Nasopharyngeal carcinoma

Introduction to nasopharyngeal carcinoma Malignant tumors that occur in the nasopharyngeal mucosa, China's Guangdong, Guangxi, Fujian, Hunan and other places are multiple areas, more men than women. Most of the age of onset is middle-aged, and there are also adolescents. The etiology is related to ethnic susceptibility (more yellows are more common in Caucasians), genetic factors, and EB virus infection. Nasopharyngeal carcinoma is an invasive tumor that invades deep structures early. basic knowledge The proportion of illness: 0.001% Susceptible people: good for middle-aged men and women Mode of infection: non-infectious Complications: migraine

Causes of nasopharyngeal carcinoma

(1) Causes of the disease

The etiology of nasopharyngeal carcinoma is unknown, and it is speculated that genetic factors and traditional habits of life may play an important role in the development of nasopharyngeal carcinoma.

Environmental factors (18%):

Environmental factors are also a cause of nasopharyngeal carcinoma. Excessive diet of salted fish, bacon and pickled foods containing nitrosamines, these foods have the effect of inducing nasopharyngeal cancer, nickel in drinking water, high lead content, The content of zinc, copper and cadmium is relatively low, the content of nickel in rice is high, and the content of molybdenum, chromium, lead and cadmium is low. The changes of these trace elements may also be related to the occurrence of nasopharyngeal carcinoma. In Guangdong, the investigation found nasopharyngeal carcinoma. In the high-incidence area, the trace element nickel content in rice and water is high, and the nickel content is also high in the hair of patients with nasopharyngeal carcinoma. Animal experiments have shown that nickel can promote nitrosamine-induced nasopharyngeal carcinoma.

Epstein-Barr virus (25%):

The lymphoblastoid cell line with Epstein-Barr virus was isolated from the tissues of nasopharyngeal carcinoma, and the Epstein-Barr virus granules were found. The EB virus high titer antibody was present in the nasopharyngeal carcinoma. The severity of the disease was high, and the disease recovered. The decrease in antibody titer indicates that Epstein-Barr virus is closely related to nasopharyngeal carcinoma.

Genetic factors (10%):

According to research on cell chromosomes and human histocompatibility antigen (HLA), the obvious ethnic aggregation of nasopharyngeal carcinoma suggests that nasopharyngeal carcinoma may be a multi-gene genetic factor.

(two) pathogenesis

Tumor-causing factors cause infinite proliferation, malignant transformation and distant metastasis of mucosal cells in the nasopharyngeal cavity.

Nasopharyngeal cancer prevention

In people's daily lives, it is very beneficial to take preventive measures from the following aspects.

1. Avoid accepting the polluted outside air environment as much as possible, because the nasopharynx is the only way for outside air to enter the lungs. The harmful gas first invades the nasopharynx before entering the lungs.

2, quit smoking and drinking.

3, pay attention to diet structure, do not partial eclipse, eat more vegetables, fruits and other foods containing a lot of vitamins, eat less or not eat salted fish, cured meat and so on.

Nasopharyngeal carcinoma complications Complications migraine

The complications of nasopharyngeal carcinoma are mainly manifested in the invasion of the tumor to the skull and surrounding blood vessels, and the corresponding clinical manifestations, visual changes, nasopharyngeal vascular rupture, etc., are often common signs of nasopharyngeal carcinoma.

Nasopharyngeal cancer symptoms Common symptoms Nasal pharyngeal stenosis Nasal and throat burning sensation Nasal bone Destruction Respiratory blood stasis unilateral headache Nasopharyngeal carcinoma distant metastasis Corneal reflex Locus occlusion

[clinical manifestations]

(1) There may be bleeding symptoms in the early stage of sucking blood stasis, which is characterized by blood in the sputum after sucking the nose or blood in the sputum. There is only a small amount of blood in the early sputum or sputum, sometimes no, late bleeding More, there may be nosebleeds.

(2) tinnitus, hearing loss, occlusion in the ear, nasopharyngeal carcinoma occurs in the side wall of the nasopharynx, when the lateral fossa or the eustachian tube opens the upper lip, the tumor can be unilateral tinnitus or hearing loss can occur in the eustachian tube. Catarrhal otitis media, unilateral tinnitus or hearing loss, and occlusion in the ear is one of the early forms of nasopharyngeal cancer.

