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Nasopharyngeal cancer

Nasopharyngeal or nasopharynx cancers are among the most common types of cancer in Turkey. Type 3 Undifferentiated Carcinoma is frequently observed in Turkey. The experts from the Ear, Nose, and Throat Department at Uniqacare Clinic provided information about nasopharyngeal cancer and its treatment methods.

What is nasopharynx?


The transition region that connects the nasal cavity and the oral cavity is known as the nasopharynx (or nasopharyngeal area). It is the space through which the Eustachian tube opens into the middle ear from both sides. Since there is no visible area that can be observed with the naked eye from within the nose, it is visualized using an endoscope through the nostrils. Alternatively, it can be visualized using a tool called a mirror from inside the mouth. Adenoid tissue, commonly referred to as "geniz eti" in Turkish, is often found in the nasopharyngeal region and is part of the body's defense mechanism. It consists of benign lymphoid tissues that are frequently present in children. In children, adenoid tissue is expected to be present up to a certain age. However, if lymphoid tissue is observed in the nasopharynx of an adult, a biopsy should be taken and sent for pathological examination.


What is nasopharyngeal cancer?


Cancers that occur in the nasopharyngeal region are referred to as nasopharyngeal cancer. It is among the commonly observed types of cancer. Both benign (non-cancerous) and malignant (cancerous) tumors can develop in the nasopharyngeal area. If the patient is an adult, the formation of adenoid tissue in this area is not expected. If an adult patient has a lesion or mass in the nasopharyngeal region, an examination must be conducted. Among adults, nasopharyngeal carcinomas are commonly observed in this area. Additionally, lymphoma and leukemia can also frequently involve this region in adults. In children, unlike adults, soft tissue (rhabdomyosarcoma) cancer can occur in the nasopharyngeal area, as well as benign conditions like angiofibroma or plasmacytoma.


There are three types of nasopharyngeal cancer:


Type 1 Squamous cell nasopharyngeal carcinoma (SCC)

Type 2 Non-keratinizing well-differentiated nasopharyngeal carcinoma

Type 3 Undifferentiated nasopharyngeal carcinoma


Type 3 nasopharyngeal carcinoma responds most quickly to treatment. The likelihood of recurrence after treatment is low. Type 1 squamous cell nasopharyngeal carcinoma can recur after treatment.


Furthermore, leukemia and lymphoma cancers can also frequently involve the nasopharyngeal region. For this reason, samples must be taken from suspicious tissues in the nasopharyngeal area for pathological examination, and it must be determined whether the tissue is benign or carries the risk of cancer.


What are the causes of nasopharyngeal cancer?


Multiple factors can play a role in nasopharyngeal cancers. Among these factors are environmental factors (air pollution, exposure to chemical vapors), genetic predisposition, and viruses.


Nasopharyngeal cancer, most commonly seen during adolescence and around the ages of 40-50, tends to affect males more frequently.


A family history of nasopharyngeal cancer also increases the risk for an individual.

The Epstein-Barr virus (EBV) is closely associated with nasopharyngeal cancer. Individuals who are EBV positive should undergo a nasopharyngeal examination.


The prevalence of nasopharyngeal cancer is higher among smokers.


Dietary habits are also among the causes of nasopharyngeal cancer. Poor dietary habits, excessive consumption of smoked foods, and cooking meals over wood fires can increase the likelihood of this disease.


What are the symptoms of nasopharyngeal cancer?


Among the most common symptoms, neck masses are notable. In adults, unilateral middle ear infections are also frequently observed. The Eustachian tube opens into the nasopharynx from both sides. When a mass obstructs either of these areas, ventilation of the ear is disrupted, leading to unilateral middle ear infections. In cases of unilateral ear infections in adults, a nasopharyngeal examination must be conducted to check for the presence of a mass in this area.


Generally, patients with nasopharyngeal cancer may experience:

  • Neck lymph nodes, mass

  • Nasal congestion

  • Nosebleeds

  • Persistent middle ear infections

  • Ear ringing and ear blockage

  • Symptoms related to cranial nerve involvement, such as visual problems and pain, which may prompt a visit to the doctor.


How is nasopharyngeal cancer diagnosed?


Nazofaryngeal region has suspected, the initial step is a physical examination. If necessary, imaging techniques such as tomography, MRI, and PET-CT are employed.


The nasopharyngeal region can be visualized through an endoscope via the nose or using a mirror through the oral cavity. Normally, the nasopharyngeal region has a flat structure. If there is a mass, swelling, or any abnormality in this area, an otolaryngologist (ear, nose, and throat specialist) should perform a biopsy. Nasopharyngeal cancer can sometimes lead to lymph node involvement in the neck. These involvements can be precisely determined through contrast-enhanced tomography or PET-CT scans. A definitive diagnosis of nasopharyngeal cancer is made through biopsy. The type of tumor is identified in the biopsy. Treatment for nasopharyngeal masses is determined based on the type of tumor; benign tumors can be surgically removed or monitored, while if the result indicates nasopharyngeal cancer, the primary treatment approach is usually a combination of radiotherapy and chemotherapy.


What are the treatment methods of nasopharyngeal cancer?


Nazopharyngeal cancer's treatment is determined based on the type of tumor identified in the biopsy. The most common treatment approach for nasopharyngeal cancer involves a combination of radiotherapy and chemotherapy. Especially, Type 3 Undifferentiated Carcinoma responds quickly to radiotherapy. Early diagnosis and regular follow-up can lead to successful treatment outcomes.


Lymphoma and leukemia diseases can also involve the nasopharyngeal region. Radiotherapy and chemotherapy are utilized in the treatment of these conditions as well.


If nasopharyngeal cancer is not detected and treated in its early stages, it can lead to metastasis in advanced stages. Given the proximity of the nasopharyngeal region to the brain, involvement of the skull base and nerves is common. Nerves such as the 6th, 3rd, 4th, and 5th cranial nerves can be affected. Metastasis to the back of the skull and nerves can cause symptoms like double vision or even lead to falls.


The patient's age and gender are among the factors that can influence the course of treatment. Nasopharyngeal cancer, which affects males more, can be negatively impacted by factors like advanced age, lymph node involvement in the neck, nerve involvement in the head region, and cancer types not caused by the Epstein Barr virus.


FREQUENTLY ASKED QUESTIONS ABOUT NASOPHARYNGEAL CANCER

How long does nasopharyngeal treatment take?


The duration of nasopharyngeal treatment varies depending on the type of tumor, whether it's benign or malignant, and whether it requires surgical intervention, radiotherapy, or chemotherapy. Ear, nose, and throat specialists, as well as oncology experts, determine the treatment approach. After these treatments, the patient should be regularly monitored by ear, nose, and throat specialists and oncologists. The first 5 years after treatment are crucial.


Where is the nasopharyngeal region located?


The nasopharyngeal region is the transitional area that connects the nasal cavity and the oral cavity. It is the space where the Eustachian tube opens into the middle ear on both sides.


What is adenoid tissue?


Adenoid tissue is located in the nasopharyngeal region and is commonly observed in children. It refers to benign lymphoid tissues that form as part of the body's defense mechanism. These tissues, known as adenoid tissue, are considered normal until a certain age in children.

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