Nasopharyngeal carcinoma
Nasopharyngeal carcinoma is a squamous cell carcinoma of the nasopharynx strongly associated with Epstein-Barr virus and especially prevalent in Southeast Asia. It often presents late with a painless neck mass, unilateral otitis media, or cranial nerve palsies, and treatment centers on radiation, often combined with chemotherapy.
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What this article covers
- Overview
A squamous cell carcinoma of the nasopharynx: nasopharyngeal carcinoma arises in the nasopharynx, the subsite of head and neck squamous cell carcinoma that also includes the oropharynx, larynx…
- Epidemiology
Especially prevalent in Southeast Asia: nasopharyngeal carcinoma occurs at higher rates in Southeast Asian populations than elsewhere, in keeping with its strong EBV association.
- Risk factors
Epstein-Barr virus infection: nasopharyngeal cancer is often associated with Epstein-Barr virus, the dominant recognized risk factor and the basis for its distinct epidemiology compared with other head and neck subsites.
- Pathophysiology
EBV-driven oncogenesis: nasopharyngeal carcinoma belongs to the group of malignancies causally associated with Epstein-Barr virus infection, distinguishing its molecular pathogenesis from the…
- Clinical features
Painless, firm, enlarged cervical lymph node: malignant neck masses are commonly painless, firm and/or fixed on examination, without antecedent infection, and this is frequently the presenting sign…
- Differential diagnosis
Oral cavity or oropharyngeal squamous cell carcinoma: oral cavity and oropharyngeal cancer presents with sore throat, chronic dysphagia, odynophagia, or oral sores and ulcers; distinguished by…
- Diagnosis
First, and confirmatory: nasopharyngoscopy with biopsy of the nasopharynx.
- Management
First, stage the disease to decide between radiation alone and chemoradiation.
- Complications
Progressive cranial nerve palsies from skull base invasion: local extension into adjacent bone and skull base structures can worsen cranial nerve function beyond the presenting deficit if the disease is untreated or advances.
- Prognosis
Stage is the most important determinant of prognosis: as with other head and neck cancers, disease stage at diagnosis drives outcome more than any other single factor.
- Prevention
No dedicated screening program for nasopharyngeal carcinoma is defined in this reference; prevention centers on prompt evaluation of red-flag symptoms rather than population screening.
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