The doctor pointed out that there are many reasons for nasal congestion. In addition to colds, runny noses or allergic attacks, some nasal diseases can also cause nasal congestion. Only unilateral persistent nasal congestion may be a benign nasal disease or a precursor to nasal cancer. These situations can't be judged by yourself. The only way is to go to the nasal clinic and check with scientific instruments to make a clear diagnosis.
It is usually a unilateral and persistent nasal obstruction caused by benign nasal diseases. Including nasal septum curvature, polypoid or fungal sinusitis, some benign tumors were released, but besides unilateral and persistent nasal congestion, they were accompanied by nosebleeds and ear swelling. You should be more careful when there is a lump in your neck, which is usually a precursor to nasal cancer. You should see a doctor as soon as possible, and don't delay the treatment.
How to distinguish the symptoms of halogen sinus tumor caused by nasal trauma?
Malignant tumors of nasal cavity and paranasal sinuses are called nasal cancer or nasopharyngeal carcinoma. We should master the common manifestations of nasal cancer for early detection and treatment. 1, nosebleeds and nosebleeds are the most common symptoms. When the cancerous tissue is very small and confined to the nasal cavity or sinuses, this symptom is the only "alarm" signal, and there is often little bleeding, sometimes only nosebleeds, so it is often ignored by patients. So pay special attention, especially to middle-aged people aged 40 to 40. If you have this symptom, you might as well ask a doctor to check it. 2. Unilateral nasal congestion and runny nose cancer appeared earlier, and nasal sinus cancer appeared later. With the enlargement of tumor tissue, nasal congestion becomes heavier and heavier, showing persistent nasal congestion. This is different from the general rhinitis with two nasal congestion alternations. After dropping 1% ephedrine solution, nasal ventilation could not be improved as obviously as rhinitis. In addition, when the tumor tissue necrosis or mixed infection, there will be a special smell of nasal mucus. 3, cheek swelling, pain and numbness This is mainly a symptom of maxillary sinus cancer. Some of these patients can feel the swelling under the local skin. 4. Eye symptoms include unilateral stereopsis, diplopia, red eye, runny nose, eye swelling and pain, and decreased vision. These symptoms usually appear earlier in ethmoidal sinus cancer. When maxillary sinus cancer and frontal sinus cancer spread to the orbit, eye symptoms will also appear. Patients often go to ophthalmology first and then to otolaryngology. The most common oral symptoms are toothache, loose teeth and difficulty in opening mouth. These symptoms are mainly related to maxillary sinus cancer. Because the roof of the mouth is the bottom wall of the maxillary sinus, the lesions of the maxillary sinus often have the symptoms of the above teeth, especially the symptoms of the first, second molars and second bicuspids on the affected side. Some upright people have almost all their upper teeth pulled out because of toothache, but the toothache has not been alleviated, and then cancer will drill out of the painful place. The diagnosis is clear, but the lesion has spread. 6. Other symptoms include swollen nose, swollen neck lymph nodes, headache and deterioration of general health, which are mostly symptoms of advanced cancer. Having said that, it must be pointed out that the above are common symptoms of nasal cancer, but as a single symptom, nasal cancer is not the most common cause of these symptoms, but mostly other diseases. This is a very important concept, otherwise it is easy to get cancer. Some diseases with the same symptoms, such as nosebleeds and nasal septum diseases; Nasal congestion is a common rhinitis; Eye and oral symptoms Common eye and tooth diseases. While being alert to nasal congestion, you should also consult your doctor carefully for examination and identification.
Li, a famous actor, suffers from nasal cancer. While everyone is sorry, there is a saying that rhinitis can lead to nasal cancer (it is reported that Li Changchun suffers from rhinitis). This makes many patients with rhinitis very worried, for fear that this rhinitis will one day become nasal cancer. Is there any scientific basis for this statement? The reporter interviewed Hua Qingquan, deputy chief physician of the Department of Otolaryngology, People's Hospital of Wuhan University.