(3) Headache is a common symptom, accounting for 68.6%, which may be the first symptom or the only symptom. The early headache is not fixed, intermittent, and the late stage is persistent migraine. The site is fixed. The reason may be that the early patient may be a neurovascular. Caused by reflex, or stimulation of the first peripheral nerve of the trigeminal nerve, advanced patients often cause tumor destruction of the skull base, caused by intracranial involvement involving the cranial nerve.

(D) double vision due to tumor invasion of the abductor nerve, often caused by the outward view of the double shadow, the trochlear nerve is invaded, often causing inward strabismus, diplopia, diplopia accounted for 6.2% to 19%, often with the trigeminal nerve damage.

(5) facial numbness of facial skin numbness, clinical examination for pain and tactile loss or disappearance, tumor invasion of the cavernous sinus often causes the first or second branch of the trigeminal nerve to be damaged; the tumor invades the foramen ovale, the anterior region of the styloid process, The third branch of the trigeminal nerve often causes numbness or paresthesia in the anterior part of the auricle, the palate, the cheeks, the lower lip and the ankle, and the facial skin numbness accounts for 10% to 27.9%.

(6) Nasal congestion may occur after nasal obstruction of the tumor. When the tumor is small, the nasal congestion is light. As the tumor grows, the nasal congestion is aggravated, mostly unilateral nasal congestion. If the tumor is blocked, the bilateral nasal congestion may occur after the bilateral nostrils.

(VII) Cervical lymph node metastasis Nasopharyngeal carcinoma is prone to cervical lymph node metastasis, about 60.3% ~ 86.1%, half of which are bilateral metastasis, cervical lymph node metastasis is often the first symptom of nasopharyngeal carcinoma (23.9% ~ 75%), a small number of patients can not find the primary lesions in the nasopharynx examination, and cervical lymph node metastasis is the only clinical manifestation, which may be related to the primary tumor of nasopharyngeal carcinoma and spread to the submucosal tissue.

(8) Tongue muscle atrophy and tongue deflection, direct invasion of nasopharyngeal carcinoma or lymph node metastasis to the posterior styloid or sublingual neural tube, causing sublingual nerve to be invaded, causing the tongue to be biased to the disease side, accompanied by diseased side of the tongue muscle atrophy .

(9) The eyelids are drooping, the fixation of the eyeball is related to the damage of the oculomotor nerve, and the loss of vision or disappearance is related to the damage of the optic nerve or the invasion of the sacral cone.

(10) The distant metastasis rate of distant metastatic nasopharyngeal carcinoma is between 4.8% and 27%. Distant metastasis is one of the main reasons for the failure of nasopharyngeal carcinoma treatment. Common metastatic sites are bone, lung, liver, etc. Multiple organs are more common at the same time.

(11) Dermatomyositis associated with dermatomyositis can also be associated with nasopharyngeal carcinoma, so patients with dermatomyositis should be carefully examined for nasopharyngeal symptoms with or without symptoms of nasopharyngeal carcinoma.

(12) Menopause as the first symptom of nasopharyngeal carcinoma is rare, and it is related to the invasion of nasopharyngeal carcinoma into the sphenoid sinus and pituitary gland.

The nasopharyngeal cavity is deep and concealed. The local symptoms of this part of the malignant tumor are not significant. It is caused by the spread of adjacent structures or lymphatic metastasis. Because of the pain in the ankle area, extraocular muscle paralysis and eyeball protrusion are first seen in the ophthalmology. Rare.

Advanced nasopharyngeal carcinoma often invades the optic nerve near the optic chiasm, causing vision loss, nasal or temporal hemianopia, which can cause blindness in one or both eyes. Fundus examination reveals optic atrophy, long nerve length, and is easily invaded by nasopharyngeal carcinoma. Therefore, it is often and earlyly violated, causing double vision, the eyeball can not be turned outwards, showing strabismus, the trochlear nerve is affected, the rotation of the outer and lower eyeball is restricted, causing difficulty in lower vision, the oculomotor nerve is compressed, causing eye movement disorder, upper jaw Drooping, trigeminal nerve branch involvement, numbness of the upper and lower palate skin and corneal reflex or disappear, eyelid tissue is affected by invasion and eyeball protrusion (Figure 2), nasopharyngeal carcinoma enters the eyelid by:

1. Transcranial sputum In most patients, cancerous tissue invades the cavernous sinus through the ruptured hole, and then reaches the eyelid through the supracondylar sac.

