Nasopharyngeal Cancer

Introduction

Nasopharyngeal carcinoma is the predominant tumor type arising in the epithelium of the nasopharynx

Management

Due to deep location of nasopharynx, and anatomic proximity to critical structures, radical surgery is typically not possible. Nasopharyngeal cancer is mainly treated by radiotherapy either alone or in combination with chemotherapy.

Stage I
Management-Radiotherapy alone to primary disease and neck

Stage II–IVB
Management-Concurrent chemotherapy and radiation to the primary disease and neck

Stage IVC
Management-palliative care (which may include chemotherapy and radiotherapy)

Induction chemotherapy can be considered for stage III– IVB
Management-if delays are anticipated in initiation of concurrent chemotherapy and radiation.

Local recurrence
Management-Chemotherapy, surgery or re-irradiation

Signs and Symptoms

Diagnostic criteria

• Neck mass, unilateral hearing loss, tinnitus, nasal obstruction, epistaxis, and cranial nerve palsies

Investigation

• FBC, RFT, LFT, HIV
• Chest X-ray
• Abdominal ultrasound
• CT scan and/or MRI of the nasopharynx, skull base, and neck
• Nasopharyngoscopy
• Endoscopic guided biopsy of the primary tumor for histology
• Pet CT may be required if available
• Immunohistochemistry may be needed to further confirm the diagnosis

Staging: TNM staging system