Nasopharynx tumors

Question 1

Risk factors of nasopharyngeal cancer?

Answer 1

Type I: Heavy alcohol, tobacco
Type II and III: EBV, Nitrosamine ingestion (salted fish), polycyclic hydrocarbons, nickel exposure
Chinese people ( HLA A2, HLA B SIN 2

Question 2

Symptoms of nasopharynx carcinoma ?

Answer 2

Nasal obstruction
Epistaxis
Conductive hearing loss due to eustachian tube obstruction
Middle ear effusion

Actual presentation when discovered:
Nodal masses in the neck (most common 75%)
Tinnitus
Headache
Diplopia, proptosis
Cranial nerve disfunction(IItoVI or IX to XII)

Question 3

Diagnosis

Answer 3

Anterior Rhinoscopy 
Biopsy 
Neck nodes examination 
Evaluation of cranial nerve function
EBV- PCR 
CT 
MRI

Question 4

What are the first nodes affected in up to 65% of cases ?

Answer 4

Retropharyngeal nodes

Question 5

Where are soft tissue masses most commonly found?

Answer 5

Lateral nasopharyngeal recess (fossa of Rosenmuller)

Question 6

Where are small lesions found ?

Answer 6

Confined to the nasopharynx by the pharyngobasilar fascia and are indistinguishable from prominent adenoidal tissue

Question 7

MRI is more sensitive to ?

Answer 7

Perineural spread and for demonstrating early the bone marrow changes of infiltration

T1: Isointense to muscle
T2: Isointense to hyperintense to muscle
T1 C+: Prominent heteregenous enhancement is typical: Perineural extension should be seen

Question 8

Post radiotherapy fibrosis can be dinstinguished from recurent/ residual tumour on MR if the fibrosis is ______ ?

Answer 8

Mature ( Early fibrotic change cannot be dinstinguished from residual/recurrent tumour)

Question 9

Type I nasopharynx carcinoma:

Answer 9

Keratinizing SCC

Question 10

Type II:

Answer 10

Non-keratinizing SCC

Question 11

Type III:

Answer 11

Undifferentiated carcinoma (Lymphoepithelioma)

Question 12

Staging TNM:

Tx, T0, Tis, T1, T2, T2a, T2b, T3, T4

Answer 12

Tx: Primary tumour cannot be assessed
T0: No evidence of primary tumour
Tis: Carcinoma in situ
T1: Carcinoma confined to the nasopharynx
T2: tumour extend to oropharynx and/or nasal fossa
a: without extension to the parapharyngeal region
b: with extension to the parapharyngeal region
T3: Invasion of adjacent bony structures and/ or paranasal sinuses
T4: Invasion of any one or more of: Intracranial content, cranial nerves, infratemporal fossa/ masticator space, hypopharynx, orbit

Question 13

Nx, N0, N1, N2, N3, N3q, N3b

Answer 13

Nx: Nodes cannot be assessed
N0: No nodal involvement
N1: Unilateral nodal involvement < 6 cm above supraclavicular fossa
N2: Bilateral nodal involvement <6cm above supraclavicular fossa
N3a: > 6 cm maximal diameter (unilateral or bilateral)
N3b: Involvement of the supraclavicular fossa

Question 14

Where do metastases of nasopharynx carcinoma occur ?

Answer 14

Lung, skeletal

Question 15

Complications after radiotherapy:

Answer 15

Xerostomia
Dental caries
Eustachian tube dysfunction
Trismus (Lockjaw)

Rare: Radionecrosis
Thyroid dysfunction
CN II dysfunction

Question 16

Most common benign tumors of the nasopharynx ?

Answer 16

Angiofribroma juvenile: Only 0.5% of all head and neck tumours
Vascular neoplasm
Only in young males

Triad of symptoms: Nasal obstruction and nasopharyngeal mass chronic otomastoiditis due to obstruction to the eustachian tube, recurrent epistaxis

Question 17

Can Angiofibroma juvenile be aggressive ?

Answer 17

Yes, locally aggressive

Question 18

Origin of angifibroma juvenile ?

Answer 18

The posterior choanal tissues in the region of the sphenopalatine foramen

Extension: Medially: Nasopharynx
Laterally: Pterygopalatine fossa
Beyond: orbit, paranasal sinuses, intracranial cavity, infratemporal fossa