Nasopharynx Cancers Flashcards
What is the nasopharynx?
The nasopharynx is located behind the nose and extends from the posterior nares to the level of the soft palate.
How does the nasal cavity connect to the nasopharynx?
The nasal cavity drains into the nasopharynx via the two posterior nares.
What structures are found on the lateral walls of the nasopharynx?
The two eustachian tubes, which connect to the middle ear.
What is the anatomical position of the nasopharynx?
It is a cuboidal structure lying on a line from the zygomatic arch to the external auditory meatus (EAM), extending inferiorly to the mastoid tip.
What can disease in the nasopharynx mimic?
Disease in the nasopharynx can mimic an inflammatory process and cause considerable respiratory or auditory dysfunction.
What lifestyle factors are linked to nasopharyngeal cancer?
Excess use of tobacco and moderate alcohol intake (up to 15 drinks a week) are linked to nasopharyngeal cancer.
What factors predispose individuals to nasopharyngeal cancer?
Factors include Chinese (or Asian) ancestry and Epstein-Barr virus (EBV) exposure.
What are the boundaries of the nasopharynx?
Anterior: nasal cavity; Superior: sphenoid sinus; Inferior: soft palate and mastoid tip; Posterior: 1st and 2nd cervical vertebra.
What are common presenting symptoms of nasopharyngeal cancer?
Symptoms include bloody discharge, auditory dysfunction, cranial nerve involvement (III, V, VI, IX, XII), painless enlarged lymph nodes in the neck, nasal obstruction, epistaxis, tinnitus, recurrent otitis media, sore throat, and headache.
What are the methods for NPC Detection and Diagnosis?
History and Physical Exam, Inspection/indirect mirror examination, Palpation, Biopsy, EBV-specific serologic tests, Fiber optic endoscopy, CT/MRI, Chest x-ray
What is the lymphatic drainage for NPC?
Retropharyngeal nodes into the Deep cervical nodes, superior jugular and posterior cervical nodes, lateral retropharyngeal nodes at the base of the skull (node of Rouviere)
What is the primary treatment for NPC?
No surgery due to location.
What chemotherapy drug is most commonly used for NPC?
Cisplatin is the chemo drug used most often.
What has IMRT replaced in NPC treatment?
IMRT replaced conventional 3D treatment.
What is the typical radiation dose for NPC treatment?
50-70 Gy QD or BID.
What are the organs at risk (OARs) in NPC treatment?
OARs include spinal cord, optic nerve, pituitary, and brainstem.
What is the superior border for NPC radiation treatment?
Superior cm beyond tumor (seen on CT) to include base of skull and sphenoid sinuses.
What is the posterior border for NPC radiation treatment?
2 cm margin beyond the mastoid process, or posterior margin may extend further to allow a 1.5 cm margin on enlarged nodes.
What is the anterior border for NPC radiation treatment?
To include the posterior third of the maxillary sinus and nasal cavity, careful attention to adequate margin (2 cm) for more anterior tumors.
What is the inferior border for NPC radiation treatment?
Thyroid notch to allow sparing of larynx.
What is the lower neck treatment approach in NPC?
Anterior supraclavicular field with larynx block.