2. Transcranial spread to eye cancer tissue and enter the eyelid in three different ways:

(1) The cancer tissue enters the pterygopalatine fossa via the wing tube and invades the apex and the iliac crest.

(2) Nasopharyngeal carcinoma on the posterior wall of the nasopharynx invades the nasal cavity forward.

(3) When the nasopharyngeal carcinoma invades the back of the nose, it may penetrate the outer side wall of the sinus sinus into the sac.

Other clinical manifestations include bloody nasal discharge or nosebleed, which is caused by surface ulceration of irregular cancer tissue. Tumor infiltrating pharyngeal crypt and eustachian tube round pillow area cause tinnitus or hearing loss, and tumor tissue obstructs nasal posterior hole to produce nasal obstruction. Skull base bone destruction or nerve involvement leads to headache, manifested as unilateral persistent paralysis, top pain, is the most common initial symptoms, the age of good hair 30 to 50 years old, more common in men, male to female ratio of 2:1.

Sore throat, discomfort, foreign body sensation as early symptoms, subsequent bloody nose or nasal obstruction, eyeball abduction, diplopia, or oculomotor involvement; vision loss or blindness, should consider the diagnosis of nasopharyngeal cancer, Perform some auxiliary checks to help with the diagnosis.

In addition to paying attention to the above clinical manifestations, the following checks should be made:

(A) Before the nasal sinus examination of the nasal mucosa, the anterior nares can be seen through the posterior nostril and the nasopharynx, and cancers invading or adjacent to the nostrils can be found.

(2) The method of indirect nasopharyngoscopy is simple and practical. The wall of the nasopharynx should be inspected in turn. Pay attention to the posterior wall of the nasopharynx and the pharyngeal crypt on both sides. Lower bulges or isolated nodules should be more noticeable.

(C) fiber nasopharyngoscopy for fiberoptic nasopharyngoscopy can first use 1% ephedrine solution to converge the nasal mucosa to expand the nasal passages, and then anesthetize the nasal passages with 1% tetracaine solution, then insert the fiberscope from the nasal cavity, While observing one side, pushing forward until the nasopharyngeal cavity, the method is simple and the mirror is fixed, but the posterior nostril and the anterior wall of the apex are not satisfied.

(4) Cervical biopsy can perform neck mass biopsy on cases that have not been diagnosed by nasopharyngeal biopsy. Generally, it can be performed under local anesthesia. The earliest hard lymph nodes should be selected during surgery to win the entire capsule. It is difficult to remove the biopsy. A wedge-shaped biopsy can be performed at the mass. The tissue should be cut to a certain depth and should not be squeezed. The surgical field should not be over-tight.

(5) Fine Needle Puncture and Absorption This is a simple, safe and effective method for tumor diagnosis. In recent years, it is more common. For those suspected of cervical lymph node metastasis, the cells can be obtained by fine needle aspiration first. The specific methods are as follows:

1. Nasopharyngeal mass puncture: Use a 7-gauge needle to connect to the syringe. After an oropharyngeal anesthesia, the needle is inserted into the tumor parenchyma under indirect nasopharyngoscopy, and the syringe is taken to make a negative pressure. After two activities, the extract was applied to a slide for cytological examination.

2. Fine needle aspiration of the neck mass: use a No. 7 or No. 9 needle to connect to the 10m1 syringe. After local skin disinfection, select the puncture point, insert the needle along the long axis of the tumor, aspirate the syringe and make the needle move in and out of the mass. The activity was performed 2 to 3 times, and the aspirate was taken for cytological or pathological examination after removal.

(6) Epstein-Barr virus serological test Currently, the IgA/VCA and IgA/EA antibody titers of Epstein-Barr virus are detected by immunoenzymatic method. The former has higher sensitivity and lower accuracy; the latter is opposite. Therefore, it is advisable to perform two kinds of antibodies for suspected nasopharyngeal carcinoma at the same time, which is helpful for early diagnosis. For cases with IgA/VCA titer 1:40 and/or IgA/EA titer 1:5, Even if there is no abnormality in the nasopharynx, the exfoliated cells or biopsy should be taken at the site of the nasopharyngeal carcinoma. If the diagnosis is still undiagnosed, it should be followed up regularly. If necessary, multiple biopsy should be performed.

