Nasopharyngeal tumours Flashcards
Fully detail the location and therefore subsequent complications of nasopharynx tumours
The nasopharynx region is posterior to the nose - A trapezoidal space posterior to choana and superiorly to soft palate.
o Anteriorly there are the choanae,
o Superiorly, the sphenoid sinus
o Posteriorly - C1, C2
o Inferiorly - the soft palate
o 2 Lateral walls - fascia pharyngobasilar, sup. constrictor pharyngeal muscle -> orifice of Eustachian Posteriorly to orifice -> pharyngeal Rosenmuller recessus
IT IS A VERY NARROW SPACE THAT IS DIFFICULT TO SEE
Relationship with nervous structures
The tumor can spread directly into different regions causing symptoms due to the involvement of one cranial nerve (can be the first sign).
o Anterior lacerum foramen - internal carotid artery, cavernous sinus and cranial nerves 4, 5 and 6.
o Rotundum and Foramen ovale with trigeminal nerve (branches V2 and V3)
o Jugular foramen with the involvement of 9, 10, 12 cranial nerves;
o Hypoglossal canal with cranial nerve 12.
Discuss the Epidemiology, Risk Factors and Histopathology
Epidemiology
o It is a very rare tumor
o Geographically distribution: typical tumor of the East Asia, mainly China, or in Mediterranean regions of Maghreb and South of Italy.
o Normally appears in the 5th decade
o Males are much more involved than females.
o It is the 4th more common malignancy in Hong Kong.
Risk Factors:
o It is viral related:
o EBV (Check blood for the presence of EBV)
EBV infection produces a simultaneous increase in the protein of the viral membrane that acts as a pro-oncogenic substance and in the p53 gene in epithelial cells.
o HPV
• More associated with the non-endemic form.
• Patients with HPV-associated tumours had poorer survival and local control, whereas distant failures were more common with EBV-associated tumours.
Histopathology
o Carcinoma (71%)
• Keratinizing squamous cell carcinoma (25%)
• Non-keratinizing carcinoma (15%)
• Undifferentiated carcinoma (60%)
o Lymphomas (18%)
o Others (11%) - cilindroma, fibrosarcoma
Describe the clinical features and insrtumental examinations of nasopharynx tumours
Key points:
o It is a very invasive tumor.
o Symptoms are rare and one usually appear with a very big tumor.
o The nasopharynx region is very difficult to inspect.
o Mostly diagnosed at stage T3 or T4 (advanced disease).
Primary tumor symptomatology is similar to that of an influenza-like viral respiratory infection.
If the tumor involves the whole nasopharynx - epistaxis and monolateral nasal obstruction are experienced.
o Monolateral obstruction - you have to send them immediately to ENT specialist for endoscopy because you have to suspect a mass of the nose.
o If the tumor involves the orifice of the Eustachian tube - tinnitus and monolateral deafness without a full disease of the ear.
o Spread of the tumor to the cranial base - cranial nerve palsy
o Superior extension of the tumour - headache, diplopia, facial pain and numbness.
o In many patients (60%), the initial appearance is a cervical adenopathy masses, usually appearing first in retropharyngeal and level II
Instumental exams o Nasal endoscopy o CT, MRI o Biopsy o This tumor is considered like a lymphoma so you have to investigate lung, bones and kidney for distal metastasis (only in this type of head and neck tumor).
Describe the classification of Nasopharyngeal cancers
Squamous cell carcinoma
• Older adult population
• In non-endemic areas
• Worse prognosis
Non-keratinizing (differentiated and undifferentiated) Carcinoma
• In endemic areas constitute most cases (>95%),
• Young patients
• EBV infection associated
Basaloid squamous cell
Detail the treatment and prognosis of nasopharynx tumours
Treatment is never surgical, but chemo-radiotherapy.
o Normally there is a good prognosis also in the presence of long distant metastasis.
o In case of recurrence, a endoscopic resection can be done if it is very small but this is rare; in case of large recurrence, a neck dissection is done.
o 50% survive at 5 years, sometimes the prognosis is based on the presence of brain or lung metastasis. It is considered rare, here we see no more than 10-15% of those tumors and normally are pts coming from the South or immigrants.
