Diagnosis: The clinical manifestations of nasopharyngeal carcinoma can be summarized as seven symptoms of nasal congestion, nosebleed, tinnitus, deafness, headache, facial numbness and diplopia, and three signs of nasopharyngeal tumor, neck mass and cranial nerve paralysis.
1. Nose symptoms: bloody nasal aspirates or bloody nose blowing may occur in the early stage; Sometimes, sometimes. Intermittent, progressive and then persistent nasal congestion; Unilateral, then bilateral nasal congestion.
2. Ear symptoms: Some nasopharyngeal carcinomas may have tinnitus on one side, ear occlusion and hearing loss in the early stage, and sometimes they are easily misdiagnosed as secretory otitis media.
3. Cervical lymphadenopathy: The first symptom of 60% patients with nasopharyngeal carcinoma is cervical lymphadenopathy, which starts from unilateral and then develops into bilateral. Therefore, once the neck mass is found, it should be paid attention to.
4. Craniocerebral symptoms: The tumor occurring in the nasopharynx recess can destroy the skull base, damage the cranial nerve, and cause symptoms such as migraine, facial numbness, pain, diplopia, ptosis, and decreased vision (grade V, VI, II, III, and IV damage to the cranial nerve); Or symptoms (ⅸ, ⅹ, brain damage) such as soft palate paralysis, choking cough, hoarseness and tongue extension deviation may occur. The condition with cranial nerve symptoms is generally not early.
Because the anatomical location of nasopharyngeal carcinoma is hidden, early nasopharyngeal carcinoma can be asymptomatic or atypical, which can only be found in routine physical examination or general survey, or until cervical lymph node metastasis, which is easy to delay the diagnosis in clinic. Therefore, when the above symptoms and signs appear, we should be especially vigilant and see a doctor in time. Anyone with symptoms of five senses, headache, neck mass or general survey of EB virus antibody titers, especially those with significantly increased EA-IgA titers, or those who come from high-incidence areas of nasopharyngeal carcinoma or have a family history of nasopharyngeal carcinoma, should undergo a series of clinical examinations such as nasopharyngoscopy, imaging, pathology, etc., so as to make a clear diagnosis and understand the scope of the lesion, provide a basis for clinical staging and planning treatment plans, and also serve as a basis for future curative effect judgment and follow-up.
Treatment: Nasopharyngeal carcinoma is mostly poorly differentiated, and the tumor is located in the nasopharynx near the skull base, with rich neurovascular resources. The lymphatic tissue structure in the surrounding anatomical position is beyond the reach of surgery in theory and technology, and cannot be controlled by surgery alone. The stimulation and harassment of surgery may also affect the development of the disease. Therefore, it has always been listed as a pure surgical contraindication, which is not recognized by all surgeons.
Nasopharyngeal carcinoma is very sensitive to radiotherapy. At present, radiotherapy is the first choice for radical treatment of nasopharyngeal carcinoma, or the comprehensive treatment based on radiotherapy. According to NCCN2020 guidelines, simple radiotherapy is often used for early nasopharyngeal carcinoma, but the best treatment scheme for locally advanced nasopharyngeal carcinoma above stage II is still controversial, including concurrent radiotherapy and chemotherapy. Intensity modulated radiotherapy (IMRT) is recommended for radiotherapy. In recent years, with the progress of medical technology, especially IMRT has become the main technology of radiotherapy, nasopharyngeal carcinoma can obviously benefit from IMRT, the local control rate is obviously improved, and the occurrence of acute and late complications can be reduced. With the development of molecular targeted drug technology and immunotherapy technology represented by PD- 1/PD-L 1, the local control rate and survival rate of nasopharyngeal carcinoma have been significantly improved.
For some special reasons, the treatment of nasopharyngeal carcinoma is mainly radiotherapy rather than surgery. Surgical resection is not suitable for the first diagnosis and treatment. Surgery is not the first choice for the treatment of nasopharyngeal carcinoma, and past experience has proved that it is not good for patients. In some places, the otorhinolaryngology department adopts the method of endoscopic surgery, which is only suitable for the resection of local recurrent nasopharyngeal lesions after radiotherapy. A small number of patients with residual or recurrent tumors may achieve better clinical results if they meet the conditions of surgical treatment.
Prognosis: There are many factors that determine the prognosis of treatment. Early diagnosis and timely standardized treatment are the key to a good prognosis. The 5-year survival rate after early radiotherapy is about 50%. The data of recent 10 years show that the radiotherapy effect of nasopharyngeal carcinoma has been obviously improved. The local control rate of early lesions can reach more than 90%. After IMRT treatment, the local control rate can be significantly improved to more than 80%, and the 5-year overall survival rate of nasopharyngeal carcinoma can be improved to more than 80%.
1. Patient-related factors such as age (40 to 40 years old), gender (female to male) and race (Asian to non-Asian) are all considered to be related to prognosis.
2.T, N stage, pathological type, tumor volume, invasion of skull base and cranial nerve, invasion of anterior intervertebral space and other disease-related factors are prognostic factors affecting radiotherapy for nasopharyngeal carcinoma.
3. Treatment-related factors The mode of radiotherapy, total dose, chemotherapy or not and the use of targeted therapy will all affect the prognosis.
In recent years, the use of immunotherapy is beneficial to the survival of patients with partial recurrence/distant metastasis, or can significantly prolong the survival time.
4. The related factors of molecular biology, the level of EB virus antibody and DNA in plasma and the changes of related genes are significantly related to the prognosis of nasopharyngeal carcinoma.