Nasopharyngeal carcinoma is a cancer of the nasopharynx. In Europe, this type of cancer is very rare, unlike in some Asian and African countries. The success of treatment depends on the type and stage of the carcinoma.
What is nasopharyngeal carcinoma?
Nasopharyngeal carcinoma is a malignant tumor in the nasopharynx. This carcinoma is one of the head and neck tumors. Nasopharyngeal carcinoma is also synonymously called epipharyngeal carcinoma or nasopharyngeal cancer. The abbreviation for the disease is NPC as a derivative of the English term “Nasopharyngeal Carcinoma”. In Central Europe and North America, nasopharyngeal carcinoma is very rarely observed. In Germany, for example, only one to two out of 200,000 people develop the disease. However, nasopharyngeal carcinoma is very common in some Asian countries such as Burma, Taiwan or South China and in some North African countries. In Taiwan, this disease is the leading cause of death in young men. The reason for the frequent occurrence of the disease there seems to be the chewing of the betel nut. In North Africa, children are particularly affected. The cause is not yet clear. There are three forms of nasopharyngeal carcinoma:
- WHO type I, which is a well-differentiated keratinizing squamous cell carcinoma, occurs in about 20 percent.
- WHO type II, with an incidence of circa 30 to 40 percent, represents nonkeratinizing squamous cell carcinoma.
- The most common form is WHO type III with approximately 40 to 50 percent of cases. This is a lymphoepithelial carcinoma (Schmincke-Regaud tumor), which is probably caused or at least favored by the Epstein-Barr virus.
Causes
There are several causes of nasopharyngeal carcinoma. For example, the so-called Epstein-Barr virus is believed to be responsible for most of the disease. However, this virus is very common. Approximately 98 percent of all adults are infected. The virus persists in the organism for a lifetime. But only a few people develop nasopharyngeal carcinoma. Therefore, a genetic component is also suspected to be the cause of the nasopharyngeal cancer development process. The Epstein-Barr virus is, among other things, the trigger for Pfeiffer’s glandular fever, which is characterized by massive swelling of the lymph nodes. During infection, a large amount of lymphocytes is produced. However, if the proliferation of lymphocytes gets out of control, lymph node cancer and other lymphocyte-linked cancers such as nasopharyngeal carcinoma can form. Nasopharyngeal carcinomas based on the proliferation of squamous cells are caused by various environmental factors, poor dietary habits, or smoking.
Symptoms, complaints, and signs
All age groups can be affected by nasopharyngeal carcinoma. However, it most commonly affects people in middle age. Often, however, carcinoma is diagnosed very late because it does not cause symptoms for a long time. Early symptoms can be nosebleeds, inflammation of the middle ear or middle ear effusion. The patient often breathes only through the mouth because of problems with nasal breathing. The disease also often becomes symptomatic after metastases have formed due to the loss of cranial nerves from III to VI. These metastases are regional lymph node metastases. This results in protruding eyeballs, seeing double images, and sometimes other visual and olfactory disturbances. In addition, persistent and severe headaches are typical, which can hardly be treated. However, the occurrence of distant metastases in the liver, lungs or bones due to the spread of cancer cells via the bloodstream is quite rare. Even patients with the advanced stage of the disease develop distant metastases in only about 30 percent of cases.
Diagnosis and course of the disease
The methods used to diagnose nasopharyngeal carcinoma are visual diagnosis, palpation, imaging and other instrumental medical procedures, and serologic laboratory tests. Visual diagnosis or inspection reveals the absence of nasal breathing, cervical lymphomas, and cranial nerve deficits. Palpation may reveal painless lymph node swelling. Functional testing of the various cranial nerves is important. Various procedures are also used to determine the ENT status. Endoscopy of the nasopharynx can detect the tumor.CT and MRI scans are used to determine the size of the tumor. Serology is used to detect antibodies to Epstein-Barr virus.
Complications
Because nasopharyngeal carcinoma is a cancer, it is associated with various complications in every case. Usually, the success in treating the disease depends very much on the time of diagnosis and the spread of the tumor to other regions of the body. Possibly, nasopharyngeal carcinoma also reduces the life expectancy of the patient, resulting in premature death. Patients often suffer from nosebleeds or inflammation in the ears. Complaints when breathing with the nose can also be indicative of the tumor and should be investigated. Particularly when the tumor moves into the lymph nodes, it can spread rapidly. Furthermore, nasopharyngeal carcinoma leads to visual complaints and thus to double vision or veil vision. Severe headaches may also occur, which cannot be relieved with the help of painkillers. The quality of life of the affected person is significantly limited and reduced due to nasopharyngeal carcinoma. The cancer is completely removed in this disease. However, it cannot be universally predicted whether this will result in a complete cure. Sufferers are usually also dependent on chemotherapy, which is associated with various side effects.
When should you see a doctor?
