Nanang Mardiraharjo,dr.,Sp.

THT-KL

Nasopharyngeal carcinoma (NPC)

Squamous cell carcinoma (SCC)
Arising from the epithelial Frequently : at the fossa of Rosenmuller

Relatively uncommon, incidence less than 1 per

100,000 male-to-female ratio was 3:1 median age was 50 years.

 More frequently in the Inuits of Alaska and ethnic

Chinese in the southern part of China, (province of Guangdong) causative factors:

Salted fish Epstein-Barr virus (EBV)

Genetic factor (alterations in multiple chromosomes:

deletion of regions at 14q, 16p, 1p, and amplification of 12q and 4q)

Histopathology
Histologic classification of NPC (WHO, 1978)
Type I: Keratinizing SCC Type II: nonkeratinizing epidermoid carcinomas. Type III: undifferentiated or poorly differentiated

carcinomas.

Clinical Presentations
4 groups of symptoms location of the primary tumor their infiltration of structures in the vicinity of the nasopharynx metastasis to the cervical lymph nodes.

 Nasal obstruction and discharge

Epistaxis Dysfunction of the eustachian tube conductive

deafness and other otologic symptoms Infiltrate the skull baseheadache Affects the cavernous sinus and its lateral wall N III, IV, VI diplopia

 involve the foramen ovale the N V facial pain and

numbness most frequent presenting symptom :painless neck mass in the upper neck. Distant metastasis : uncommon (vertebra, liver, and lung)

Diagnosis
physical signs examination of the postnasal space

estimation of antibody levels against EBV

imaging studies endoscopic examination

biopsy

Serology
EBV-specific antigens : early replicative antigens, latent phase antigens, late antigens Antibody response to Epstein-Barr virus : IgA anti- early antigen (EA) IgA anti- viral capsid antigen (VCA)

Imaging Studies
Computed tomography (CT)
Magnetic resonance imaging (MRI) bone marrow

infiltration Positron emission tomography (PET)

Computed tomography (axial view) showing tumor in the nasopharynx (T).

A: Axial view of positron emission tomography superimposed with computed tomography image, showing increased activity at the primary site in the nasopharynx signifying presence of tumor (arrow). B: Sagittal view of the same patient.

Endoscopic Examination
The rigid Hopkin telescopes: 0,30 and 70 excellent view of the nasopharynx do not have a suction or biopsy channel Flexible endoscope: has a suction channel biopsy forceps can be inserted through it

Rigid endoscope (0) inserted through the left nasal cavity and tumor in the nasopharynx is identified (Tumor).

Rigid endoscope (30) inserted through the left nasal cavity of the same patient and tumor in the nasopharynx identified (Tumor). The posterior edge of the septum is visible (S).

Rigid endoscope (70) inserted through the oral cavity, inspecting the nasopharynx from below. Posterior edge of the nasal septum (S) right eustachian tube orifice (arrow) and nasopharyngeal tumor can be seen extending from the right lateral wall onto the roof of the nasopharynx (Tumor).

Staging
AMERICAN JOINT COMMITTEE ON CANCER STAGING FOR NASOPHARYNGEAL CANCER Tumor in nasopharynx (T) T1 Tumor confined to the nasopharynx T2 Tumor extends to soft tissues of oro-pharynx and/or nasal fossa
T2 a without parapharyngeal extension T2 b with parapharyngeal extension

T3 Tumor invades bony structures and/or paranasal sinuses T4 Tumor with intracranial extension and/or involvement

of cranial nerves, infratemporal fossa, hypopharynx, or orbit

Regional Lymph Nodes (N) NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Unilateral metastasis in lymph node(s), 6 cm or less in greatest dimension, above the supraclavicular fossa N2 Bilateral metastasis in lymph node(s), 6 cm or less in greatest dimension, above the supraclavicular fossa N3 Metastasis in a lymph node(s) N3a greater than 6 cm in dimension N3b extension to the supraclavicular fossa

Distant Metastasis (M) MX Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis

Stage grouping

Treatment
Radiotherapy NPC is radiosensitive radiotherapy :primary treatment modality for decades. can also produce undesirable complications Chemotherapy For NPC cases with advanced locoregional disease combination with radiotherapy (neoadjuvant, concurrent, and adjuvant chemotherapy)

Terapi
Radioterapi

dosis : 6600 7000 rad Sitostatika (neoajuvan, konkuren, ajuvan kemoterapi) mis.: cisplatin, carboplatin, 5 FU, bleomisin, paclitaxel, docetaxel

Prognosis
Stadium dini 5 ysr: 70 80 % Stadium lanjut 5 ysr : 15-25%