Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Although much commoner in the eastern hemisphere, with an age-standardised incidence rate of 0.39 per 100 000 population, cancers of the nasopharynx form one of the rarer subsites in the head and neck.1 This paper provides recommendations on the work up and management of nasopharyngeal cancer based on the existing evidence base for this condition. Recommendations • Patients with nasopharyngeal carcinoma (NPC) should be assessed with rigid and fibre-optic nasendoscopy. (R) • Nasopharyngeal biopsies should be preferably carried out endoscopically. (R) • Multislice computed tomographic (CT) scan of head, neck and chest should be carried out in all patients and magnetic resonance imaging (MRI) where appropriate to optimise staging. (R) • Radiotherapy (RT) is the mainstay for the radical treatment for NPC. (R) • Concurrent chemoradiotherapy offers significant improvement in overall survival in stage III and IV diseases. (R) • Surgery should only be used to obtain tissue for diagnosis and to deal with otitis media with effusion. (R) • Radiation therapy is the treatment of choice for stage I and II disease. (R) • Intensity modulated radiation therapy techniques should be employed. (R) • Concurrent chemotherapy with radiation therapy is the treatment of choice for stage III and IV disease. (R) • Patients with NPC should be followed-up and assessed with rigid and/or fibre-optic nasendoscopy. (G) • Positron emission tomography-computed tomography (PET-CT), CT or MRI scan should be carried out at three months from completion of treatment to assess response. (R) • Multislice CT scan of head, neck and chest should be carried out in all patients and MRI scan whenever possible and specially in advanced cases with suspected recurrence. (R) • Surgery in form of nasopharyngectomy should be considered as a first line treatment of residual or recurrent disease at the primary site. (R) • Neck dissection remains the treatment of choice for residual or metastatic neck disease whenever possible. (R) • Re-irradiation should be considered as a second line of treatment in recurrent disease. (R).
Highlights
Nasopharyngeal carcinoma (NPC) is a squamous cell carcinoma (SCC) arising from the mucosal surface of the nasopharynx
Concurrent chemotherapy with radiation therapy is the treatment of choice for stage III and IV disease. (R)
Aetiology and risk factors The Epstein–Barr virus (EBV) and consumption of salted fish containing dimethylnitrosamine have been implicated in its aetiology
Summary
Nasopharyngeal carcinoma (NPC) is a squamous cell carcinoma (SCC) arising from the mucosal surface of the nasopharynx. The most common site is the fossa of Rosenmüller which is a recess just medial to the medial crura of the eustachian tube. Nasopharyngeal carcinoma is frequent in patients of Southern Chinese, Northern African and Alaskan origin. The incidence in the Hong Kong population is between. 20 and 30 per 100 000 inhabitants a year, but in Western countries the adjusted incidence is very low; around 1 per 100 000 per annum.[2]. Aetiology and risk factors The Epstein–Barr virus (EBV) and consumption of salted fish containing dimethylnitrosamine have been implicated in its aetiology. Clinical presentation Nasopharyngeal carcinoma is more common in men than in women (3:1), with a median age at presentation of 50 years.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
