Nasopharyngeal cancer

Head & Neck Oncology: Nasopharyngeal Carcinoma (NPC)

High-Yield Revision Notes for Board Review & PG Entrance Examinations

Nasopharyngeal Carcinoma (NPC) is a malignancy arising from the epithelial lining of the nasopharynx, most commonly in the Fossa of Rosenmüller. It is unique in its epidemiology, pathology, and management compared to other head and neck squamous cell carcinomas.

1. Epidemiology & Etiology

• Geographic Distribution: Highest incidence in Southern China (Cantonese population) and Southeast Asia.
• Major Risk Factors:
  • Epstein-Barr Virus (EBV) Infection: Strongly associated with undifferentiated NPC.
  • Genetic Predisposition: HLA-A2 and HLA-Bw46 associations.
  • Dietary Factors: High consumption of salt-cured fish (nitrosamines).

2. Clinical Presentation

Patients often present late due to the occult nature of the nasopharynx.

• Neck Mass: Most common presenting sign (painless, metastatic cervical lymphadenopathy—often in the upper jugular chain).
• Ear Symptoms: Unilateral Otitis Media with Effusion (OME) due to obstruction of the Eustachian tube.
• Nasal/Cranial Nerve Symptoms: Epistaxis, nasal obstruction, and diplopia (if it involves the cavernous sinus/cranial nerves).

3. Histopathology (WHO Classification)

• Type I: Keratinizing Squamous Cell Carcinoma (least common, least EBV association).
• Type II: Non-keratinizing Carcinoma.
• Type III: Undifferentiated Carcinoma (most common, strongly associated with EBV, “Lymphoepithelioma”).

4. Management & Facts

• Primary Treatment: Radiotherapy is the treatment of choice (NPC is highly radiosensitive). Chemotherapy (cisplatin-based) is added in advanced stages (Concurrent Chemoradiotherapy).
• Staging: Primarily based on MRI of the nasopharynx and neck.

5. High-Yield Board Points