Nasopharyngeal carcinoma

1. Nasopharyngeal carcinoma

2. ABU SUFIAN HASSAN AHMED EL HAJ (E.N.T. Consultant) Associate Professor Department of Surgery Faculty of Medicine, University of Gezira

3. ANATOMY

4. ANATOMY

6. Introduction The Nasopharynx has a cuboidal shape, the lateral walls are formed by the Eustachian tube and the fosse of Rosenmuller.The roof, sloping downwards from the anterior to posterior, is boarder by pharyngeal Hypopharyx, pharyngeal tonsil, and pharyngeal bursa with the base of skull above.

7. Anteriorly, the Nasopharynx abutted the choanae and nasal cavity, posterior boundary is formed by the muscle of posterior pharyngeal wall. Inferiorly, the Nasopharynx ends at an imaginary horizontal line formed by the upper surface of the soft palate and the posterior pharyngeal wall.

8. Pathology of the Nose and Nasopharynx 1. Congenital malformations. 2. Inflammation. 3. Infection and Granulomatus Diseases 4. Trauma. 5. neoplasm

9. 1- Congenital malformations 1.Choanal stenosis or atresia. 2.Involvmemt in cleft palate. 3.Saddle nose in hypertelorism.

10. 1.Choanal stenosis or atresia.

11. 2. Inflammations & Infections. A. Acute Rhinitis or Rhino sinusitis B. Chronic Rhinitis or Rhino sinusitis - Nonspecific, - Specific

12. Cont. A. Acute Rhinitis or Rhino sinusitisInflammation of the nasal mucosa with or with out Inflammation of the PNS mucosa due to: (i) Allergy (ii) Viral infection (iii) Bacterial infection

13. Cont. B. Chronic Rhinitis or Rhino- sinusitis: i- Chronic Non specific infection as,Bacterial infection

14. ii- Chronic specific infection as, 1- Tuberculosis 2- Leprosy 3- Scleroma 4- Fungal infections as, * Aspergillosis * Rhinosporidiosis * Candidiasis 5- Leishmaniasis

15. Nasal polyposis a. Allergic i- Allergic rhinitis ii- Vasomotor rhinitis * bilaterally * ethimoids * associated ;Asthma, penicillin& aspirin allergy.

16. Cont. nasal polps Non –allergic including antro-choanal polps

17. 4. Trauma.

18. 5.Neoplasm Benign tumors Malignant tumors

19. Benign tumors 1-Epithelial i- Papilloma : HPV , EBV a- Squamous ,fungiform : wart , in vestibule & septum. b- Inverted Papilloma(Tansitional) lateral wall , high recurrence , 10% malignant transformation (intermediate tumour)

20. Benign tumors 1-Epithelial Cont. c- Keratoacanthoma. (exposed skin to sun ___scc) d- Adenoma ( mucous glands).

21. Malignant tumors Epithelial Carcinoma a. Scc b. Tansitional – type c. Adenocarcinama d. Anaplastic Malignant Melanoma

22. 2- Vascular Benign tumors a. Capillary haemangioma b. Juvenile angiofibroma c. Haemangiopericytoma (intermediate tumour) Malignant tumors Haemangiopendothelioma(Angiosarcom)

23. 3- Lymphoid tissue i- Lymphoma II- Myeloma

24. 4- Neurogenic i.Neurofibroma II. Nasal glioma (ectopic glial tissue) iii. Olfactory neuroblastom iv. Neurilemmoma (schwannoma) –nerve sheath-

25. 5- Bone and connective tissues Benign tumors a. Osteoma b. Chondroma c. Ossifying fibroma Malignant tumors a. Fibrosarcoma b.Chondrosarcoma c. Osteogenic sarcoma

26. Tumours of the Nasopharynx Benign tumors a. Tansitional – type papilloma b. Adenoma c. Cavernus haemangioma d. Juvenile angiofibroma

27. Malignant tumors 1-Carcinomas a. Anaplasticcarcinoma including (lymphoepitheoma) b. Squamous cell carcinoma c. Tansitional – type carcinoma d.Adenocarcinama .

28. Malignant tumors NPx 2-Lymphoma and Myeloma 3-Sarcomas a.Rhabdomyosarcoma b. Fibrosarcoma c. Chondrosarcoma 4- Chondroma arising from the base of skull

29. Nasopharyngeal carcinoma (NPC) is epidemiologically and histologically different from other head and neck cancers5

30. . It is an, Epstein-Barr Virus (EBV)–associated carcinoma. It has been demonstrated that EBV is harbored in almost every NPC tumor, regardless of the degree of differentiation and geographic distribution.2, 3, 4,5

31. NPChighest incidence in the World is in Southeast China, Hong Kong and Mediterranean basin.

32. North Africa and Mediterranean basin. It commonly has poorly differentiated or undifferentiated pathology with a high incidence of cervical lymph node metastasis and great radiosensitivity and chemosensitivity1

33. Age distribution ranged from 11 to 82 years with mean age44.25 years and median of 46 years. The male to female ratio was2:1.

35. Table (2): Types of malignancies encountered at INMO.

36. Graph 1: Sex distribution 33.3% Female MALE 66.7%

37. On the other hand it has low incidence in Europe, Japan and North America.(JCO, Abdelrahhim). Most cases presents with local disease and cervical lymphadenopathy.

38. Nasopharyngeal cancer (NPC) is a common cancer in Sudanese and affects men more than women.

39. Sudanese usually presents late with cervical lymphadenopathy. The commonest histological types were WHO type II and III.

40. CLINICAL PRESENTATIONS

41. NPC characterize by non-specific presentation. Most cases presents with local disease and/or cervical lymphadenopathy, approximately 60-90% of patients present with cervical nodal metastasis3, 11, 12, 13. Patients with nodal metastasis have, higher rates of treatment failure

42. Symptoms related to primary tumor include ear pain, nasal tone speech, hearing loss, trismus and symptoms and signs of other cranial nerves involvement 14. Larger tumors may cause nasal block and bleeding. In Sudan NPC is the leading cancer in men15.

44. CLINICAL PRESENTATIONS The patients had different clinical presentations The most common clinical presentation in the order of frequency was • Cervicallymphadenopathy(73.2%). • Nasal block(33.9%). • Hearing impairment(27.7%). • Epistaxis(22.3%). • Earpain(18.8%). • Palatal paralysis(14.3%).

45. 1- NECK MASS Cervical lymph nodes - More than 75% - unilateral or bilateral - Jugulodigastic L N

47. 2. NASAL. > 40% Of patients may presented with Nasal symptoms, in the forms of: - Nasal bleeding - Nasal mass. - Nasal discharge. . - Nasal deformity - Nasal obstruction.

48. 3- EAR > 30% Of patients may presented with otological symptoms, Include - Ear pain, - Hearing loss, - Ear discharge ( Secrotory otitis media) Eustachian tube obstruction

49. CRINIAL NERVES

50. Table (1) : Cranial nerve injury