Parisa Momtaz and David G. Pfister
Definition
• CA of the nasopharynx, the tubular passage behind the nasal cavity & includes the superior surface of the soft palate
• Malignant tumor arising from the epithelial lining of the upper aerodigestive tract
• Differs from other CA of the head & neck in regards to natural hx, epidemiology, histology, & response to tx
• Of the CA of the head & neck, has among the highest propensities to metastasize to distant sites
Figure 17-1
Epidemiology/Risk Factors
• Uncommon in the United States & Western Europe
• Very common in southern China & Hong Kong
• Intermediate risk in Southeast Asia, North Africa, Middle East
• A/w EBV
• FHx
• Environmental factors: High intake of salt-preserved foods
Clinical Manifestations
• Nasal obstruction/epistaxis
• HA due to skull base involvement
• Neck mass due to cervical LN mets
• Serous otitis media
• Diplopia due to invasion of both the cavernous sinuses & branches of CN III, IV, VI
Diagnosis/Work-up
• H&P w/nasopharyngeal exam; mirror & fiberoptic exam
• Nasopharyngeal bx
• MRI +/− CT w/contrast of the nasopharynx, base of skull to clavicles
• Imaging to evaluate for distant met: Particularly for endemic disease (see below) & when advanced neck disease is present
• Dental evaluation
• Nutrition, speech & swallowing evaluation
• Audiogram before starting platinum-based chemotherapy
Pathology
Staging:
• Stage I: T1 N0
• Stage II: T1 N1 or T2 N0, N1
• Stage III: T1 N2 or T2 N2 or T3 N0, N1, N2
• Stage IVA: T4 N0, N1, N2, M0
• Stage IVB: Any T N3, M0
• Stage IVC: Any T, any N, M1
Treatment
• Due to the anatomic location, tx for nasopharyngeal carcinomas is radiation based
• RT: Definitive tx for stage I disease
• Concurrent chemoradiation w/platinum-containing regimen followed by adjuvant cisplatin & 5-FU more efficacious than radiotherapy alone for advanced stage M0 disease (Intergroup Trial 0099 Al-Sarraf et al. JCO 1998;16:1310) (Wee J et al. JCO 2005;23:6730): Definitive treatment for stage II-IVB disease
• More recent data questions benefits of adjuvant cisplatin & 5-FU (Chen L et al., Lancet Oncol 2012:13:163)
• Concurrent carboplatin may replace concurrent cisplatin w/RT if there is a contraindication to cisplatin (Chitapanarux I, et al. EJC 2007;43:1399)
• Neck dissection recommended for pts who achieve a CR at the 1° but have residual disease in the neck
• Met disease/Stage IVC: Initial Rx should consist of a platinum-based regimen ± radiation-based Rx
Nutrition, Speech, and Swallowing
• Given anatomic location of the tumor & s/e of RT, multidisciplinary approach w/evaluation by dentist, nutritionist, speech & swallowing therapist
• Close monitoring of nutritional status & pre- & post-tx functional evaluation
• Dysphagia & swallowing function can be assessed w/clinical swallowing assessments & videofluoroscopic swallowing studies
• Do not need to place PEG prior to initiation of tx; however feeding tubes should be considered if sev. wt loss