Nasopharyngeal Carcinoma: Sun Rong Ph.D. Department of Otolaryngology Clinical College of Chongqing Medical University

重庆医科大学附属第一医院
The First Affiliated Hospital of CQMU
Nasopharyngeal Carcinoma
（NPC）
Sun Rong Ph.D.
Department of Otolaryngology
Clinical college of Chongqing Medical University
patients with NPC
the morbidity is high , the 5-year survival rate ( 70%)
diagnose and treat early is very important
Definition
 Nasopharyngeal carcinoma (NPC) is a tumor
arising from the epithelial cells that cover the
surface and line the nasopharynx
Outline
Overview
Pathogenesis
Clinical feature
3
Diagnosis
Treatment
Overview
 Regional distribution (endemic in southern China)
 distinct geographic distribution
Southeast Asia, HongKong and parts of East and North Africa

Overview
The national distribution of the incidence of NPC
中国男性鼻咽癌高死亡专率地区地理分布图（引自《中国恶性肿瘤死亡调查研究》第248页图10-7）
Red colour represents high mortality
Overview
 NPC is the first morbidity of the head and neck

malignant tumor
 It is prevalent in Southern China, Southeast Asia
 The morbidity in male is two or three times as many as
in female
 The predilection age is 40～50 ages
Pathogenesis
Pathogenesis
Environmental
Genetic factor EBV factor
Pathogenesis
Genetic factor
 genetic susceptibility:
yellow race are more than white race, This type of

cancer more commonly affects people in Asia and
northern Africa
 familial aggregation
Pathogenesis
Epstein-Barr virus
 In 1964 Esptein and Barr found firstly in Burkitt lymphoma
 In 1966 Old firstly found NPCwas related to EBV
Researchers found antibody of EBV in the serous of the patients

and EBV-DNA in the tissue of this carcinoma
Pathogenesis
Environmental factor
 Nitrosamin
salted food, fish and preserved vegetables
 microelement nickel(Ni)
Ni has been found very high in water and rice

in southern china
exposure to chemical carcinogens
Clinical Features
Five Clinical features☆
1. Rhinol symptom
2. Aural symptom
3. Enlarged cervical lymph node
4. Symptom of cranial nerve
5. Distant metastasis
Anatomy of nasopharynx
the common passage of respiratory tract and digestive tract

Anatomy of nasopharynx
back view of the nasopharynx

Clinical manifestation
 Rhinol symptoms:
pharyngeal recess---- a clinically occult site
patients remain asymptomatic for a prolonged period
nasal obstruction
bloody rhinorrhea
 Aural symptom:
tinnitus, hearing loss, hydrotympanum, it is
usually misdiagnosed as secretory otitis media
 Cervical lymph node enlarged/ metastases （ 60%）:
usually in the posterior triangle
progressive enlargement, hard, inertia
negative tenderness
It is unilateral initial , and
becomes bilateral after development
 Symptom of cranial nerve:
Erosion into the skull base
through the foramen lacerum
Cranial nerves V, VI are most

commonly affected
 Symptom of cranial nerve:
Ⅴ（trigeminal nerve ）-headache , facial numbness
Ⅵ (abducens nerve)-diplopia
XI (accessory nerve)-difficult to shrug
XII (Hypoglossal nerve)-deviation of tongue
The third nerve The 12th nerve The sixth nerve

 Distant metastasis:
The most frequent sites of distant
metastases are bone (75 %), lung,
liver, and distant nodes
The patient can appear the

corresponding symptom
CT scan
Horizontal section Coronary section

Examination
 Posterior rhinoscopy
 Electronics Nasopharyngo-scope or nasendoscopy
The predilection site is the anterior top of the nasopharynx and

the pharyngeal recess
Examination
 Serological examination of EB virus:
EB VCA, EB NA-IgA, IgG, IgM
Helpful but not diagnostic
 Imaging examination: CT MRI PET-CT
Assess the invasion scope
 Cervical palpation: enlarged lymph node
Diagnosis
 Medical history + Careful examination
bloody rhinorrhea, nasal obstruction, tinnitus, hearing loss,

headache ,facial numbness
 Biopsy of nasopharynx
golden standard /definitive diagnosis
transnasally or transorally by endoscopy
Pathology
 Pathology:
The poorly differentiated squamous cell carcinoma is

the commonest pathological type(95%-98%)
Treatment
 Radiation therapy firstly:
linear accelerator
 Chemical therapy
The effect is not so well, but we can

use it to increase the sensitivity of
radiation therapy.
Cisplatin , Carboplatin
Treatment
 Surgery
The anatomy of Nasopharynx and skull base is complex
It is anatomically difficult and usually impossible
Residual tumor or local recurrence after radiotherapy
Emphasis
 What are the causes of NPC?
 The five clinical manifestations of NPC
 How to treat NPC?

Nasopharyngeal Carcinoma: Sun Rong Ph.D. Department of Otolaryngology Clinical College of Chongqing Medical University

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重庆医科大学附属第一医院

The First Affiliated Hospital of CQMU

Southeast Asia, HongKong and parts of East and North Africa

 NPC is the first morbidity of the head and neck

 The predilection age is 40～50 ages

yellow race are more than white race, This type of

 In 1966 Old firstly found NPCwas related to EBV

Researchers found antibody of EBV in the serous of the patients

salted food, fish and preserved vegetables

Ni has been found very high in water and rice

exposure to chemical carcinogens

3. Enlarged cervical lymph node

4. Symptom of cranial nerve

the common passage of respiratory tract and digestive tract

back view of the nasopharynx

pharyngeal recess---- a clinically occult site

patients remain asymptomatic for a prolonged period

usually in the posterior triangle

progressive enlargement, hard, inertia

It is unilateral initial , and

becomes bilateral after development

Cranial nerves V, VI are most

The third nerve The 12th nerve The sixth nerve

The patient can appear the

Horizontal section Coronary section

The predilection site is the anterior top of the nasopharynx and

bloody rhinorrhea, nasal obstruction, tinnitus, hearing loss,

golden standard /definitive diagnosis

transnasally or transorally by endoscopy

The poorly differentiated squamous cell carcinoma is

The effect is not so well, but we can

The anatomy of Nasopharynx and skull base is complex

It is anatomically difficult and usually impossible

Residual tumor or local recurrence after radiotherapy

 The five clinical manifestations of NPC

 How to treat NPC?

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