Nasopharyngeal cancer

Uncommon in India except in north-east[mongoloid origin]
Common in S.China, Indonesia, Taiwan.

Commonest origin : Rosenmuller fossa in lateral nasopharynx.
Metastases involves : nearly all Cranial nerves & Cervical lymph nodes.

Aetiology	genetic succeptibility in chineese Epstein-Barr virus environ - air pollution, smoking (tobacco, opium), dry salted fish(nitrosamines), incense & wood smoke
Pathological types
most common 85%	SqCC [variants: transitionalCC, lymphoepitheloima
10%	lymphomas
5%	rhabdomyosarcoma, malignant mixed salivary tumor, malignant chordoma
3 morphological types
proliferative	causes obstructive symptoms
ulcerative	epistaxis
infiltrative	invades sub-mucosa

CFs:

1. nasal obstruction:
   • discharge
   • denasal speech (rhinolalia clausa)
   • epistaxis
2. Eusthacian tube obstruction :
   • conductive deafness
   • unilateral serous/suppurative otitis media
3. Ophthalmo-neuralgic :
   • into orbit apex & CN2 - exophthalmos, blindness
   • 5 - facial pain, ↓ corneal reflex
   • CN6 - squint, diplopia
   • 3,4,6 - ophthalmoplegia
   • 9,10,11 - Jugular foramen syndrome
   • into hypoglossal canal - CN12
   • cervical sympathetic chain - Horner's syndrome
4. Cervical nodal metastases - in 75% , can be the only manifestation
5. Distant metastases to organs

Δ

• Ex postnasal space - NPmirror/nasopharyngoscope
• Xray,CTscan - extension, skull base erosion
• Biopsy - histology
• no lesion - histology by transpalatal approach for a strip of mucosa&submucosa from rosenmuller fossa

Rx

1. Irradiation for primary tumor - 6000rads
2. Radical neck dissection for persisting nodes
3. recurrent tumor -
   • external radiation
   • Brachytherapy [intracavitary implants]
   • Cryosurgery thr palatal fenestration
4. Palliative Systemic chemo – radiation failure, distant metastases

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