Director Hua thinks this kind of worry is unnecessary, because so far, there is no research on rhinitis leading to nasal cancer in the medical field. Director Hua said that nasal cancer is a malignant tumor, which is a high incidence area in the Pearl River Delta of China, and the incidence rate in Wuhan is in the middle. As for the cause of nasal cancer, it is not clear at present, except that the disease is familial and related to EB virus infection. Director Hua pointed out that this does not mean that rhinitis has nothing to do with nasal cancer, because EB virus can cause upper respiratory tract infection, and sometimes this infection will have rhinitis symptoms.
What worries Director Hua is that the symptoms of nasal cancer are similar to rhinitis, with headache and stuffy nose, which makes some patients, especially those with a history of rhinitis, often wait until the late stage for treatment. Director Hua reminded patients that if the typical symptoms of nasal cancer often appear, the nose is bloody (that is, the sputum spit out by the nose is bloody), they should see a doctor. In addition, tinnitus and upper neck mass (late symptoms) may also be signs of nasal cancer.
It is understood that the 5-year survival rate of patients with advanced nasal cancer after radiotherapy is 30%-40%.
Epidemiological characteristics of 1 nasopharyngeal carcinoma
Nasopharyngeal carcinoma is a kind of head and neck tumor with high malignancy. Due to different regions, races and ages, the incidence rate varies greatly. Nasopharyngeal carcinoma is mainly found in Southeast Asia, especially in southern China (such as Guangdong, Guangxi, Fujian, Hunan and Jiangxi). ). The incidence of yellow people is high, but it is rare for white people and black people. In Guangdong province, the incidence of people who speak Cantonese is significantly higher than that of people who mainly speak Minnan dialect and Hakka dialect. Its incidence began to rise rapidly at the age of 30, and reached its peak at the age of 50 ~ 59. Most of them are male, and the ratio of male to female is 2.5 ~ 4: 1.
Clinical symptoms and signs of nasopharyngeal carcinoma
2. 1 73.7% cases of epistaxis and epistaxis have this symptom, especially those whose lesions are located in the top and back wall of nasopharynx, or those with ulcers or cauliflower on the tumor surface, and the symptoms are more typical. Light can cause nosebleed, and severe can cause nosebleed.
2.2 Tinnitus or hearing cancer is located in the pharyngeal recess or occipital part of eustachian tube, which often leads to tinnitus or hearing loss. Because the tumor often infiltrates and compresses the eustachian tube, the tympanum forms negative pressure, and exudative otitis media appears.
2.3 The nasal obstruction tumor is located in the anterior wall of nasopharynx, or the primary tumor infiltrates into the retronasal foramen, which can cause mechanical obstruction and cause nasal obstruction.
2.4 Headache often manifests as unilateral persistent pain, mostly at the top of temporal lobe. The reasons are: ① Neurovascular reflex pain; ② The end of the first branch of trigeminal nerve was compressed at the dura mater; ③ The cervical lymph node mass compresses the internal jugular vein, resulting in venous reflux disorder; ④ Inflammation and infection; ⑤ Bone destruction of skull base.
2.5 Eye symptoms include visual impairment, visual field defect, exophthalmos, diplopia, eye movement limitation, neuropathic keratitis, etc. Optic atrophy and edema can be seen in the fundus. It can be caused by cancer invading the orbit through intracranial or extracranial routes, or by cervical lymph node metastasis pressing the cervical sympathetic ganglion.
2.6 The symptoms of cranial nerve injury mainly occur in the cranial part of the cranial nerve, not the central damage. It is common that many pairs of cranial nerves are involved one after another or at the same time, among which trigeminal nerve, abducens nerve, glossopharyngeal nerve and hypoglossal nerve are more involved, thus corresponding symptoms of cranial nerve damage appear.
2.7 Symptoms of tumor metastasis The cervical lymph node metastasis rate is as high as 79.3%, which can be unilateral or bilateral. The cervical lymph node metastasis occurred earlier in the deep anterior group and the posterior group. Distant metastasis is more common, and it can also be transferred to the whole body through blood.
2.8EB The titer of EB virus-specific antibody increased significantly. At present, immune enzyme method is widely used to detect IgA/VCA (coat antigen) and IgA/EA (early antigen) antibody titers of EB virus in patients' serum. Anyone whose IgA/VCA titer is ≥ 1∶40 and/or whose IgA/EA titer is ≥ 1∶5 should be suspected as nasopharyngeal carcinoma.
