ENT cancer

1. Nasopharyngeal
Carcinoma
IMM 2006

2. NPC-Introduction
 Epithelial tumour
 Unique tumour Characteristics
 Distinct geographical distribution
 Clinical characteristics
 Pathological characteristics

3. NPC-Epidemiology
 Occurs sporadically most parts of the
world
 Highest incidence in China and
southeast Asia
 Annual incidence O.5/100000-50/100000

4. NPC-epidemiology
 Age: 9-15 yrs-10%
 Peak 25-45Yrs
 Sex : male:female-2_3:1

5. NPC-Risk factors
 Genetics
 Environment
 ?Chinese herbal medicine, incence
 Dietary-nitrosamines-smoked fish
 Alcohol and smoking (type I)
 ?activates EBV
 EBV infection (types II and III)
 Human papilloma virus (type I)

6. NPC- WHO Classiffication
 Keratinising (25%)-Type 1
 Non-Keratinizing (15%)-type II
 Undifferentiated (60%)-Type III
 Type I and II commoner in endemic
areas

7. NPC-Presentation
 Sino-Nasal
 Orbital
 Oropharyngeal
 Aural
 Neurological-Intracranial,cranial nerves
 Cervical
 Distant metastases

8. NPC-Diagnosis
 Clinical presentation
 Endoscopy-Biopsy
 EUA-Biopsy
 Imaging
 CT scan
 MRI
 Ultrasound
 Plain Xrays

9. Staging
 For management , prognostication,
comparison of results
 TNM
 HO, AJC, UICC
 Different from other H&N tumours

10. NPC-Staging
 T1-Tumour confined to nasopharynx
 T2-tumour extending to the oropharynx
and/or nasal fossa
a. Parapharyngeal involvement
b. No parapharyngeal involvement
T3-Invades bony structures or paranasal
sinuses
T4-Intracranial extensionand/or cranial
nerves involvement,infratemporal fossa,
hypopharynx or orbit

11. NPC-Staging
 N0 –No regional nodes
 N1-Unilateral nodes<6cm
 N2-Bilateral nodes <6cm
 N3a-Node(s) >6cm
 N3b-supraclavicular nodes

12. NPC-Staging
 Stage 0-Tis,N0,M0
 Stage 1-T1.N0,M0
 Stage IIA-T2,N0,M0
 Stage IIB-T1,N1,M0. T2a,N1,M0.
T2bN0,M0. T2b,N1,M0
 Stage III- T1,N2,M0. T2a,N2,M0.
T3,N0,M0. T3,N1,M0. T3,N2,M0

13. NPC-Staging
 IVA-T4,N0,M0. T4,N1,M0. T4,N2,M0.
 IVB-Any T,N3,M0
 IVC-Any T, any N, M1

14. NPC-Treatment
 Radiotherapy
 External beam
 Brachetherapy
 Chemoradiation
 Concurrent chemotherapy
 Adjuvant
 Neoadjuvant
 Surgery-Biopsy, Primary, Neck
dissection

15. NPC -Prognosis
 Dependant on stage and histological
type
 Local control rates- T stage dependant
70-80%
 10yr actuarial survival 30-45%
 T1-85/95%, T2-80/90%,T3-60/75%, T4-
40/60%

16. NPC-Prognosis
 Regional control rates-Nodal control rates
 N0>90%
 N1-2 >80%
 N3 60-80%
 50% nodal recurrence associated with local
recurrence
 10 Year actuarial regional control with radiation
alone at M.D. Anderson hospital 83%

17. NPC- Prognosis
 Distant failure
 NPC higher distant Mets than other H&N
tumours-25/35%
 Nodal stage highly predictive
 Histology highly predictive- Type II and III
worse
 T stage not influential
 Bones and lungs commonest sites of
heamatogenous spread

18. NPC – Treatment of
Recurrence
 Surgery
 Local salvage surgery-various surgical approaches-
40% 3yrs disease free
 Neck dissection
 Re-radiation--locoregional control of 15-40%
 External beam
 Brachytherapy
 Combination
 High rate of temporal bone encephalopathy
 Stereotactic radiosurgery with radiotherapy