Pocket Oncology (Pocket Notebook Series), 1st Ed.

NASOPHARYNGEAL CARCINOMA

Parisa Momtaz and David G. Pfister

Definition

• CA of the nasopharynx, the tubular passage behind the nasal cavity & includes the superior surface of the soft palate

• Malignant tumor arising from the epithelial lining of the upper aerodigestive tract

• Differs from other CA of the head & neck in regards to natural hx, epidemiology, histology, & response to tx

• Of the CA of the head & neck, has among the highest propensities to metastasize to distant sites

Figure 17-1

Epidemiology/Risk Factors

• Uncommon in the United States & Western Europe

• Very common in southern China & Hong Kong

• Intermediate risk in Southeast Asia, North Africa, Middle East

• A/w EBV

• FHx

• Environmental factors: High intake of salt-preserved foods

Clinical Manifestations

• Nasal obstruction/epistaxis

• HA due to skull base involvement

• Neck mass due to cervical LN mets

• Serous otitis media

• Diplopia due to invasion of both the cavernous sinuses & branches of CN III, IV, VI

Diagnosis/Work-up

• H&P w/nasopharyngeal exam; mirror & fiberoptic exam

• Nasopharyngeal bx

• MRI +/− CT w/contrast of the nasopharynx, base of skull to clavicles

• Imaging to evaluate for distant met: Particularly for endemic disease (see below) & when advanced neck disease is present

• Dental evaluation

• Nutrition, speech & swallowing evaluation

• Audiogram before starting platinum-based chemotherapy

Pathology

Staging:

• Stage I: T1 N0

• Stage II: T1 N1 or T2 N0, N1

• Stage III: T1 N2 or T2 N2 or T3 N0, N1, N2

• Stage IVA: T4 N0, N1, N2, M0

• Stage IVB: Any T N3, M0

• Stage IVC: Any T, any N, M1

Treatment

• Due to the anatomic location, tx for nasopharyngeal carcinomas is radiation based

• RT: Definitive tx for stage I disease

• Concurrent chemoradiation w/platinum-containing regimen followed by adjuvant cisplatin & 5-FU more efficacious than radiotherapy alone for advanced stage M0 disease (Intergroup Trial 0099 Al-Sarraf et al. JCO 1998;16:1310) (Wee J et al. JCO 2005;23:6730): Definitive treatment for stage II-IVB disease

• More recent data questions benefits of adjuvant cisplatin & 5-FU (Chen L et al., Lancet Oncol 2012:13:163)

• Concurrent carboplatin may replace concurrent cisplatin w/RT if there is a contraindication to cisplatin (Chitapanarux I, et al. EJC 2007;43:1399)

• Neck dissection recommended for pts who achieve a CR at the 1° but have residual disease in the neck

• Met disease/Stage IVC: Initial Rx should consist of a platinum-based regimen ± radiation-based Rx

Nutrition, Speech, and Swallowing

• Given anatomic location of the tumor & s/e of RT, multidisciplinary approach w/evaluation by dentist, nutritionist, speech & swallowing therapist

• Close monitoring of nutritional status & pre- & post-tx functional evaluation

• Dysphagia & swallowing function can be assessed w/clinical swallowing assessments & videofluoroscopic swallowing studies

• Do not need to place PEG prior to initiation of tx; however feeding tubes should be considered if sev. wt loss