• Nasopharynx Cancer

    Nasopharynx Cancer The pharynx is a muscular tube that connects the nose and mouth to the esophagus; it is commonly known as the throat. The nasopharynx is the upper part of this that contains the opening from the back of the nasal passages. It includes the adenoid tissue, eustachian tube openings, and the walls of the pharynx. It connects to the nasal passages above and the oropharynx below. Its purpose is to allow passage air and nasal secretions from the nose to the oropharynx and hypopharynx, where they are inhaled or swallowed.

    The growth and division of cells are normally regulated by the body. When cells divide in an uncontrolled manner they form a mass or tumor. Cancers, or malignant tumors, are masses that have the ability to spread to other parts of the body, and often invade or destroy tissues near to where they arise. Benign tumors do not have the ability to spread to other parts of the body and are not considered cancers.

    Nasopharyngeal carcinoma is a malignant tumor arising in the nasopharynx. Nasopharyngeal cancer develops from the cells that line the pharynx, which are called squamous cells. Lymphomas can also develop from the adenoid tissue. (This will focus on squamous cell cancers of the nasopharynx)

    Risk Factors

    • Asian descent: rates are highest in peoples from southern China, Hong Kong and Singapore. American Eskimo and Mediterranean peoples have intermediate rate, while people from other countries have very low rates of nasopharyngeal carcinoma
    • Emigrants from southeast Asia to the United States decrease their risk of nasopharyngeal carcinoma, but the rate is still 7 time higher than in caucasian Americans
    • Diet that is high in preserved foods and salted fish, or low in fruits, carotene and fiber increases risk of nasopharyngeal carcinoma
    • Epstein-Barr virus infection is associated with nasopharyngeal carcinoma

    Symptoms

    • Nasal obstruction
    • Nose bleeds
    • Throat pain
    • Ear pain, blockage or ringing
    • Hearing loss from fluid in the ear
    • Mass in the neck
    • Headache

    Diagnosis

    • A detailed history of symptoms taken by your physician
    • A full examination of the head and neck
    • Endoscopy is usually performed by an ear nose and throat physician in the office. This involves passing a rigid or flexible scope through the nose to view the nasopharynx.
    • Biopsy may be performed in the office or in the operating room, depending on the location of the tumor. This obtains a sample of the tumor cells to prove the diagnosis of cancer.
    • Needle biopsy may be performed in the office if a neck mass is present
    • MRI scan: uses powerful magnets to look at the structures of the head and neck
    • CT scan: this is a specialized X-ray performed with intravenously injected dye to look at the structures of the head and neck
    • PET scan: uses an injection of radioactive sugar to look for cells that are using a lot of energy, such as cancer cells

    Treatment

    The stage (based on the size and spread of the cancer), type and location of the tumor help the cancer team determine what type of treatment is most appropriate. The neck is often treated even if no neck mass is present, because spread of microscopic cancer cells is common. Nasopharyngeal cancer is often difficult to remove surgically if it has spread into the surrounding tissues, but it often responds well to radiation treatment. 

    Radiation Therapy

    Radiation therapy uses radiation to kill cancer cells. Radiation may be used as the primary therapy for a cancer, with chemotherapy, or after surgery. The normal cells surrounding the tumor and lymph nodes are also affected by radiation therapy. The radiation is most commonly delivered from the outside with beams focused on the tumor, and the lymph nodes of the neck. This is performed in multiple treatments; usually daily for several weeks. There are many important structures close to the nasopharynx, such as the eyes, brain and spinal cord. Intensity Modulated Radiation Therapy (IMRT) is often used when treating nasopharyngeal cancer to better target the tumor, while sparing surrounding structures. Occasionally, radioactive materials are placed near the tumor surgically, and these radiation sources may later be removed. 

    Chemotherapy

    Chemotherapy is the use of medications to kill cancer cells. There are many types of chemotherapy medications, that may be given orally, or by injection. Chemotherapy can affect cancer cells throughout the body, but some of the body's normal cells are also affected by these medications. Chemotherapy may be given before radiation, during radiation, or both. 

    Surgery

    Surgery is rarely used as the primary treatment for nasopharyngeal carcinoma. It may be used to remove a mass that remains or redevelops after radiation therapy. The nasopharynx may be reached through the nose with a scope, or through various incisions. These incisions may be in the mouth, or may be on the face. Sometimes removal of facial bones is necessary to reach the tumor, and these bones are put back in place with titanium plates and screws at the end of the procedure.

    The lymph nodes of the neck may also be removed surgically if a neck mass is present. This is called a neck dissection. Depending on the location of the tumor, the lymph nodes on the same side of the neck as the tumor, or both sides of the neck will be removed. All normal structures that are uninvolved by tumor will be preserved at the time of neck dissection. 

    Rehabilitation

    Treatment of nasopharyngeal carcinoma may produce scarring in the pharynx. This can affect speech, breathing and swallowing. The goal of rehabilitation after treatment is to preserve these functions. Therapy with a speech and swallowing pathologist may be necessary. Occasionally, surgery may be necessary to relieve scar tissue in the back of the nose or roof of the mouth. More commonly ear tubes are necessary, because the ears do not drain to the back of the nose well after treatment.
     

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