(7) Nasopharyngeal lateral radiographs, skull base films and CT examinations Each patient should be routinely used as a nasopharyngeal lateral photograph and a skull base photograph, suspected of paranasal sinus, middle ear or other parts of the invasion, should be corresponding In the examination of the radiograph, the conditional unit should perform a CT scan to understand the local expansion. In particular, it is necessary to grasp the infiltration range of the parapharyngeal space, which is extremely important for determining the clinical stage and formulating the treatment plan.

(8) B-mode ultrasonography B-mode ultrasonography has been widely used in the diagnosis and treatment of nasopharyngeal carcinoma. The method is simple and non-invasive. The patient is willing to accept it. In nasopharyngeal carcinoma cases, it is mainly used for liver, neck, retroperitoneal and pelvic cavity. Check the lymph nodes to see if there is liver metastasis and lymph node density, and whether there is cystic or not.

(9) Magnetic resonance imaging examination Because magnetic resonance imaging (MRl) can clearly show the various levels of the skull, sulci, cerebral gyrus, gray matter, white matter and ventricles, cerebrospinal fluid pipelines, blood vessels, etc., using the SE method to show T1, T2 prolonged The intensity image can diagnose nasopharyngeal carcinoma, upper frontal sinus cancer, etc., and shows the relationship between the tumor and surrounding tissues.

[pathological changes]

(1) The predilection site and the gross form of nasopharyngeal carcinoma often occur at the top of the posterior wall of the nasopharynx, followed by the side wall, which is extremely rare in the anterior wall and the bottom wall. The general morphology of nasopharyngeal carcinoma is divided into five types. That is, nodular type, cauliflower type, submucosal type, infiltrating type and ulcer type.

(2) Growth and diffusion law The spread of nasopharyngeal carcinoma has its regularity. The earlier nasopharyngeal carcinoma is confined to the nasopharynx, which can be called a localized type. As the tumor grows, the cancer can approach the adjacent sinus cavity. The gap and the base of the skull directly spread, nodular or cauliflower-type tumors can protrude into the nasopharyngeal cavity, while invasive, submucosal and ulceral types grow in the submucosa, and the cancer can grow into the nasal cavity, oropharynx, and It can be extended to the parapharyngeal space, pterygopalatine fossa or invading the eyelid. The cancer can expand directly upward, destroying the skull base and cranial nerve. The neck metastasis of nasopharyngeal carcinoma is through the lymphatic drainage system, and the distant metastasis can pass. The lymphatic system re-enters the blood circulation or the cancer cells directly invade the surrounding blood vessels, enter the blood circulation and transfer to distant organs.

(3) Histological classification

1. Carcinoma in situ: The concept of carcinoma in situ means that the cancer cells have not broken through the basement membrane. Nasopharyngeal carcinoma in situ is no exception. In the cancerous foci, there must be a complete basement membrane, and the cancer cells in situ are proliferating. When the flower buds or nail-like processes are subcutaneously subcutaneously, there is still a clear basement membrane separating the cancer cells from the lamina propria of the mucosa. The diagnosis of nasopharyngeal carcinoma in situ is mainly based on cytological criteria, followed by histology. The arrangement and structure, therefore, the cytological criteria for the diagnosis of nasopharyngeal carcinoma in situ must be strictly controlled, that is, the image of the change must be recognized to a certain extent, and the ratio of seroplasm is increased in the cancer cells in situ compared with normal epithelial cells. That is, its nuclear area is significantly increased.

2. Invasive cancer

(1) Micro-invasive cancer: refers to the basement membrane being broken by cancer cells, but the infiltration range is not more than 400 times that of the light microscope. The cell morphology is more obvious than the carcinoma in situ, and it is infiltrating through the basement membrane. .

(2) Squamous cell carcinoma: Although most of the nasopharyngeal carcinomas originate from the columnar epithelium, most of the nasopharyngeal carcinomas are squamous cell carcinomas. To diagnose squamous cell carcinoma, the squamous differentiation must be characterized in the sections. Differentiation refers to: 1 keratinized beads; 2 intracellular and extracellular keratinization; 3 intercellular bridges; 4 cells in the nest of cancer cells are arranged in a layer like squamous epithelium, cells are not in a conformal cell, according to cancer cells The degree of squamous differentiation can be classified into high, moderate and low differentiation grades of nasopharyngeal squamous cell carcinoma.

