Nasopharyngeal Cancer Flashcards
What is the m/c initial symptom of NP CA?
Neck mass (often painless)
What is the 2nd m/c presenting symptom of NP CA?
Serous otitis media from ET obstruction
What is the m/c CN palsy a/w NP CA?
CN 6 palsy
What is the infectious disease a/w NP CA?
EBV
EBV serology tests
- EA (Early Intracellular Antigen): early antigen
- VCA (Viral Capsule Antigen): late antigen, most specific immunologic finding in NP CA
- Low titers of IgA EA and IgA VCA is a poor prognostic sign
Anatomical boundaries of the nasopharynx
- Ant: Choanae
- Sup: base of the skull (body of the sphenoid)
- Inf: plane of the soft palate
- Lat: ET orifices
- Post: Superior constrictor muscles
What is the m/c site of tumor in the nasopharynx?
Fossa of Rosenmuller
What is Passavant’s Ridge
Interdigitating superior constrictor muscles that form a band at the posterior pharyngeal wall during swallowing that abuts the soft palate
What are the subsites of NP CA
- Posterior NP wall
- Lateral NP wall
- Soft palate
T1 NP CA
Confined to NP or extends to OP or nasal cavity (w/o parapharyngeal extension)
T2 NP CA
Parapharyngeal extension
T3 NP CA
Invades bony structures of the skull base or paranasal sinuses
T4 NP CA
Invades intracranially or cranial nerves, hypopharynx, orbit, or extends to infratemporal fossa/masticator space
WHO Classification
World Health Organization classification based on histopathology
WHO Type I
Keratinizing SCCa
- 2nd m/c subtype
- Squamous differentiation
- Not a/w EBV
- Worse prognosis
- Less sensitive to RT
WHO Type II
Nonkeratinizing SCCa
- No squamous differentiation
- A/w EBV
- Better prognosis
- Sensitive to RT
WHO Type III
Undifferentiated
- Includes lymphoepithelioma, anaplastic, and clear cell variants
- M/c subtype
- Indistinct cell margins
- May have lymphocytic stroma (lymphoepithelioma)
- A/w EBV
- Better prognosis
- Sensitive to RT
MAN of Stage I and II NP CA
RT to primary site and b/l necks
MAN of Stage III and IV NP CA
Chemo/RT then adjuvant chemo
