The most common type of nasopharyngeal tumour is nasopharyngeal carcinoma (NPC) – A carcinoma arising in the nasopharyngeal mucosa that shows light microscopic or ultrastructural evidence of squamous differentiation. It encompasses squamous cell carcinoma, non keratinizing carcinoma and basaloid squamous cell carcinoma. Adenocarcinoma and salivary gland type carcinoma are excluded.

Epidemiology

NPC shows a distinct racial, geographical distribution and multifactorial etiology. Globally, there were approximately 65,000 incidence and 38,000 deaths in the year 2000. There are certain populations for which the incidence is considerably higher, notably native and foreign-born Chinese, Southeast Asian, North Africans and the Arctic region (Canada and Alaska). In high risk groups, NPC incidence rises after the age of 30 years and peaks at 40-60 years, with rates in men are commonly 2-3 fold those observed in women.

Etiology

Genetic susceptibility, infection of Epstein Barr Virus (EBV), and environmental factors (dieatary and non dietary) may play a role in pathogenesis of NPC.  The evidence of NPC and EBV association includes : raised level of IgA against EBV in most NPC patients, presence of EBV DNA or RNA in all tumour cells, presence of EBV in a clonal episomal form and presence of EBV in the precursor lesion of NPC, but not in the normal nasopharyngeal epithelium.

Diet of food contain high levels of volatile nitrosamines have been implicated as the carcinogen for NPC development. Other preserved or fermented foods, consume during weaning and early childhood, also have been incriminated as risk factors. Consumption of salted fish become a relative risk factor from case control studies in Hongkong and China.  Others environmental risk factors include cigarette smoking, occupational exposure to smoke, chemical fumes and dusts, formaldehyde and radiation exposure.

Clinical Features

About half of the patients have multiple symptoms, but 10% are asymptomatic. Painless enlargement of upper cervical lymph nodes, blood stained post nasal drip, and symptoms related to Eustchian tube obstruction such as serous otitis media are commonly presenting feature.

Treatment

Nasopharyngeal carcinoma is particularly sensitive to radiation therapy, making it the first line of treatment. Surgery and chemotherapy are used in certain cases.

Radiation therapy destroys quickly growing cells, including cancer cells, in the area where the beams are focused. You typically receive radiation treatment five days a week for six or seven weeks. Internal radiation therapy (brachytherapy) is sometimes used in recurrent nasopharyngeal carcinoma.

Chemotherapy may be used to treat nasopharyngeal carcinoma in three ways : Chemotherapy at the same time as radiation therapy (concomitant therapy), Chemotherapy before radiation therapy (neoadjuvant therapy), and Chemotherapy after radiation therapy (adjuvant therapy).

Surgery is usually reserved for recurrent nasopharyngeal carcinoma. Surgery to remove cancerous lymph nodes in the neck is the most common surgery for nasopharyngeal carcinoma. Surgery to remove a tumor from the nasopharynx requires surgeons to make an incision in the roof of your mouth in order to access the area.