1 highly differentiated squamous cell carcinoma: in most cancer tissues, intercellular bridges or keratosis are called differentiated squamous cell carcinoma, or keratinized squamous cell carcinoma. There is usually no lymphocyte infiltration in the cancer nest. Sometimes It can also be seen that individual scattered lymphocytes, the cancer nesting boundary is generally clear, and sometimes there is a complete membrane wrap. The majority of this type of cancer is fibrous tissue type, accompanied by infiltration of neutrophils, lymphocytes, plasma cells, etc. But plasma cells are generally not too much.

2 moderately differentiated squamous cell carcinoma: refers to the clear intercellular bridge and / or keratinization in cancer tissue, not individual but a certain number of nasopharyngeal carcinoma, whether intracellular or extracellular keratinization The number of highly differentiated squamous cell carcinomas is much less, there are varying numbers of lymphocytes infiltrating in the cancer nest, and there are many different plasma cells in the nest, interstitial changes and poorly differentiated squamous cells. Cancer is similar, but unlike highly differentiated squamous cell carcinoma.

3 low-differentiated squamous cell carcinoma: under light microscope, a certain number of cancer cells can also show intercellular bridge or intracellular keratinization, but the number is small, the cancer cells are deeply stained, the nucleoli are hypertrophy, and often have some eosinophilic Red staining, the boundary between cancer nest and interstitial is clear, but it can also be intertwined with interstitial. There are various lymphocytes infiltrating in the cancer nest. The interstitial can be of various types, that is, lymphoid cells are abundant. Invasive, granulation tissue, fibrotic and intrinsic tissue types, regardless of the type of interstitial, each with varying amounts of plasma cell infiltration.

(3) Adenocarcinoma: Nasopharyngeal adenocarcinoma is extremely rare compared with nasopharyngeal squamous cell carcinoma, especially in the high-incidence area of nasopharyngeal carcinoma. According to histological observation, adenocarcinoma must be derived from glands.

1 highly differentiated adenocarcinoma: the cancer parenchyma and interstitial boundaries are clear, the cancer nest is more obvious, some cancer cells are arranged in acinar; some are arranged in a high columnar duct-like structure; some are adenoid cystic carcinoma or sieve The structure of cancer; some are simple adenocarcinoma.

2 moderately differentiated adenocarcinoma: refers to a certain number of clear glandular cavities that are seen in cancerous tissues, but with adenocarcinomas with partially undifferentiated cancerous structures, which are often the result of further metamorphosis of the above highly differentiated adenocarcinomas, so Traces of highly differentiated adenocarcinoma are retained.

3 poorly differentiated adenocarcinoma: a clear glandular structure can be seen in the cancer tissue, the number is very small, most of the cancer tissue is the structure of undifferentiated carcinoma, the tumor cells are foamy foam, and the Alcian blue staining is weakly negative.

(4) vesicular nucleus cell carcinoma: most of the cancer cells whose nucleus is vacuolated can be called vesicular nucleus cell carcinoma. Because of its special morphology and good prognosis after radiotherapy, it is independent. For the first type, the so-called nuclear vacuolar change means that the nucleus is large and round or elliptical or fertile fusiform, the nuclear area is more than three times the area of the lymphocyte nucleus, and the chromatin in the nucleus is rare, thus making the nucleus vacuolated. The chromatin perglyzes unevenly on the inner surface of the nuclear membrane, thus making it thick and uneven, and even the nucleus is similar to the nuclear membrane defect. To diagnose the nasopharyngeal nucleus cell carcinoma, more than 75% of the cancer must be found in the section. The nucleus is vacuolated, and less than 25% of the remaining cancer cells may be poorly differentiated squamous cell carcinoma or undifferentiated carcinoma. The criteria for diagnosing vesicular nucleus cell carcinoma are determined to have more than 75% vacuolization. Because of this, the cancer cells can show its unique biological characteristics, that is, the prognosis is better after radiation therapy.

(5) Undifferentiated cancer: The distribution of cancer cells is more diffuse, often mixed with interstitial cells, medium or small cells, short shuttle type, elliptic or irregular, less brain, slightly basophilic, increased nuclear chromatin , granules or lumps, sometimes visible nucleoli.

