Nasopharyngeal Cancer

Nasopharyngeal Cancer

Nasopharyngeal cancer is cancer that attacks the tissues in the nasopharynx. This cancer generally grows as a malignant cancer.  Among the types of cancer that attack the head and neck, nasopharyngeal cancer is one of the most common.

The nasopharynx is one part of the throat . Its position is located behind the nasal cavity and behind the roof of the mouth. When affected by nasopharyngeal cancer, a person may experience symptoms in the form of disturbances in speaking, hearing, or breathing.

Nasopharyngeal cancer is quite difficult to detect, because the symptoms often only appear when it is in an advanced stage. To overcome this, doctors will use radiation therapy and chemotherapy methods.

Causes of Nasopharyngeal Cancer

The exact cause of nasopharyngeal cancer (nasopharyngeal carcinoma) is still unknown. However, this condition is thought to be associated with Epstein-Barr virus (EBV) infection. EBV is usually found in saliva. Transmission can occur through direct contact with other people or through contaminated objects.

Nasopharyngeal cancer is thought to arise due to EBV infection in the patient's nasopharyngeal cells. As a result, cells that have been infected with this virus experience abnormal cell growth.

EBV is the cause of several diseases, such as mononucleosis . However, in most cases, EBV does not cause a prolonged infection. Until now, the relationship between EBV and nasopharyngeal cancer is still being studied.

In addition to EBV, there are several other factors that can increase a person's risk of developing nasopharyngeal cancer, namely:

  • Male gender
  • 30–50 years old
  • Often eat foods that are preserved with salt
  • Have a family history of nasopharyngeal cancer
  • Have a history of ear, nose, and throat (ENT) disorders, such as rhinitis, otitis media, and nasal polyps
  • Smoking and consuming alcohol
  • Frequent exposure to wood powder or formaldehyde chemicals

Symptoms of Nasopharyngeal Cancer

In its early stages, nasopharyngeal cancer may not cause symptoms. Symptoms often begin to appear when the cancer has spread further. Common symptoms of nasopharyngeal cancer can include:

  • Lump in throat
  • Nosebleed
  • Constantly stuffy nose or runny nose
  • Ringing in the ears ( tinnitus ) or feeling uncomfortable
  • Hearing impairment
  • Recurrent ear infections
  • Headache
  • Blurred or shadowy vision
  • Difficulty opening mouth
  • Numbness in the face
  • Sore throat

When to go to the doctor

Some of the symptoms above are similar to those of other, milder conditions. However, if the above symptoms last for a long time and are quite disturbing, you should consult a doctor , especially if there are factors that can increase your risk of developing nasopharyngeal cancer.

Nasopharyngeal Cancer Diagnosis

The diagnosis of nasopharyngeal cancer begins with asking questions regarding the symptoms experienced, lifestyle, and the patient's and family's medical history. To confirm the patient's condition, the doctor will perform a series of examinations aimed at diagnosing and determining the severity of the cancer.

Examinations that will be carried out by the doctor include:

Physical examination

Nasopharyngeal cancer can cause lumps in the neck. The lump is usually a sign that the cancer has spread to the lymph nodes. Therefore, the ENT doctor will start the diagnosis process by pressing several parts of the neck, to detect the presence of a lump.

Nasopharyngoscopy

Nasopharyngoscopy or nasoendoscopy is a procedure to view the inside of the nasopharynx, using the endoscopic method . This procedure is done with the help of a special instrument called a nasopharyngoscope.

Nasopharyngoscope is an instrument in the form of a small tube with a camera, which will be inserted into the nasopharynx through the nose. The camera on the nasopharyngoscope will send images to the monitor, so the doctor can observe the condition of the nasopharynx.

Biopsy

A biopsy is done by taking a sample of the lump in the nasopharynx to be examined under a microscope. In sampling, doctors also usually use a nasoendoscope.

