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Nasopharyngeal Cancer
Clinical OncologyOtolaryngologyGeneral Surgery
Nasopharyngeal cancer is one of the top ten cancers in Hong Kong that cannot be ignored. There are 600 to 800 cases of nasopharyngeal cancer in the city every year. Unlike many other cancers, nasopharyngeal cancer tends to occur at a relatively early age, with the peak incidence between 40 and 60 years old, considered the prime of one's life. The incidence rate is almost three times higher in males than in females. Compared to Western countries, nasopharyngeal cancer is more commonly found in Southern China.
In 2020, nasopharyngeal cancer ranked eighth among the most common cancers in men and seventeenth among women in Hong Kong, accounting for 2.2% of the total number of new cancer cases.
Cancer originates from one or more genetic mutations in the body, causing abnormal growth of normal cells, invading nearby structures, and spreading to other body parts. Nasopharyngeal cancer is caused explicitly by atypical squamous cells on the surface of the nasopharynx.
Symptoms
The early symptoms of nasopharyngeal cancer are similar to some upper respiratory tract diseases, such as rhinitis and sinusitis. If you suspect these early signs of nasopharyngeal cancer, you should get checked as soon as possible.
Suppose you notice symptoms like tinnitus, hearing loss, frequent episodes of otitis media, persistent nasal congestion, bloody nasal or throat discharge, or the appearance of painless neck lumps. In that case, there is a chance you might have nasopharyngeal cancer, and you should seek prompt medical evaluation. When the tumour extends to the base of the skull and the brain, it can lead to problems such as headaches, facial numbness, double vision, and difficulty closing the jaw. |
In more severe cases of nasopharyngeal cancer, complications can occur as the cancer cells grow and invade nearby structures such as the throat, brain, and bones. Additionally, cancer cells can spread to other parts of the body, leading to lymph node metastasis in the neck and affecting the lungs and liver. If you observe symptoms suggestive of nasopharyngeal cancer, early medical evaluation is essential.
Factors
Cancer originates from one or more genetic mutations within the body, which drive normal cells to grow abnormally, invade nearby structures, and spread to other parts of the body. Nasopharyngeal cancer, specifically, is caused by atypical squamous cells on the surface of the nasopharynx.
The following factors influence the likelihood of developing nasopharyngeal cancer:
Genetic factors | When there are genetic issues or unhealthy family habits, the risk of nasopharyngeal cancer is higher among siblings and close relatives of patients compared to the general population. |
Viral infections | EB virus, which is the pathogen for infectious mononucleosis, is prevalent worldwide. Most adults in Hong Kong have been exposed to this virus, often with mild symptoms. However, individuals with specific genetic predispositions are at a higher risk of developing nasopharyngeal cancer if they become infected. How the virus contributes to cancer is still under medical research. |
Dietary habits | In regions like South China, prolonged and excessive consumption of salted fish and smoked foods may contribute to the development of nasopharyngeal cancer. |
In other words, to reduce the risk of nasopharyngeal cancer, one should focus on improving daily lifestyle habits, minimize excessive salt intake, and also consider avoiding smoking based on some data suggesting an increased risk associated with smoking.
![nasopharyngeal cancer Hong Kong](media/images/service/a80a7fdb1b844ba1b438.jpg)
Diagnosis
要檢查是否患有鼻咽癌,醫生會先詢問相關症狀的情況,以及病歷、家族病史等,也會詳細檢查耳、鼻和喉,以及觀察頸部是否出現腫瘤。然後醫生會使用內窺鏡查看鼻咽是否同樣出現腫瘤,如發現腫瘤,就要從該處切除一小片活組織,以顯微鏡觀察是否惡性,並確定病因。
醫生隨後便會為患者進行詳細評估,包括造影檢查,檢視腫瘤有沒有伸延到頭骨、腦部或神經線等,以診斷鼻咽癌的分期。檢查一般可分為三種分式:
- 磁力共振掃描
利用磁場構建體內組織和器官細緻影像的大型掃描,患者或須注射造影劑,確保影像清晰。此方法最能清楚顯示微細的病變。
- 電腦掃描
為體內組織拍攝不同角度的X光片,構成立體影像,檢查癌細胞有沒有擴散。
- 正子斷層(PET)掃描
經靜脈注入帶有少量放射性的造影劑後,利用掃描器探測體內細胞對葡萄糖的吸收和分佈情況,了解細胞有沒有出現異常狀況,並判斷癌症有否轉移至其他部位。另外,EB病毒基因測試亦有預測病情將來的進展和監測病情的作用。
根據腫瘤的大小及影響範圍,鼻咽癌大致可分為:
階段 | 影響範圍 |
---|---|
I期 | 癌腫局限於鼻咽位置,未有侵蝕周邊組織。 |
II期 | 癌腫已經侵蝕咽喉側邊組織,或已經蔓延到鼻咽以外的單邊淋巴組織,但仍未擴散到較遠距離的位置。 |
III期 | 癌細胞已經擴散到頸部兩側的淋巴結,但仍未擴散到較遠距離的位置,或者腫瘤已經伸延到頭骨或鼻竇。 |
IVA期 | 腫瘤已經伸延到腦部,或已經侵蝕腦神經線,或已經擴散到鎖骨上的淋巴結,或淋巴結已經超過6厘米。 IVB期 |
IVB期 | 腫瘤已經擴散到較遠位置,例如骨、肝臟或肺部。 |
為鼻咽癌分期,主要目的是協助醫生設計治療方案、計算放射劑量、決定施行方法等。
Treatment
The treatment of nasopharyngeal cancer primarily involves two methods: radiation therapy and chemotherapy, depending on the tumour's location, cancer staging, and the overall health of the patient. These two treatment methods can be used individually or in combination.
Radiation Therapy | Radiation therapy is the primary treatment for patients with nasopharyngeal cancer who haven't experienced distant spread. It involves the use of high-energy X-rays to irradiate the tumour, effectively killing cancer cells. For patients with remote space, radiation therapy can also alleviate symptoms caused by the spread, such as bone pain. |
Chemotherapy | Radiation therapists create a plastic mould tailored to the patient's facial and head shape to secure the body for accurate radiation targeting. After wearing the plastic mould, patients undergo a computer scan to help doctors delineate the tumour and identify crucial organs to be avoided, such as the spinal cord and brainstem. Finally, a personalized plan is designed by a physicist or radiation therapist to determine the optimal angles and intensity of radiation. |
Surgery | In addition to the above two treatments, surgical removal of the tumour is also an option for treating nasopharyngeal cancer. However, because nasopharyngeal cancer is located deep within the head, the tumour is challenging to remove altogether. As a result, surgery is typically considered when the tumour persists, recurs, or when radiation therapy is ineffective. During surgery, nearby nerves may be affected, leading to potential side effects such as ear numbness, oral pain and dryness, jaw stiffness, and neck stiffness. It is advisable to undergo regular follow-up examinations, such as imaging scans or endoscopic evaluations, to monitor recovery progress. |
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