Nasopharyngeal carcinoma natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Overview

Nasopharyngeal carcinoma produces few symptoms early in its course, with the result that most cases are quite advanced when detected. Once the tumor has expanded from its site of origin in the lateral wall of the nasopharynx, it may obstruct the nasal passages and cause nasal discharge or nosebleed. The five-year survival rate of nonkeratinizing and undifferentiated nasopharyngeal carcinomas, with appropriate treatment, is about 65% overall. The common complications of nasopharyngeal carcinoma include airway obstruction, dysphagia and disfigurement of the neck or face.

Natural history

If left untreated nasopharyngeal carcinoma produces few symptoms early in its course. Once the tumor has expanded from its site of origin in the lateral wall of the nasopharynx, it may obstruct the nasal passages and cause nasal discharge or epistaxis.

Prognosis

The five-year survival rate of nonkeratinizing and undifferentiated nasopharyngeal carcinomas is approximately 65%. The prognosis of keratinizing NPC is significantly worse, due to its greater resistance to radiation. Prognosis is influenced both by stage and tumour type.

• type I: keratinizing squamous cell carcinoma - 42% 5-year survival
• type II: non-keratinizing squamous cell carcinoma - 65% 5-year survival
• type III: undifferentiated carcinoma - 14% 5-year survival

Complications

Complications of nasopharyngeal carcinoma include:

• Airway obstruction
• Difficulty swallowing
• Disfigurement of the neck or face
• Hardening of the skin of the neck
• Loss of voice and speaking ability
• Spread of the cancer to other body areas (metastasis)

A potential complication of radiotherapy is radiation necrosis of the temporal lobes, as well as cranial nerve dysfunction and atrophy and fibrosis of the muscles of mastication and salivary glands.