Next, the doctor will perform the following examinations, to determine the severity of the patient's nasopharyngeal cancer:

  • X-ray photo
  • CT scan
  • MRI
  • Positron Emission Topography (PET) scan

Nasopharyngeal cancer is divided into 4 stages, namely:

  • Stage 0
    Also called cancer in situ . At this stage, abnormal cells appear in the nasopharynx that can become cancerous and have the potential to spread to surrounding tissues.
  • Stage I
    Abnormal cells in the nasopharynx have turned into cancer. Cancer can spread to the tissues around the nasopharynx, such as the oropharynx (the part of the throat below the nasopharynx) or the nasal cavity.
  • Stage II The
    cancer has grown or has spread to one or more lymph nodes on one side of the neck or behind the throat.
  • Stage III The
    cancer has spread to the lymph nodes on both sides of the neck, to the bones, or to the nearby sinus cavities.
  • Stage IV
    Cancer has spread to other tissues or organs. In stage IVA the cancer spreads to other parts of the head such as the brain, throat, eyes, or salivary glands. While in stage IVB, the cancer spreads to organs far from the nasopharynx, such as the collarbone or lungs.

Nasopharyngeal Cancer Treatment

Treatment of nasopharyngeal cancer can vary, according to the history of the disease, the stage of cancer, the location of the cancer, and the general condition of the patient. Some of the commonly used nasopharyngeal cancer treatment methods are:

1. Radiotherapy

Radiotherapy is usually done to treat early-stage nasopharyngeal cancer. This procedure uses high-energy rays, to kill and stop the growth of cancer cells.

2. Chemotherapy

Chemotherapy is the administration of drugs that function to kill cancer cells. Chemotherapy is usually supported by radiotherapy or immunotherapy procedures, so that the effectiveness of treatment can be maximized.

3. Surgery

Because the nasopharynx is adjacent to many blood vessels and nerves, surgical procedures to treat nasopharyngeal cancer are rarely used. This method is more often used to remove cancer in the lymph nodes in the neck.

4. Immunotherapy

Immunotherapy is the administration of drugs that stimulate the immune system to fight cancer cells. Types of immunotherapy drugs prescribed by doctors, according to the patient's condition and needs. Examples of immunotherapy drugs to treat nasopharyngeal cancer are pembrolizumab or cetuximab .

In addition to the above treatment methods, doctors can also perform palliative care, namely treatment to prevent or treat symptoms and side effects of the treatment received.

Palliative care can be given in conjunction with other methods of treating nasopharyngeal cancer, with the aim of making the patient feel comfortable.

Complications of Nasopharyngeal Cancer

Complications that may occur due to nasopharyngeal cancer can vary in each patient. If the size is getting bigger, nasopharyngeal cancer can press on other nearby organs, such as nerves, throat, to the brain.

If the cancer or the affected lymph nodes press on the nerves, the patient may feel a radiating pain that is very disturbing. Nasopharyngeal cancer can also trigger blood clots in the brain, which can lead to stroke-like syndrome (SLS).

Nasopharyngeal cancer generally spreads to the lymph nodes around the neck. However, it is possible that nasopharyngeal cancer can spread to more distant organs, such as the bones, lungs, and liver.

Radiotherapy used as a method of treating nasopharyngeal cancer can also cause several complications, including:

  • Hypothyroidism
  • Dry mouth
  • Scar tissue on the neck
  • Dental abnormalities, such as osteonecrosis
  • Hypoplasia of muscle and bone tissue
  • hypoparathyroidism
  • Growth disorders
  • Loss of hearing ability

Prevention of Nasopharyngeal Cancer

There is no way to prevent nasopharyngeal cancer. However, there are some efforts that can be done to maintain health, so that the risk of nasopharyngeal cancer can be reduced. These efforts include:

  • Avoid consumption of foods preserved with salt
  • Avoid cigarette smoke or quit smoking
  • Do not consume alcoholic beverages
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