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IDENTIFYING NASOPHARYNGEAL CARCINOMA: COMMON SYMPTOMS AND EFFECTIVE TREATMENT APPROACHES
Nasopharyngeal carcinoma (NPC) is a type of cancer that originates from the epithelial cells of the nasopharynx - the region located behind the nose and above the throat (nasopharynx). It is a head-neck tumor characterized by an uneven geographical distribution, being more prevalent in Southeast Asia.
NPC is often difficult to detect early due to its hidden location and non-specific initial signs, this often leads to many cases being diagnosed at an advanced stage or with cervical lymph node metastasis.
Classification
NPC is primarily classified according to its histological characteristics and degree of differentiation:
According to epithelial types: keratinizing epithelium, non-keratinizing epithelium, and poorly differentiated or undifferentiated type.
By stage and extent of spread: primary tumor size, lymph node metastasis, local invasion, or distant metastasis. International staging systems (TNM) are applied for evaluation. (Johns Hopkins notes that primary tumor and lymph node stage are major determinants of prognosis).
Causes (risk factors)
NPC has multifactorial pathogenesis, combining genetic factors, bacterial/viral infection, environmental factors, and dietary habits:
1. Epstein-Barr Virus (EBV):
EBV is considered a central factor in many cases of NPC, particularly the non-keratinizing and undifferentiated types. EBV can cause persistent infection, promoting cellular transformation through epigenetic mechanisms or directly affecting epithelial cell DNA.
2. Genetic / Ethnic Factors:
Individuals of ethnic origin from high-risk areas (e.g., Southeast Asia) have a greater risk.
Family history of NPC.
3. Diet; food preservatives:
The consumption of salt-cured food, such as salted fish, is associated with an increased risk of NPC in regions where the consumption of preserved foods is customary.
4. Other environmental / occupational factors:
Smoking and alcohol consumption are considered to increase the risk in some types of nasopharyngeal carcinoma – however, the specific role for non-squamous and undifferentiated NPC is more complex.
Exposure to chemicals, occupational dust can be a contributing factor.
Symptoms
NPC often presents non-specific symptoms, frequently mistaken for benign ear-nose-throat diseases. As it progresses, the symptoms become clearer:
Painless cervical lymphadenopathy (neck mass) is one of the common manifestations.
Nasal obstruction or blockage, nosebleeds (epistaxis).
Hearing changes: hearing impairment, tinnitus, fluid in the middle ear, recurrent otitis media due to eustachian tube obstruction.
Headache, facial pressure, numbness or loss of sensation in a facial area if there is cranial nerve invasion.
Difficulty swallowing, sore throat, or a sensation of a foreign body in the pharynx if the tumor invades the throat or mouth.
Other systemic symptoms such as weight loss, fatigue, dry cough if there is metastasis or widespread tumor.
Diagnosis
Diagnosis of NPC requires a combination of clinical, endoscopic, imaging, and histopathological approaches:
1. Clinical examination & past medical history:
Pre-existing symptoms such as nasal congestion, nosebleeds, changes in hearing, cervical lymphadenopathy.
Risk factors such as ethnicity, family history, EBV infection.
2. Nasoendoscopy:
Use a flexible endoscope to directly observe the nasopharyngeal region, identifying tumors if present.
Take a biopsy sample when a suspicious lesion is detected.
3. Imagings:
CT scan or MRI of the head and neck region to determine the size of the primary tumor and the extent of invasion into adjacent structures.
PET-CT scan or radionuclide imaging if indicated to detect distant metastases or widespread lymph node involvement. (SingHealth / NUHS/Singapore often uses IMRT and treatment planning guided by tumor imaging).
4. Microbiological / Viral / Histological Examination:
Detection of EBV in tissue and serum can be useful for diagnosis, staging, and monitoring.
Histopathological classification (squamous or non-squamous epithelium, differentiated or undifferentiated).
5. Staging:
Use the TNM (tumor, node, metastasis) system for staging.
Assess the patient's function and overall condition to determine treatment strategy.
Treatments
The treatment strategy for NPC depends on the disease stage, histological type, patient's health, and the patient's wishes. Both Johns Hopkins and specialized hospitals in Singapore emphasize a multidisciplinary approach to treatment.
1. Radiation therapy:
This is the primary method for most cases, especially for in situ or early-stage tumors. John Hopkins notes that initial NPC 'responds well' to radiotherapy.
Modern radiation therapy techniques such as Intensity-Modulated Radiation Therapy (IMRT) are widely used to optimize the radiation dose to the tumor while simultaneously reducing damage to surrounding healthy tissue.
2. Chemotherapy:
Often used in combination with radiation therapy, especially when the tumor is large, has lymph node, or has a high risk of widespread dissemination.
Can be used concurrently with radiotherapy (concurrent chemoradiotherapy) or after radiotherapy to treat residual cells.
3. Surgery:
It is not the primary choice in the initial treatment of NPC due to its difficult-to-access location and extensive lesions.
It can be used in some cases of recurrence or when the tumor does not respond to radiation-chemotherapy, provided that distant metastasis has not developed or can be surgically removed.
4. Supportive therapy & comprehensive care:
Symptom management (e.g., pain, bleeding, congestion, hearing changes) to improve quality of life.
Follow-up after treatment to detect recurrence or early metastasis.
Nutritional consultation, physical therapy if there are effects on swallowing, speech, head-neck motor function.
Reference:
Healthhub
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