Thyroid & Adrenal
Followings is true of carcinoma of the nasopharynx
|A||High incidence of nodal metastasis|
|D||Surgery offers good chance of cure|
a. Tumors arising in the nasopharynx are usually of squamous cell origin and range from lymphoepithelioma to well-differentiated carcinoma.
b. Risk factors for nasopharyngeal carcinoma include area of habitation, ethnicity, environment, and tobacco use. A strong correlation exists between nasopharyngeal cancer and the presence of EBV infection, such that EBV titers may be used as a means to follow a patient's response to treatment.
c. The symptoms associated with presentation of nasopharyngeal tumors include nasal obstruction, posterior (level V) neck mass, epistaxis, headache, serous otitis media with hearing loss, and otalgia.
d. Cranial nerve involvement is indicative of skull base extension and advanced disease.
e. Parapharyngeal involvement occurs from posterolateral infiltration of tumor beyond the pharyngobasilar fascia.
f. Lymphatic spread occurs to the posterior cervical, upper jugular, and retropharyngeal nodes, and is frequently bilateral.
g. Distant metastasis is present in 5% of patients at presentation.
h. Examination of the nasopharynx is facilitated by the use of the flexible or rigid fiberoptic endoscope.
i. Erosion or enlargement of neural foramina (on CT imaging) or enhancement of cranial nerves (on MRI) is indicative of perineural spread of disease and portends a worse prognosis.
j. The status of the cavernous sinus and optic chiasm should also be evaluated when reviewing imaging to determine the potential for treatment related morbidities.
k. For squamous cell carcinoma and undifferentiated nasopharyngeal carcinoma, the standard treatment is a combination of chemotherapy and radiation therapy.
l. Combination therapy produces superior survival rates for nasopharyngeal carcinoma in comparison to radiation alone.
m. Intracavitary radiation boost with implants to the tumor may be included as an adjunct to external beam radiotherapy to improve local control of advanced tumors.
n. Surgical treatment for nasopharyngeal carcinoma is rarely feasible, but may occasionally be considered as salvage therapy for patients with localized recurrences