Anatomy

Nasopharynx lies in central skull, between posterior to nasal cavity and superior to oropharynx. Superior nasopharynx is skull base, with orifices of eustachain tube on both sides. Neck major vessels pass through surrounding with many lymph tissues.

Etiology

Etiology of nasopharyngeal carcinoma (NPC) is still unclear, and it maybe related to the following reasons:

1. Ethnical factor: People in south-eastern part of China and Taiwan contract the disease easily.
2. Genomic factor: People whose first-degree relatives have NPC are at a higher risk (20 times).
3. Virus factor: Patients of NPC have higher antibody of EB virus in serum.
4. Eating habit: eat preserved food often.
5. Environmental factor: Poor ventilation, contact to sulfuric acid gas.

Clinical symptoms

Due to anatomy of nasopharynx, NPC tend to have neck lymph nodes metastasis, aural, and nasal and cranial nerve symptoms. Nasal symptoms include bloody-tinged nasal discharge or sputum; Aural symptoms include unilateral aural fullness, tinnitus, and otitis media with effusion; cranial nerve symptoms include headache, facial numbness, and diplopia.

Diagnosis

We use whole body bone scan, abdominal sonography, PET/CT and chest X-ray to evaluate distant metastasis.

Treatment

With the advance of medical treatment, NPC is one of the cancers with best treatment outcome. Before treatment, dentists will evaluate the condition of your teeth to prevent alveolar disease after the treatment.

Radiotherapy is the main treatment, including linear accelerator, intensity modulated radiation therapy (IMRT), 3DCRT, image-guide radiation therapy (IGRT) and proton therapy. We combine chemotherapy and radiotherapy to treat patients of advance staging or neck lymph nosed metastasis. Surgery only applies to nasopharyngeal residual tumor, neck residual lymph nodes after chemotherapy and radiotherapy. Regular follow up is necessary after treatment.

Side effect

Oral ulcer and neck skin ulcer are common symptoms in acute stages of treatment, which will recover after symptomatic treatment and nutrition supply. Some patients will have saliva reduction, dry mouth, sticky nasal discharge, hearing loss, otitis media, middle ear effusion, neck muscle fibrosis, and temporal- mandibular joint stiffness. Few will have osteoradionerosis and temporal lobe necrosis.