Histological classification of nasopharyngeal carcinoma
3. 1WHO classification 1978, who classifies nasopharyngeal carcinoma into three types: corneal squamous cell carcinoma; Non-keratinized squamous cell carcinoma; Undifferentiated carcinoma. 199 1 2000 revised who classified nasopharyngeal carcinoma into two types: corneal squamous cell carcinoma; Non-keratinized carcinoma (differentiated; Undifferentiated type). The most important difference is whether there are obvious signs of keratinization. The former has obvious keratinization, which is more common in the elderly, and is not closely related to EB virus infection. The latter account for the majority of nasopharyngeal carcinoma without obvious keratinization, and they (especially undifferentiated type) are closely related to EB virus infection. In non-keratinizing cancer, differentiated cancer cells have clear boundaries and are arranged in layers or pavements, while undifferentiated cancer cells have unclear boundaries and are spindle-shaped, and some are spindle-shaped. Non-keratinized cancer (especially undifferentiated cancer) often has a large number of lymphocyte infiltration.
3.2 Domestic Classification According to authoritative classification in China, nasopharyngeal carcinoma can be divided into two categories: carcinoma in situ and invasive carcinoma. Invasive carcinoma includes five subtypes: tiny invasive carcinoma, squamous cell carcinoma (high, medium and low differentiation), adenocarcinoma (high, medium and low differentiation), vesicular carcinoma and undifferentiated carcinoma. This classification is often used for pathological diagnosis in China.
Histological characteristics of four common nasopharyngeal carcinoma types
4. 1 carcinoma in situ mostly occurs in superficial epithelium, and a few in crypt epithelium. Most carcinoma in situ is found between columnar epithelium (columnar carcinoma in situ); A few are located in squamous epithelium (squamous cell carcinoma in situ). Cancer in situ can involve the whole epithelium or only part of the epithelium. The diagnosis of nasopharyngeal carcinoma in situ is mainly based on cytological criteria, followed by histological features. In situ cancer cells were negative or extremely weakly positive in CK immunohistochemical staining and AB mucus staining, which could be distinguished from normal, atypical hyperplasia and metaplastic cells, while the latter were positive in CK and AB staining.
4.2 Invasive cancer
4.2. 1 Micro-invasive cancer cells break through the epithelial basement membrane and infiltrate downward, but the infiltration depth does not exceed the high (×400) visual field. The diagnosis of small invasive carcinoma requires continuous biopsy to confirm that there is no large invasive carcinoma around the invasive lesion. Most of the micro-invasive cancers on epithelial surface infiltrated downward with spindle cancer cells, and most of the micro-invasive cancers in epithelial recesses infiltrated downward with cystic cancer cells.
4.2.2 Squamous cell carcinoma Most of nasopharyngeal carcinoma originated from columnar epithelium, but most of them were squamous cell carcinoma. The differentiation characteristics of tumor squamous epithelium include: keratinized beads; Intercellular bridge; Intracellular and/or extracellular keratinization; Squamous epithelial arrangement of cancer cells in cancer nests. According to the degree of differentiation, it can be divided into three levels: high, medium and low. Highly differentiated squamous cell carcinoma, intercellular bridge and/or keratinization can be seen in most cancer tissues. Keratinization is divided into intracellular or extracellular, and sometimes the two together form keratin beads. The boundary of cancer nest is clear, cancer cells are well differentiated and mitosis is rare. There was no lymphocyte infiltration in the cancer nest. The matrix is mainly fibrous and usually accompanied by infiltration of neutrophils, lymphocytes and plasma cells. EMA and CK (especially high molecular weight CK) showed strong positive reaction. In moderately differentiated squamous cell carcinoma, a certain number of intercellular bridges or/and keratinization can be seen in the cancer tissue, but the number is far less than that of well differentiated squamous cell carcinoma. There is unequal lymphocyte infiltration in the cancer nest, and there are different numbers of plasma cells around the cancer nest Its interstitial features are the same as those of poorly differentiated squamous cell carcinoma. Sometimes most cancer cells have small or medium spindle nuclei, the cytoplasm is slightly eosinophilic or dichromatic, and the cancer cells