CASE ANALYSIS on

NASOPHARYNGEAL CARCINOMA

TERRY MAE SARCIA 4B1-BSN GROUP 3

Nasopharyngeal Tumors Several types of tumors can develop in the nasopharynx. Some of these tumors are benign (noncancerous), but others are malignant (cancerous). It is important to discuss what type of tumor you might have with your doctor.

Benign nasopharyngeal tumors Benign tumors of the nasopharynx are fairly rare and tend to occur in children and young adults. These tumors do not spread to other parts of the body and are usually not life-threatening. They include tumors or malformations of the vascular (blood-carrying) system, such as angiofibromas and hemangiomas, and benign tumors of minor salivary glands within the nasopharynx. Treatment of these tumors (if it is needed) is different from that for cancerous nasopharyngeal tumors and is not discussed further in this document. If you have one of these tumors, you and your doctor will talk about what treatments might be appropriate for you. Nasopharyngeal cancers These tumors can invade surrounding tissues and spread to other parts of the body. Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasopharynx. The nasopharynx is the upper part of the pharynx (throat) behind the nose. The pharynx is a hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). Air and food pass through the pharynx on the way to the trachea or the esophagus. The nostrils lead into the nasopharynx. An opening on each side of the nasopharynx leads into an ear. Nasopharyngeal cancer most commonly starts in the squamous cells that line the oropharynx (the part of the throat behind the mouth). Nasopharyngeal cancer is a type of head and neck cancer. Ethnic background and exposure to the Epstein-Barr virus can affect the risk of developing nasopharyngeal cancer. Anything that increases your risk of getting a disease is called a risk factor. Risk factors may include the following:

Chinese or Asian ancestry. Exposure to the Epstein-Barr virus: The Epstein-Barr virus has been associated with certaincancers, including nasopharyngeal cancer and some lymphomas. Drinking large amounts of alcohol.

Possible signs of nasopharyngeal cancer include trouble breathing, speaking, or hearing. These and other symptoms may be caused by nasopharyngeal cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

A lump in the nose or neck. A sore throat. Trouble breathing or speaking. Nosebleeds.

Trouble hearing. Pain or ringing in the ear. Headaches.

Tests that examine the nose and throat are used to detect (find) and diagnose nasopharyngeal cancer. The following tests and procedures may be used:

Physical exam of the throat: An exam in which the doctor feels for swollen lymph nodes in the neck and checks for anything else that seems unusual. Nasoscopy: A procedure to look inside the nose for abnormal areas. A nasoscope is inserted through the nose. A nasoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer. Neurological exam: A series of questions and tests to check the brain, spinal cord, and nervefunction. The exam checks a persons mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. PET scans may be used to find nasopharyngeal cancers that have spread to the bone. Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time. Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologistto check for signs of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer (whether it affects part of the nasopharynx, involves the whole nasopharynx, or has spread to other places in the body). The type of nasopharyngeal cancer. The size of the tumor. The patients age and general health.

After nasopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the nasopharynx or to other parts of the body. There are three ways that cancer spreads in the body. The process used to find out whether cancer has spread within the nasopharynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used todiagnose nasopharyngeal cancer are often also used to stage the disease. The three ways that cancer spreads in the body are:

Through tissue. Cancer invades the surrounding normal tissue. Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body. Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, ifbreast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. The following stages are used for nasopharyngeal cancer: Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells are found in the lining of the nasopharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. Stage I In stage I, cancer has formed and the cancer:

is found in the nasopharynx only; or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity.

The oropharynx is the middle part of the throat and includes the soft palate, the base of the tongue, and the tonsils.

Pea, peanut, walnut, and lime show tumor sizes. Stage II In stage II nasopharyngeal cancer, the cancer:

is found in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity. Cancer has spread to one or more lymph nodes on one side of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are 6 centimeters or smaller; or is found in the parapharyngeal space. Cancer may have spread to one or more lymph nodes on one side of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are 6 centimeters or smaller.

