H&N Evaluation and Management of Nasopharyngeal Carcinoma Flashcards
What are the primary risk factors associated with
nasopharyngeal carcinoma?
● EBV
● Genetics (including ethnicity and gender)
● High intake of preserve foods (nitrosamines)
People of what ethnicity are most commonly
affected by nasopharyngeal carcinoma?
Chinese. It is endemic in Southern China and Southeast
Asia.
What food confers an increased risk for nasopharyngeal carcinoma?
Salted fish. Thought to be related to the volatile nitros-
amines released in steam while cooking salt-cured foods
and early exposure to these foods in childhood
What genetic factors have been associated with
nasopharyngeal carcinoma?
● Family history (especially first-degree relatives)
● Haplotype human leukocyte antigen (HLA) alleles
● Genetic polymorphisms in CYP2A6 (nitrosamine metabolizing gene)
● Male sex 3:1 ratio
Describe the basic structure of the herpes virus
that represents a major risk factor for developing
nasopharyngeal carcinoma.
Epstein-Barr virus (EBV): ● Nuclear core early antigens (Ea) ● Double-stranded DNA ● Viral capsid antigen (VCA) ● Lytic membrane proteins (LMP): LMP-1, -2, -3 ● EBV nuclear antigens (EBNA): 1–6 ● EBV encoded ribonucleic acids (EBER)
What is the primary mode of transmission of EBV
infection?
Saliva
In which nasopharyngeal cell type is EBV infection
a risk factor for the development of malignancy?
Pseudostratified columnar respiratory epithelium. It is
carried for life by the infected person.
What is the most common nasopharyngeal
malignancy?
Nasopharyngeal carcinoma
How does the WHO classify nasopharyngeal
carcinoma?
● Type 1 (I): Squamous cell carcinoma
● Type 2a (II): Keratinizing undifferentiated carcinoma
● Type 2b (III): Nonkeratinizing undifferentiated carcinoma
In lymphoepitheliomas, does the lymphoid infil-
trate give prognostic information?
No
In lymphoepitheliomas, what characterizes a
Regaud pattern?
Tumor cells growing in well-defined aggregates admixed
with a lymphoid infiltrate
What is the most common clinical manifestation
for nasopharyngeal carcinoma?
Lymphadenopathy (60%)
In addition to cervical lymphadenopathy, what
initial symptoms are common in nasopharyngeal
carcinoma?
● Blood tinged/stained saliva/sputum; more common than
epistaxis
● Conductive hearing loss, serous otitis media
● Epistaxis
● Nasal obstruction
● Tinnitus
● Cranial nerve palsy
A patient with nasopharyngeal carcinoma has
headache and cranial nerve deficits. What do these
symptoms most likely indicate?
Intracranial extension
What syndrome is defined by tumor invasion of
the base of skull with involvement of CN III–VI
resulting in facial pain and diplopia?
Petrosphenoidal syndrome
What notochord remnant presents as a benign
cystic nasopharyngeal mass?
Thornwaldt cyst
A patient has an ulcerative nasopharyngeal mass,
bulky unilateral adenopathy, V1/V2 numbness,
and ophthalmoplegia. This process has most likely
invaded what structure?
Cavernous sinus
A middle-aged immigrant from the Guangdong
province in Southern China presents with a
unilateral middle ear effusion. What is the most
important diagnostic maneuver?
Nasopharyngoscopy
A patient with locally advanced nasopharyngeal
cancer complains of ipsilateral dry eye. Which
nerve is most likely affected?
Vidian nerve
A patient with locally advanced nasopharyngeal
cancer has a unilateral true vocal-fold paralysis,
winged scapula, and uvular deviation. What is the
name of this syndrome?
Vernet syndrome
A patient with locally advanced nasopharyngeal
cancer has an ipsilateral constricted pupil and
ptosis. What structure has been invaded?
Cervical sympathetic trunk
What blood test predicts survival in EBV-related
nasopharyngeal carcinoma?
Polymerase chain reaction (PCR) of EBV DNA
What serologic test allows for screening and
monitoring response to therapy in EBV-related
nasopharyngeal carcinoma?
Anti-EBV viral capsid antigen (VCA) and early antigen (EA) immunoglobulin A (IgA)
What characterizes WHO type 1 nasopharyngeal
carcinoma?
Keratinization