are arranged in bundles or weaves (squamous cell carcinoma, spindle cell subtype); Sometimes most cancer cells are polygonal, with clear cell boundaries, transparent cytoplasm and small nuclei (squamous cell carcinoma, clear cell subtype). In moderately differentiated squamous cell carcinoma, it is often seen that the cancer cell nucleus is enlarged, vacuolar and nucleated. Average and CK are usually positive numbers. In poorly differentiated squamous cell carcinoma, clear intercellular bridges and/or keratinization can be seen in the cancer tissue, but the number is very small. The boundary of cancer cells is clear or faintly visible. The nucleus is deeply stained, with obvious shape and size, and tumor giant cells can be seen. Cancer cells are spindle-shaped, or polygonal transparent, or cystic nuclear cells. The boundary of cancer nest is clear or mixed with stroma, and there is unequal lymphocyte infiltration in cancer nest. The stroma is lymphocyte-rich infiltration type, or granulation tissue type, fibrosis type and inherent tissue type, often accompanied by unequal plasma cell infiltration. Sometimes the cancer tissue grows outward and forms a papillary structure (papillary squamous cell carcinoma) with the fibrous vascular stroma as the axis. Sometimes, cancer tissue grows endogenously, forming an arrangement similar to bladder transitional epithelium. There is a thin boundary film around the cancer nest, and the boundary is very clear. It used to be called "transitional cell carcinoma", but it is still classified as poorly differentiated squamous cell carcinoma. The moving average and CK can be positive numbers.
4.2.3 Adenocarcinoma is extremely rare. It can be derived from small salivary glands or columnar epithelium covered by nasopharyngeal mucosa. According to the degree of differentiation, it can also be divided into three subtypes: high, medium and low differentiation. Highly differentiated adenocarcinoma can be divided into salivary gland type and ordinary type. The former includes adenoid cystic carcinoma (more common), mucoepidermoid carcinoma (more common), malignant pleomorphic adenoma and malignant basal cell adenoma (less common). The latter includes mucinous adenocarcinoma, papillary carcinoma and tubular adenocarcinoma. Moderately differentiated adenocarcinoma, a certain number of clear glandular cavities are formed in the cancer tissue, and some of them are undifferentiated cancer structures. This is usually caused by the progression of well-differentiated adenocarcinoma. In poorly differentiated adenocarcinoma, only a few glandular cavities are formed in the cancer tissue, and most of them are undifferentiated cancer structures. AB mucus staining can be used to identify the authenticity of glandular cavity. If the cytoplasm of cancer cells contains mucus particles and mucus exists in the glandular cavity, it is confirmed that the cancer cells are adenocarcinoma cells.
Adenocarcinoma is CK positive, especially low molecular weight CK.
4.2.4 Cystic nuclear cell carcinoma The nuclei of most cancer cells are vacuolated, that is, the nuclei are round, oval or fat spindle, and the nuclear chromatin is scarce, which makes the nuclei vacuolated. Chromatin is unevenly accumulated under the nuclear membrane, which makes the thickness of the nuclear membrane uneven and huge vesicular nuclear cells can be seen. Hypertrophic nucleoli, one or several. The cytoplasm of cancer cells is pale and the boundary is unclear. There is often uneven lymphocyte infiltration in cancer nests. In pathological diagnosis, this type can only be diagnosed when the vacuolar cancer cells in the nucleus account for more than 75%. This type of nasopharyngeal carcinoma has a good prognosis after radiotherapy. CK immunohistochemical staining is often positive.
4.2.5 Undifferentiated cancer tissue lacks clear intercellular bridge and/or keratinization, and there is no clear glandular cavity structure. There are two histological manifestations of this type. First, cancer cells have clear boundaries, forming an obvious cancer nest structure, surrounded by fibrous tissue and lymphocytes. The arrangement of cancer cells is similar to squamous epithelium, but there is no intercellular bridge and/or keratinization, which is Rego type. Second, the cancer cells are small round, spindle-shaped or pleomorphic, without intercellular bridge or keratinization, without glandular cavity formation, and the cancer cells are scattered, which is Schmink type and easy to be confused with large cell malignant lymphoma, but the cancer cells are EMA and CK positive, or the reticular fiber staining is nested, which can be distinguished from lymphoma.