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Nasopharyngeal Carcinoma PowerPoint Presentation

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Description : Check out this medical presentation on Nasopharyngeal Cancer, which is titled "Nasopharyngeal Carcinoma", to know about Nasopharyngeal Cancer.

Tags : Nasopharyngeal Cancer, Nasopharyngeal Carcinoma

Published on : May 25, 2021 | Views : 2695 | Downloads : 6

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Slide 1-

Nasopharyngeal Carcinoma พ.ท. ขจรเกียรติ ประสิทธิเวชชากูร
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Epidermiology
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Incidence Rare neoplasm in most parts of world Higher incidence in Chinease & Taiwan Chinease gene increase incidence of NPC Age > 40 years
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Incidence Emigration from high incidence to low incidence area  reduces incidence of NPC Male : female = 3:1
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Risk factor Genetic maker of NPC  HLA-A2 ( found in Chinease population ) EB-virus Nitrosamines Polycyclic hydrocarbons Chronic nasal sinus infection Poor hygiene
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Anatomy
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Pathology
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Pathology The most common is squamous cell carcinoma Most common position is Rosenmuller fossa Mass lesion exophytic mass Ulcerative mass Infiltrative mass
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Histopathology
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Histopathology Base on predominant histologic type WHO type 1 : Squamous cell carcinoma nonkeratizing WHO type 2 : Trasitional cell carcinoma
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Histopathology WHO type 3 : Undifferentiated carcimomas Lymphoepitheliomas Anaplastic carcinomas
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WHO type 1 Squamous cell carcinoma nonkeratizing Strong intracellular bridges Less keratin production Less associate EBV 25% of case Radioresistant tumor
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WHO type 2 Trasitional cell carcinoma Not produce keratin Greater degree of tumor pleomorphism Most common is papillary morphology 12% of case
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WHO type 3 Undifferentiated carcimomas Lymphoepitheliomas, Anaplastic carcinomas, Clear cell carcinoma, Spindle cell carcinoma Most common cell type of NPC Clear nucleus 63% aggressive behavior Radiosensitive
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Tumor Spreading
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Local invasion Anterior : involve hard palate, medial pterygoid plate, ethmoid & maxillary sinus Lateral : involve internal jugular V, internal carotid A, CN IX X XI XII,
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Local invasion Medial : Eustachian tube involvement, mastoid air cell Superior : involve base of skull, throught foramen lacerum & cavernous sinus Inferior : oropharynx & soft palate
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Lymphatic spreading Most common is neck node spreading Bilateral involvement Most common position is upper jugular node Least at submandibular & submental node
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Distance metastasis Most common is Bone Lung Liver Other sites are rare
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Clinical Manifestation
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Clinical Manifestation Related to location of primary tumor & course of disease Most common complaint is Hearing loss & lump in the neck
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Neck mass Most common spread to neck lymph node Complaint neck mass Bilateral metastasis to lymph node is common
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Neck mass Most common location is Upper jugular node ( compose of jugular node, spinal accessory node ) retropharyngeal node induce headache
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Frequency of lymph node manifestration Upper jugular region Posterior cervical group Middle & lower jugular group Supraclavicular group
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Nasal cavity involvement Blood-tinge anterior or posteriornasal drainage Obstruction of nasal pathway Epistaxis Halithosis Nasal congest
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Ear involvement Result from eustachian tube involvement Sensation of ear blockage Serous otitis media Conductive hearing loss Tinitus
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Neurologic involvement Cranial nerve involvement found 25 - 28% Pain in the neck, facial pain, facial pareathesia ( CN V ) Diplopia ( CN VI )
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Neurologic involvement CN III & IV  late phase CN VII & VIII  less involvement CN IX, X & XI  can be found
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Clinical Manifestation Neck lump 60% Ear (s) plugging & fullness 41% Hearing loss 37% Nasal bleeding 30% Nasal obstruction 29% Head pain 16% Ear pain 14% Neck pain 13% Weight loss 10% Diplopia 8% Symptom & sign of NPC frequency at diagnostic in Mayo clinic series Kuala Lumpur 1983, University of Malaya
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Clinical Manifestation Neck mass 68% Headache 58% Ear pain 52% Nasal obstruction, bloody discharge 48% Facial pareathesia 22% Dysphagia 16% Diplopia, strabismus 14% Facial pain, eye pain 12% Halithosis 12% Exopthalmos 2% Symptom from NPC found in Siriraj hospital 2532
Slide 37-

Other sign & symptom Weight Anorexia low grade fever Trismus Nasal regurgitation of fluid
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Diagnostic Evaluation
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Clinical evaluation History taking Physical examination Nasopharyngoscopy Endoscopic nasopharyngoscopy
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Radiologic evaluation Plain film head & neck CT scan head & neck ( for evaluation & treatment planning ) MRI ( if intracranial extension )
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Histopathologic evaluation Biopsy Most common site are roof of nasophalynx & Rosenmuller fossa
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Immunology Indirect immunofluorescence for IgG & IgA antibodies to viral capsid antigen (VCA) & early antigen (EA) Most specific test for diagnosis Highly predictive of the clinical course not yet commercially available
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Immunology Antibody-dependent cellular cytotoxicity ( ADCC ) Often predict the clinical course of WHO type 2&3
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Clinical Staging
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Clinical Staging T classification Tis carcinoma in situ T1 tumor confine in one site of nasopharynx no tumor visible T2 tumor involve 2 site T3 extension of tumor into nasal cavity or oropharynx T4 tumor invasion of skull or cranial involvement
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Clinical Staging N Classification Nx node cannot be assessed N0 no regional lymph node positive N1 single ipsilateral lymph node size < 3 cm.
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Clinical Staging N2a single ipsilateral lymph node size 3 - 6 cm. N2b multiple ipsilateral lypmh node size < 6 cm. N2c bilateral or contralateral lymph node size < 6 cm. N3 lymph node size > 6 cm.
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Clinical Staging M classification Mx not assessed M0 no distance metastasis M1 distance metastasis present
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Stage grouping Stage I T1 N0 M0 Stage II T2 N0 M0 Stage III T3 N0 M0 T<3 N1 M0 Stage IV T4 N<1 M0 any T N 2-3 M0 any T any N M1
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Treatment
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Radiotherapy The most proper treatment 60 - 70 Gy for 6 - 7 weeks 75 Gy if present brain involvement
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Radiotherapy Complication Dental caries Otitis media & otitis externa Trismus
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Chemotherapy Control distance metastasis Complication Hair loss Nausea & vomitting Weight loss Anorexia
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Surgery Lymph node present after radiotherapy 4 - 6 weeks Recurrent lymph node enlargement
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Prognosis
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Prognosis 5 years survival ( A.C. 1965 ) Stage I 44% Stage II 30% Radiotherapy + Chemotherapy  good result
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^_^ Thank You ^_^