The oropharynx is the middle part of the throat and includes the soft palate, the base of the tongue, and the tonsils. The parapharyngeal space is a fat-filled, triangular area near the pharynx, between the base of the skull and the lower jaw. Stage III In stage III nasopharyngeal cancer, the cancer:

is found in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity. Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller; or is found in the parapharyngeal space. Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller; or has spread to nearby bones or sinuses. Cancer may have spread to one or more lymph nodes on one or both sides of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are 6 centimeters or smaller.

The oropharynx is the middle part of the throat and includes the soft palate, the base of the tongue, and the tonsils. The parapharyngeal space is a fat-filled, triangular area near the pharynx, between the base of the skull and the lower jaw. Stage IV

Stage IV nasopharyngeal cancer is divided into stages IVA, IVB, and IVC.

Stage IVA: Cancer has spread beyond the nasopharynx and may have spread to the cranialnerves, the hypopharynx (bottom part of the throat), areas in and around the side of the skull or jawbone, and/or the bone around the eye. Cancer may also have spread to one or more lymph nodes on one or both sides of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are 6 centimeters or smaller. Stage IVB: Cancer has spread to lymph nodes between the collarbone and the top of the shoulder and/or the affected lymph nodes are larger than 6 centimeters. Stage IVC: Cancer has spread beyond nearby lymph nodes to other parts of the body.

Recurrent Nasopharyngeal Cancer Recurrent nasopharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the nasopharynx or in other parts of the body. There are different types of treatment for patients with nasopharyngeal cancer. Different types of treatment are available for patients with nasopharyngeal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Three types of standard treatment are used: Radiation therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiationtherapy uses a machine outside the body to send radiation toward the cancer. Internal radiationtherapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stageof the cancer being treated. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid glandworks. The doctor may test the thyroid gland before and after therapy to make sure it is working properly. It is also important that a dentist check the patients teeth, gums, and mouth, and fix any existing problems before radiation therapy begins. Intensity-modulated radiation therapy (IMRT) is a type of 3-dimensional radiation therapy that uses that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles. This type of radiation therapy causes less damage to healthy tissue near the tumor. Compared to standard radiation therapy, intensity-modulated radiation therapy may be less likely to cause xerostomia (dry mouth). This may improve the patient's quality of life.

Stereotactic radiation therapy uses a rigid head frame attached to the skull to aim radiation directly to a tumor, causing less damage to nearby healthy tissue. The total dose of radiation is divided into several smaller doses given over several days. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into avein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Chemotherapy may be given after radiation therapy to kill any cancer cells that are left. Treatment given after radiation therapy, to lower the risk that the cancer will come back, is called adjuvant therapy. Surgery Surgery is a procedure to find out whether cancer is present, to remove cancer from the body, or to repair a body part. Also called an operation. Surgery is sometimes used for nasopharyngeal cancer that does not respond to radiation therapy. If cancer has spread to the lymph nodes, the doctor may remove lymph nodes and other tissues in the neck. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. Stage I Nasopharyngeal Cancer Treatment of stage I nasopharyngeal cancer is usually radiation therapy to the tumor and lymph nodes in the neck. Stage II Nasopharyngeal Cancer Treatment of stage II nasopharyngeal cancer may include the following:

Chemotherapy given with radiation therapy, followed by more chemotherapy. Radiation therapy to the tumor and lymph nodes in the neck.

Stage III Nasopharyngeal Cancer Treatment of stage III nasopharyngeal cancer may include the following:

Chemotherapy given with radiation therapy, which may be followed by more chemotherapy. Radiation therapy to the tumor and lymph nodes in the neck.

Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy. A clinical trial of chemotherapy given before, with, or after radiation therapy.

Stage IV Nasopharyngeal Cancer Treatment of stage IV nasopharyngeal cancer may include the following:

Chemotherapy given with radiation therapy, followed by more chemotherapy. Radiation therapy to the tumor and lymph nodes in the neck. Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy. Chemotherapy for cancer that has metastasized (spread) to other parts of the body. A clinical trial of chemotherapy given before, with, or after radiation therapy.

Treatment Options for Recurrent Nasopharyngeal Cancer Treatment of recurrent nasopharyngeal cancer may include the following:

Intensity-modulated radiation therapy, stereotactic radiation therapy, or internal radiation therapy. Surgery. Chemotherapy. A clinical trial of chemotherapy. A clinical trial of stereotactic radiation therapy.