Nasopharyngeal carcinoma history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]
Overview
Symptoms of nasopharyngeal carcinoma include swelling in the neck, cough, sore throat and weight loss.[1]
Symptoms
Symptoms of nasopharyngeal carcinoma include:
- Abnormal (high-pitched) breathing sounds
- Epistaxis
- Cough
- Hemoptysis
- Dysphagia
- Hoarseness
- Arthralgia
- Neck pain
- Sore throat
- Swelling or lumps in the neck
- Weight loss
Overview
The majority of patients with [disease name] are asymptomatic.
OR
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
History and Symptoms
- The majority of patients with [disease name] are asymptomatic.
OR
- The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
- Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
- Most symptoms of nasopharyngeal carcinoma can be divided into four subtypes:
- Existence of mass in the nasopharynx:
- Epistaxis
- Nasal obstruction
- Nasal discharge
- Latero-posterior invasion of the tumor to the nasopharyngeal space and dysfunction of eustachian tube:
- Tinnitus
- Hearing decreasing
- Involvement of skull base accompanied by damaging of the 5th and 6th cranial nerves:
- Headache
- Diplopia
- Facial pain, and numbness
- Neck mass
- Existence of mass in the nasopharynx:
- The majority(75–90%) of patients with NPC present with loco regionally advanced disease,commonly with cervical lymph node metastases.87,88 The presenting symptom at ology of patients with NPC can be divided into 4 main categories:(1)related to a mass in the nasopharynx (epistaxis,obstruction,and discharge),(2) related to Eustachian tube dysfunction(decreased hearing,tinnitus),(3)skull base involvement(erosion)with impairment of the 5th and 6th cranial nerves(headache,diplopia,facial pain,and numbness/ paresthesia),and(4)neck mass . In a large retrospective study from Hong Kong comprising almost 5000 patients,the initial symptoms at presentation were,with decreasing frequency,a neck mass(76%),aural dysfunction(62%),headache (35%),diplopia(11%),weight loss(7%),and trismus (3%).89 Distant metastatic disease at presentation is rather uncommon and has been reported to be present in approximately 5%patients from southern China.90 NPC is predominantly a disease of adults with a peak occurrence in the 4th to 6th decade,but NPC also affects young patients even in the pediatric population . In a study from Hong Kong, Shametal. presented a series of 71 Chinese patients ranging in age from 9 to 20 years. The presenting symptoms were often multiple, comprising nasal(77%)and ear(73%)symptoms,headache (60%), and neck swelling(63%).The median duration of these symptoms was 2–3 months,and 90%of the patients were Stage III or IV at presentation. All patients were treated primarily by radiotherapy. Among them,44 patients died of disease,and the median time to death was 18 months.The authors concluded that,in Hong Kong,the histological features, pattern of relapse,and survival of NPC in the young are not different from that of adults.However,the young patients presented with more advanced-stage disease.91 It should be noted that, similar to oropharyngeal SCC, NPC may also present with cystic lymph node metastasis in the neck.92 Thompson and Heffner reported that of 136 cystic neck metastases,8%were derived from the nasopharynx 93 and the corresponding figure in an other study was 1.8%
- Patients with nasopharyngeal carcinoma can present with symptoms from one or more of four categories. The categories consist of (1) presence of tumour mass in the nasopharynx (epistaxis, nasal obstruction, and discharge); (2) dysfunction of the eustachian tube, associated with the latero posterior extension of the tumour to the paranasopharyngeal space (tinnitus and deafness); (3) skull-base erosion and palsy of the fifth and sixth cranial nerves, associated with the superior extension of the tumour (headache, diplopia, facial pain and numbness); and (4) neck masses, usually appearing first in the upper neck. Symptoms such as anorexia and weight loss are uncommon in patients with nasopharyngeal carcinomas and distant spread should be suspected when such symptoms are present. Unfortunately, because of the non-specific nature of the nasal and aural symptoms and the difficulty of making a clinical examination of the nasopharynx, most patients with the disease are diagnosed only when the tumour has reached an advanced stage (stages III and IV). A retrospective analysis of 4768 patients identified symptoms of nasopharyngeal carcinoma at presentation as neck mass (76%), nasal dysfunction (73%), aural dysfunction (62%), headache (35%), diplopia (11%), facial numbness (8%), weight loss (7%), and trismus (3%). The physical signs present at diagnosis were enlarged neck node (75%) and cranial nerve palsy (20%). The cranial nerves most commonly affected were the third, fifth, sixth, and 12th nerves.21,22 The presenting symptoms in young patients were in general similar to those reported in adults.
History
Patients with [disease name]] may have a positive history of:
- [History finding 1]
- [History finding 2]
- [History finding 3]
Common Symptoms
Common symptoms of [disease] include:
- [Symptom 1]
- [Symptom 2]
- [Symptom 3]
Less Common Symptoms
Less common symptoms of [disease name] include
- [Symptom 1]
- [Symptom 2]
- [Symptom 3]
A nose bleed, a stuffed nose with bloody drainage, or serious otitis media may be among the earliest clinical symptoms. However, the disease may initially grow unnoticed and spread locally to adjacent areas in the oropharynx or invade the skull base with cranial nerve paralyses. Cranial nerves III to VI are most commonly affected. The nasopharynx has an abundant supply of regional lymphatic vessels. These drain through the internal jugular vein and the posterior cervical and retropharyngeal chains. As a result, NPC frequently spreads regionally leading to early lymph-node involvement in the neck. Clinically, lymph-node involvement is frequently bilateral and bulky. It may be the first clinical presentation and is independent of the size of the primary tumour. Systemic dissemination also occurs more readily than in other head-and-neck cancers; frequently involved organs are the bones, lung, and liver. Bone-marrow invasion, dermatomyositis, and paraneoplastic syndromes, including hypertrophic osteoarthropathy and the syndrome of inappropriate secretion of antidiuretic hormone, fever of unknown origin, and leukemoid reaction have been described.
Patients with NPC commonly present with headache,
cranial nerve involvement, nasal obstruction, or a neck
mass because of nodal metastases. However, patients may
remain asymptomatic for a long time, given the often
References
- ↑ Richard Cote, Saul Suster, Lawrence Weiss, Noel Weidner (Editor). Modern Surgical Pathology (2 Volume Set). London: W B Saunders. ISBN 0-7216-7253-1.