Nasopharyngeal cancer examination

(A) Before the nasal sinus examination of the nasal mucosa, the anterior nares can be seen through the posterior nostril and the nasopharynx, and cancers invading or adjacent to the nostrils can be found.

(2) The method of indirect nasopharyngoscopy is simple and practical. The wall of the nasopharynx should be inspected in turn. Pay attention to the posterior wall of the nasopharynx and the pharyngeal crypt on both sides. Lower bulges or isolated nodules should be more noticeable.

(C) fiber nasopharyngoscopy for fiberoptic nasopharyngoscopy can first use 1% ephedrine solution to converge the nasal mucosa to expand the nasal passages, and then anesthetize the nasal passages with 1% tetracaine solution, then insert the fiberscope from the nasal cavity, While observing one side, pushing forward until the nasopharyngeal cavity, the method is simple and the mirror is fixed, but the posterior nostril and the anterior wall of the apex are not satisfied.

(4) Cervical biopsy can perform neck mass biopsy on cases that have not been diagnosed by nasopharyngeal biopsy. Generally, it can be performed under local anesthesia. The earliest hard lymph nodes should be selected during surgery to win the entire capsule. It is difficult to remove the biopsy. A wedge-shaped biopsy can be performed at the mass. The tissue should be cut to a certain depth and should not be squeezed. The surgical field should not be over-tight.

Histopathological examination in the presence of a mass or suspected tumor area to bite the tissue, the affected lymph nodes should also be removed for pathological diagnosis, squamous cell carcinoma, large cell bodies, intercellular bridge visible, so the cell boundaries are clear, cytoplasmic, eosinophilic Partial keratinization; obvious nuclear, deep staining, large nuclear heteromorphism, visible nuclear division, keratinization in the center of the cancer nest, forming keratinized beads, depending on the degree of keratinization or the number of keratinized beads and the number of intercellular bridges Squamous cell carcinoma is classified into three types: high, moderate, and poorly differentiated. The special type of nasopharynx and oropharyngeal squamous cell carcinoma is lymphopyremia, which is poorly differentiated and may have invaded the eyelids even before the primary tumor. Lymphatic metastasis occurs, sometimes the primary tumor is small, and local biopsy is difficult. Most blind biopsy may reveal the primary tumor, and 1/3 of the patients have a certain degree of skull base destruction. Most of the brain nerves are damaged, the first is nerve damage. Later, other neural crests, lymphoid epithelioma are divided into two subtypes:

(1) Regaud type: the cells are large, poorly differentiated, and the nucleus is round or elliptical. The vacuoles are like, and the mitotic cells are distributed in a rich lymphoid matrix.

(2) Schmincke type: a cancer cell similar to the degeneration of reticulocytes, which is dispersed in a lymphoid matrix in a small nest or a mass.

These two types lack keratinization, so the diagnosis is difficult, but electron microscopy showed tension between the cytoplasm and intercellular desmosome, and positive Keratin staining confirmed from the epithelium.

(5) Fine Needle Puncture and Absorption This is a simple, safe and effective method for tumor diagnosis. In recent years, it is more common. For those suspected of cervical lymph node metastasis, the cells can be obtained by fine needle aspiration first. The specific methods are as follows:

1. Nasopharyngeal mass puncture: Use a 7-gauge needle to connect to the syringe. After an oropharyngeal anesthesia, the needle is inserted into the tumor parenchyma under indirect nasopharyngoscopy, and the syringe is taken to make a negative pressure. After two activities, the extract was applied to a slide for cytological examination.

2. Fine needle aspiration of the neck mass: use a No. 7 or No. 9 needle to connect to the 10m1 syringe. After local skin disinfection, select the puncture point, insert the needle along the long axis of the tumor, aspirate the syringe and make the needle move in and out of the mass. The activity was performed 2 to 3 times, and the aspirate was taken for cytological or pathological examination after removal.

(6) Epstein-Barr virus serological test Currently, the IgA/VCA and IgA/EA antibody titers of Epstein-Barr virus are detected by immunoenzymatic method. The former has higher sensitivity and lower accuracy; the latter is opposite. Therefore, it is advisable to perform two kinds of antibodies for suspected nasopharyngeal carcinoma at the same time, which is helpful for early diagnosis. For cases with IgA/VCA titer 1:40 and/or IgA/EA titer 1:5, Even if there is no abnormality in the nasopharynx, the exfoliated cells or biopsy should be taken at the site of the nasopharyngeal carcinoma. If the diagnosis is still undiagnosed, it should be followed up regularly. If necessary, multiple biopsy should be performed.