Nosebleeds, a feeling of tightness in the nose or sinuses, a general feeling of malaise, and an increasing feeling of illness should be presented to a physician. Swollen lymph, a decrease in physical as well as mental performance, and internal weakness should be examined and treated. In case of inflammation of the middle ear, disturbances in hearing or vision, as well as irregularity in smelling, a doctor must be consulted for determination of the cause. Headaches, sleep disturbances as well as changes in phonation are signs of a health impairment that should be evaluated by a physician. If existing complaints increase or new disorders develop, a physician is needed. Interruptions or restrictions in breathing, a lack of oxygen in the organism or difficult breathing must be examined. There is a risk of an undersupply of oxygen to the body, which in severe cases can be life-threatening. Changes in weight, loss of appetite as well as a withdrawal from social life are further indications of a present disease. Since nasopharyngeal carcinoma leads to a premature end of life if left untreated, a visit to the doctor should be made at the first symptoms. The sooner a diagnosis can be made and therapy initiated, the better the chances of cure. A doctor is needed for sudden nosebleeds, an unusual taste in the mouth, and swelling of the nose, throat, or neck.
Treatment and therapy
The success of therapy depends on the stage of the disease. In the case of small and localizable tumors, its complete removal may already lead to cure. However, this is not successful in most cases. Due to the difficult accessibility of the tumor, complete removal is very rarely possible. Therefore, surgery is usually not advisable. The main treatment method is radiation therapy. This can often treat the tumor very well. In most cases, however, only the survival time is prolonged. In favorable cases, however, a complete cure is also possible. However, keratinizing squamous cell carcinomas react worse to radiation treatment. In advanced carcinomas, good results are often still achieved by a combination therapy of radiotherapy with chemotherapy. Oxaliplatin is used as the chemotherapeutic agent. Because Schmincke-Regaud tumor is particularly sensitive to radiation, the cure rate here is as high as 90 percent with radiation in stage I disease.
Outlook and prognosis
The chances of cure, as is generally the case with all malignant cancers, are highly dependent on the stage of the tumor. However, due to the very high radiation sensitivity of malignant tumor tissue, there are definitely very good chances of cure. This also applies if the cancer has already settled in the regional lymph nodes. For patients with tumors in the first stage, the cure rate is between about 70 and 80 %.However, the prognosis is worse in patients with keratinizing nasopharyngeal carcinoma, as this type is considerably more resistant to radiotherapy. The prognosis is generally best for cancer if it is detected early. Often, these are tumors that grow further into the anterior portion of the nasal cavity. Such tumors have a fairly good prognosis comparable to tumors that are further back in the nasopharynx. The type of cancer also plays a role in the chances of cure. In the case of nasopharyngeal carcinoma of the Schmincke-Regaud type, well over 90% of patients can be successfully treated if diagnosed in time. This is mainly due to the high radiosensitivity of the tumor tissue. However, in the fourth stage of cancer, the chance of cure decreases to about 20 to 40%. Survival for 5 years with appropriate therapy varies from 90% to 58% in those diagnosed early compared with advanced disease.
Prevention
The best prevention of nasopharyngeal carcinoma is to refrain from smoking and drinking alcohol. Specifically, this also applies to chewing tobacco and betel nut. Otherwise, the general risk of developing a malignant tumor is significantly reduced by a healthy lifestyle.
Follow-up
In most cases of nasopharyngeal carcinoma, the measures and options for direct follow-up are significantly limited. For this reason, the affected person should see a doctor relatively early in order to prevent the occurrence of further complaints or complications. As a rule, the condition cannot heal on its own, so treatment by a physician is always necessary. In many cases, nasopharyngeal carcinoma cannot be completely cured if it is detected late and the tumor has already spread in the body of the affected person. Many of the patients are dependent on a surgical intervention, through which the complaints can be alleviated. In this case, the affected person should in any case rest and take care of his body after the operation. Efforts and stressful or physical activities should be avoided in order not to put unnecessary strain on the body. The support and help of one’s family is also helpful in the case of nasopharyngeal carcinoma and can prevent the development of psychological upsets or depression. Whether there will be a decreased life expectancy due to the disease cannot be universally predicted.
Here’s what you can do yourself
Nasopharyngeal cancer is associated with an immense loss of well-being and the quality of life to which you are accustomed. Nevertheless, in order not to lose courage and hope, the affected person should direct his inner attitude and cognitive processes to positive areas of his life. In daily interaction with fellow human beings, technical aids such as smartphones, apps or computers can make everyday life easier. In addition, sign language such as German sign language or another individual communication technique can help to replace spoken language. If there is a loss of sight, Braille helps to communicate with each other. Through the various methods, conversation with fellow human beings is possible and purposeful. In self-help groups or in internet forums experiences can be exchanged with other affected people. Mutual help for self-help is made possible and makes it easier to cope with everyday life. Mental balance is particularly important. For this, the patient can try out mental techniques and strengthen himself. Meditation, Qi Gong, sound therapies or yoga help to mobilize the inner forces and promote harmony. Via cognitive training, thoughts can be better focused on the supportive areas of life. By adapting and changing one’s own behavior to the circumstances and developments of the current life circumstances, well-being is strengthened.
