. Unknown parameter |month= ignored (help)
  4. ↑ A. W. Lee, W. Foo, R. Chappell, J. F. Fowler, W. M. Sze, Y. F. Poon, S. C. Law, S. H. Ng, S. K. O, S. Y. Tung, W. H. Lau & J. H. Ho (1998). “Effect of time, dose, and fractionation on temporal lobe necrosis following radiotherapy for nasopharyngeal carcinoma”. International journal of radiation oncology, biology, physics. 40 (1): 35–42. PMID 9422555. Unknown parameter |month= ignored (help)
  5. ↑ Anne W. M. Lee, Dora L. W. Kwong, Sing Fai Leung, Stewart Y. Tung, Wai Man Sze, Jonathan S. T. Sham, Peter M. L. Teo, To Wai Leung, Po Man Wu, Rick Chappell, Lester J. Peters & John F. Fowler (2002). “Factors affecting risk of symptomatic temporal lobe necrosis: significance of fractional dose and treatment time”. International journal of radiation oncology, biology, physics. 53 (1): 75–85. PMID 12007944. Unknown parameter |month= ignored (help)
  6. ↑ J. Chong, L. K. Hinckley & L. E. Ginsberg (2000). “Masticator space abnormalities associated with mandibular osteoradionecrosis: MR and CT findings in five patients”. AJNR. American journal of neuroradiology. 21 (1): 175–178. PMID 10669246. Unknown parameter |month= ignored (help)
  7. ↑ Chong, V.F.H.; Ong, C.K. (2008). “Nasopharyngeal carcinoma”. European Journal of Radiology. 66 (3): 437–447. doi:10.1016/j.ejrad.2008.03.029. ISSN 0720-048X.
  8. ↑ Mould, R F; Tai, T H P (2002). “Nasopharyngeal carcinoma: treatments and outcomes in the 20th century”. The British Journal of Radiology. 75 (892): 307–339. doi:10.1259/bjr.75.892.750307. ISSN 0007-1285.
  9. ↑ Richard Cote, Saul Suster, Lawrence Weiss, Noel Weidner (Editor). Modern Surgical Pathology (2 Volume Set). London: W B Saunders. ISBN 0-7216-7253-1.
  10. ↑ Treatment and prognosis of nasopharyngeal carcinoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/nasopharyngeal-carcinoma

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Diagnosis

Diagnosis

Staging | History and Symptoms | Physical Examination | Staging | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical therapy | Interventions | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case#1


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