(7) Nasopharyngeal lateral radiographs, skull base films and CT examinations Each patient should be routinely used as a nasopharyngeal lateral photograph and a skull base photograph, suspected of paranasal sinus, middle ear or other parts of the invasion, should be corresponding The examination of the radiograph, the conditional unit should be CT scan to understand the local expansion, especially the infiltration range of the parapharyngeal space, which is very important for determining the clinical stage and formulating the treatment plan, see the nasopharyngeal lateral film, see The soft tissue of the posterior wall of the apex is diffusely thickened or partially protruded. If the skull base is invaded, the irregular osteolytic defect or the enlarged tunnel is seen. The CT scan has high resolution and can clearly show the soft tissue density. Tumor shadow and bone destruction area, the range of lesions in the nasopharyngeal space (Fig. 3), eyelid, sinus, pterygopalatine and cavernous sinus involvement (Fig. 4), CT design for radiation therapy, surgical approach Selection and follow-up observations are significant and should be used as routine tests.

(8) B-mode ultrasonography B-mode ultrasonography has been widely used in the diagnosis and treatment of nasopharyngeal carcinoma. The method is simple and non-invasive. The patient is willing to accept it. In nasopharyngeal carcinoma cases, it is mainly used for liver, neck, retroperitoneal and pelvic cavity. Check the lymph nodes to see if there is liver metastasis and lymph node density, and whether there is cystic or not.

(9) Magnetic resonance imaging examination Because magnetic resonance imaging (MRl) can clearly show the various levels of the skull, sulci, cerebral gyrus, gray matter, white matter and ventricles, cerebrospinal fluid pipelines, blood vessels, etc., using the SE method to show T1, T2 prolonged The intensity image can diagnose nasopharyngeal carcinoma, upper frontal sinus cancer, etc., and shows the relationship between the tumor and surrounding tissues.

Check the EB virus-related antibodies to understand the occurrence and development of the disease.

Diagnosis and diagnosis of nasopharyngeal carcinoma

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests .

Differential diagnosis

1. Nasopharyngeal lymphosarcoma

Lymphatic sarcoma occurs in young people, the primary tumor is large, often with severe nasal congestion and ear symptoms. The lymph node metastasis of the disease is not limited to the neck, and multiple lymph nodes can be involved in the body. The damage of the cranial nerve is not as good as that of the nasopharynx. Cancer is more common, and finally requires pathological diagnosis.

2, proliferative lesions

The apical wall of the nasopharynx, the posterior or posterior wall of the apex, see single or multiple nodules, and the bulge is like a hillock. The size is about 0.5 to 1 cm. The surface of the nodule is light red and smooth, mostly in the nasopharyngeal mucosa or gland. On the basis of the sample, it can also be caused by squamous metaplasia of the mucosal epithelium, and the epithelial retention of the keratinized epithelium can form a change of epidermoid cyst. Part of the mucosal gland is secreted vigorously, forming a cystic cyst, and the mucosa on the surface of the nodule is rough. , erosion, ulcers or oozing, need to consider the possibility of cancer, should be biopsy to confirm the diagnosis.

3, nasopharyngeal tuberculosis, patients with a history of tuberculosis, in addition to nasal resistance, blood stasis, there are low fever, night sweats, weight loss embolism, check nose ulcers, edema, lighter color; secretion smear, can be found Acid-fast bacilli, may be associated with cervical lymphatic tuberculosis; lymph node enlargement, bell-shaped, adhesion, no tenderness, cervical lymph node puncture can find tuberculosis, strong CT test, X-ray chest often suggest active pulmonary tuberculosis Stove.

4, pharyngeal mucosal inflammation is characterized by mucosal roughness, especially in severe inflammation, nasopharyngeal mucosal follicles proliferate, surface irregularities, and even mulberry-like, with purulent secretions on the surface, often need to be differentiated from mucosal invasive cancer.

5, allergic rhinitis nasopharyngeal mucosa pale, smooth and edematous.

6, atrophic rhinitis, the anterior mucosa of the nasopharynx has a shallow ulcer, surrounded by purulent secretions, need to be differentiated from ulcerative nasopharyngeal carcinoma.

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