2 Introduction 85% adult nasopharyngeal malignancies are carcinoma Common pediatric malignancies of naso-pharynx are rhabdomyosarcoma & lymphoma30% pediatric nasopharyngeal malignancies are carcinoma
3 Introduction Race: More in Chinese & North African people Sex: Male preponderance of 3:1Age: Small peak: yrs; large peak: yrsGross: Proliferative, Ulcerative & Infiltrative typesHistology: 85% Squamous cell carcinoma,10% Lymphomas, 5% Mixed
4 Aetiology1. Genetic: Commonest in Chinese population. HLA-A2 & HLA-B-Sin 2 histocompatibility locus2. Viral: Epstein-Barr Virus3. Environmental: Exposure to nitrosamines (dry salted fish), polycyclic hydrocarbons (smoke from incense & wood), smoking, chronic nasal infection, poor ventilation of nasopharynx
5 W.H.O. classification Type 1: keratinizing squamous cell carcinoma Type 2: non-keratinizing (transitional) carcinoma Without lymphoid stroma (intermediate cell) With lymphoid stroma (lympho-epithelial)Type 3: undifferentiated (anaplastic) carcinoma Without lymphoid stroma (clear cell)
13 Investigations 1. Nasopharyngoscopy & Diagnostic Nasal Endoscopy: Tumor mass seen in nasopharynxCommonest site is fossa of Rosenmüller2. Nasopharyngeal tumor biopsy: seen or blind3. F.N.A.C. of neck node: done in occult primary4. C.T. scan head & neck: for tumor extent, skull base erosion & cervical lymph node metastasis
14 Investigations 5. M.R.I. head & neck: for intracranial extension. 6. Tests for metastases: C.T. chest + abdomen, bone scan, P.E.T. scan, liver function tests.7. Serologic tests: Immuno-fluorescence for IgA antibodies to Viral Capsid Antigen, IgG antibodies to Early Antigen, Antibody Dependent Cellular Cytotoxicity assay.
37 Brachytherapy Used for small tumor, residual or recurrent tumor Interstitial: Radioactive source (Radium, Iridium, Iodine, Gold) inserted into tumor tissueIntracavitary: Radioactive source placed inside catheter or moulds & inserted into nasopharynxHigh dose rate (HDR): High intensity radiation delivered with precision under computer guidance
45 Prognosis W.H.O. Type 2 & 3 carcinomas have good response to radiotherapy & better survival rates.5 year survival rates for treated patients:Stage I = 95 – 100 %Stage II = 60 – 80 %Stage III = 30 – 60 %Stage IV = 20 – 30 %