ENT oncology - Nasopharyngeal cancer
ENT oncology - Nasopharyngeal cancer
Cancer of the nasopharynx or nasal cavity is a tumor that is located in the upper part of the pharynx (nasopharynx), or located behind the sinuses, of the side wall and is connected with the ear.
Geographical areas of high risk for the development of this type of cancer: South-East Asia, North Africa, and the Middle East, around the Mediterranean area.

The disease occurs either in young people aged 20-30 years or after 50 years. Men suffer more often than women. The risk factor that can trigger this disease is Epstein-Barr virus (EBV).

It is almost always detected and is accompanied by an increase in the level of anti-EBV antibodies and a search for viral load in the analyzes.
Papilloma virus can also be detected in some patient groups (HPV16).
This is the only type of ENT cancer that is not related to alcohol or smoking.

VARIOUS FORMS in accordance with the international classification of WHO distinguish between:

Type 1: keratinizing squamous cell carcinoma is rare and is observed especially in regions of the world with a very low overall disease incidence.
Type 2: non-keratinizing squamous cell carcinoma (15 to 20% of cases).
Type 3: UCNT (Undifferentiated carcinoma of the nasopharyngeal type) of epithelial origin with a characteristic lymphoid stroma, ranges from 65% (North America) to 95% (China) of cases.

Possible symptoms are nasal congestion, nosebleeds, loss of hearing or unilateral deafness or unilateral serous otitis media.
Sometimes, there may be neurological signs with damage to one or more nerves of the base of the cranium.

In some cases, the tumor can be palpated, this occurs with isolated cervical lymphadenopathy. A diagnostic evaluation with a biopsy performed by an ENT surgeon and anatomical and pathological analysis of the probe are required.
A general head and face scanner and / or PET with 18-FDG and / or MRI allow you to see a possible expansion at the base of the skull or intracranial pathological expansion, as well as find metastases.

A dental examination and panendoscopy are also performed under general anesthesia. The main treatment is radiotherapy-chemotherapy. There is no need for surgery.
The treatment consists of: targeted tumor radiosurgery, Arc-therapy of the common cavity and bilateral irradiation of the cervical lymph nodes. The usual dose with standard fractionation (1.8-2 Gy per session, 5 sessions per week) is 70 Gy for the tumor and 45-60 Gy for the areas adjacent to the tumor for preventive treatment.

There is high interest in the new radiotherapy techniques that allow good coverage of target volumes and reduction of side effects.
These techniques allow dose limitation for healthy tissues through the use of intensity modulation (VMAT) and modulated volumetric arc therapy. Simultaneously with radiotherapy, chemotherapy with cisplatin 100 mg / m2 is carried out every three weeks.
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