Nasopharyngeal Cancer (NPC)

Nasopharyngeal Cancer (NPC)

What is Nasopharynx?

The nasopharynx is the upper part of the throat (pharynx) behind the nose, where air passes on its way to the lungs. It connects the nasal cavity to the pharynx and plays a key role in respiration and speech. Different types of cells line the nasopharynx, and cancer can develop in any of these cells.

Types of Nasopharyngeal Cancer (NPC)

NPC can be categorized based on the types of cells involved:

• Keratinizing Squamous Cell Carcinoma (WHO Type 1)

• Non-Keratinizing Squamous Cell Carcinoma (WHO Type 2)

• Undifferentiated or Poorly Differentiated Carcinoma (WHO Type 3)

Statistics

• Incidence in India: 5,697 cases per year, ranking 28th among cancers.

• Mortality: 4,148 deaths annually, ranking 27th in cancer mortality.

Risk Factors

• Tobacco Use: A leading cause of cancers in the head and neck, with 85% of cases linked to tobacco in various forms such as cigarettes, beedis, or pan masala.

• Alcohol Consumption: Chronic alcohol use increases the risk.

• Combined Use of Alcohol and Tobacco: The risk multiplies when both are consumed.

• Geographical Influence: High prevalence in Southeast China and Hong Kong.

• Epstein-Barr Virus (EBV): Exposure to EBV is a significant risk factor.

• Gender: Men are twice as likely to develop NPC as women.

• Age: Risk increases with age.

• Dietary Factors: Frequent consumption of salted meats and preserved fish increases the risk.

• Environmental Exposure: Chronic exposure to smoke and dust.

• Marijuana Use: Research suggests an association with NPC.

Symptoms

• Lump in the neck

• Nasal obstruction

• Hearing loss

• Ear pain or ringing

• Persistent sore throat

• Difficulty breathing or speaking

• Frequent nosebleeds

• Facial pain or numbness

• Chronic headaches

• Difficulty opening the mouth

• Double vision or blurred vision

• Fatigue

• Unexplained weight loss

Diagnosis

• Physical Examination: The doctor examines the neck for lumps or swelling.

• Blood Tests: Checks for antibodies against the Epstein-Barr Virus (EBV).

• Endoscopy: A thin, lighted tube is inserted through the nose or mouth to inspect the nasopharynx. If abnormalities are detected, a biopsy may be performed.

• Biopsy: A tissue sample is examined under a microscope to confirm the diagnosis.

• Imaging Tests:

• X-ray

• CT Scan

• MRI

• Ultrasound

• Bone Scan

• PET-CT

• Hearing and Neurological Tests: To assess any impact on hearing or the nervous system.

Treatment Options

1. Radiation Therapy

• Uses high-energy radiation to destroy cancer cells. It is usually given once daily for five days a week.

• Types of Radiation Therapy:

• External Beam Radiation Therapy (EBRT): The most common method for NPC. Intensity-Modulated Radiation Therapy (IMRT) delivers precise doses to minimize damage to healthy tissues.

• Proton Therapy: Uses proton beams instead of X-rays and is effective for advanced NPC near the brain or spinal cord.

• Stereotactic Radiosurgery (SRS): Delivers highly focused radiation to tumors involving the skull or brain.

• Brachytherapy: Places a radioactive source close to the tumor site.

Side Effects of Radiation:

• Skin redness, itching, or dryness

• Dry mouth and thick saliva

• Fatigue

• Mouth sores

• Difficulty swallowing

• Loss of appetite

• Hypothyroidism (low thyroid function)

• Dental issues: Radiation to the mouth area may cause tooth decay and fragility, so a dental checkup is recommended before treatment.

2. Chemotherapy

• Involves the use of drugs to kill cancer cells.

• Common chemotherapy regimens:

• Gemcitabine (Gemzar) + Cisplatin (Platinol)

• Docetaxel (Taxotere), Cisplatin, + 5-Fluorouracil (5-FU)

• Cisplatin + 5-FU

• Capecitabine (Xeloda)

Side Effects of Chemotherapy:

• Fatigue

• Hair loss

• Nausea and vomiting

• Loss of appetite

• Mouth sores

• Diarrhea

• Increased risk of infections

3. Immunotherapy

• Boosts the immune system to target cancer cells.

• Common drugs used for NPC:

• Toripalimab (Tuoyi)

• Camrelizumab (AiRuiKa)

• Tislelizumab

• Pembrolizumab (Keytruda)

• Nivolumab (Opdivo)

Note: Immunotherapy is generally reserved for specific cases where other treatments are not effective.

4. Surgery

• Surgery is rarely performed due to the complex location of the nasopharynx.

• If the cancer spreads to the lymph nodes, a neck dissection may be necessary to remove the affected nodes.

Follow-Up Care

Regular follow-up is essential to monitor recovery and manage side effects. This includes:

• Physical examinations

• Blood tests

• Imaging scans to detect any recurrence

• Hearing tests to assess any impact from treatment

Nasopharyngeal cancer, though rare, can be effectively treated if detected early. Radiation therapy is the cornerstone of treatment, often combined with chemotherapy and, in certain cases, immunotherapy. Lifestyle modifications such as avoiding tobacco and alcohol play a crucial role in prevention. Early diagnosis, timely treatment, and consistent follow-up can significantly improve outcomes.

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