Nasopharyngeal Cancer

The nasopharynx is the upper part of the pharynx (throat) behind the nose. The pharynx is a
hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea
(windpipe) and esophagus (the tube that goes from the throat to the stomach). Air and food pass
through the pharynx on the way to the trachea or the esophagus. The nostrils lead into the
nasopharynx. An opening on each side of the nasopharynx leads into an ear. Nasopharyngeal
cancer most commonly starts in the squamous cells that line the oropharynx (the part of the
throat behind the mouth).
Nasofaring adalah bagian atas dari faring (tenggorokan) di belakang hidung. aring adalah
tabung hampa sekitar 5 inci pan!ang yang dimulai di belakang hidung dan berakhir di bagian atas
trakea (batang tenggorokan) dan esofagus (tabung yang berlangsung dari tenggorokan ke perut).
"dara dan lulus makanan melalui faring dalam per!alanan ke trakea atau kerongkongan. #ubang
hidung mengarah ke nasofaring. $ebuah pembukaan pada setiap sisi nasofaring mengarah ke
telinga. %anker nasofaring paling sering dimulai pada sel&sel skuamosa yang melapisi orofaring
(bagian tenggorokan di belakang mulut).
Anatomy of 'ar(Nose)Throat and Nasopharyngeal
$ign and symtoms of nasopharyngeal cancer
Anything that increases your risk of getting a disease is called a risk factor. *isk factors may
include the following+
,hinese or Asian ancestry.
'xposure to the 'pstein&-arr .irus+ The 'pstein&-arr .irus has been associated with
certain cancers( including nasopharyngeal cancer and some lymphomas.
Apapun yang meningkatkan risiko terkena penyakit yang disebut faktor risiko. aktor risiko
dapat mencakup hal berikut+
/ ,ina atau keturunan Asia.
/ 0aparan .irus 'pstein&-arr+ 1irus 'pstein&-arr telah dikaitkan dengan kanker tertentu(
termasuk kanker nasofaring dan beberapa limfoma.
These and other symptoms may be caused by nasopharyngeal cancer. 2ther conditions may
cause the same symptoms. A doctor should be consulted if any of the following problems occur+
A lump in the nose or neck.
A sore throat.
Trouble breathing or speaking.
Nosebleeds.
Trouble hearing.
0ain or ringing in the ear.
3eadaches.
Tests that examine the nose and throat are used to detect (find) and diagnose nasopharyngeal
cancer.
4e!ala ini dan lainnya dapat disebabkan oleh kanker nasofaring. %ondisi lain dapat
menyebabkan ge!ala yang sama. $eorang dokter harus berkonsultasi !ika ada masalah berikut
ter!adi+
/ $ebuah ben!olan di hidung atau leher.
/ $akit tenggorokan.
/ %esulitan bernapas atau berbicara.
/ 5imisan.
/ 5asalah pendengaran.
/ *asa sakit atau dering di telinga.
/ $akit kepala.
Tes yang memeriksa hidung dan tenggorokan digunakan untuk mendeteksi (menemukan) dan
mendiagnosa kanker nasofaring.
The following tests and procedures may be used+
0hysical exam of the throat+ An exam in which the doctor feels for swollen lymph nodes
in the neck and looks down the throat with a small( long&handled mirror to check for
abnormal areas.
Nasoscopy+ A procedure to look inside the nose for abnormal areas. A nasoscope is
inserted through the nose. A nasoscope is a thin( tube&like instrument with a light and a
lens for .iewing. 6t may also ha.e a tool to remo.e tissue samples( which are checked
under a microscope for signs of cancer.
Neurological exam+ A series of questions and tests to check the brain( spinal cord( and
ner.e function. The exam checks a person7s mental status( coordination( and ability to
walk normally( and how well the muscles( senses( and reflexes work. This may also be
called a neuro exam or a neurologic exam.
3ead and chest x&rays+ An x&ray of the skull and organs and bones inside the chest. An x&
ray is a type of energy beam that can go through the body and onto film( making a picture
of areas inside the body.
5*6 (magnetic resonance imaging)+ A procedure that uses a magnet( radio wa.es( and a
computer to make a series of detailed pictures of areas inside the body. This procedure is
also called nuclear magnetic resonance imaging (N5*6).
,T scan (,AT scan)+ A procedure that makes a series of detailed pictures of areas inside
the body( taken from different angles. The pictures are made by a computer linked to an
x&ray machine. A dye may be in!ected into a .ein or swallowed to help the organs or
tissues show up more clearly. This procedure is also called computed tomography(
computeri8ed tomography( or computeri8ed axial tomography.
0'T scan (positron emission tomography scan)+ A procedure to find malignant tumor
cells in the body. A small amount of radioacti.e glucose (sugar) is in!ected into a .ein.
The 0'T scanner rotates around the body and makes a picture of where glucose is being
used in the body. 5alignant tumor cells show up brighter in the picture because they are
more acti.e and take up more glucose than normal cells do. 0'T scans may be used to
find nasopharyngeal cancers that ha.e spread to the bone.
#aboratory tests+ 5edical procedures that test samples of tissue( blood( urine( or other
substances in the body. These tests help to diagnose disease( plan and check treatment( or
monitor the disease o.er time.
-iopsy+ The remo.al of cells or tissues so they can be .iewed under a microscope by a
pathologist to check for signs of cancer.
Tes berikut dan prosedur dapat digunakan+
/ isik u!ian tenggorokan+ $ebuah u!ian di mana dokter merasa pembengkakan kelen!ar getah
bening di leher dan melihat ke bawah tenggorokan dengan cermin kecil bergagang pan!ang
untuk memeriksa daerah abnormal.
/ Nasoscopy+ $uatu prosedur untuk melihat ke dalam hidung untuk daerah abnormal. $ebuah
nasoscope dimasukkan melalui hidung. Nasoscope adalah tipis( tabung&seperti instrumen
dengan cahaya dan lensa untuk melihat. 3al ini !uga mungkin memiliki alat untuk
mengambil contoh !aringan( yang diperiksa di bawah mikroskop untuk tanda&tanda kanker.
/ Neurologis u!ian+ $erangkaian pertanyaan dan tes untuk memeriksa otak( sumsum tulang
belakang( dan fungsi saraf. "!ian mengecek status mental seseorang( koordinasi( dan
kemampuan untuk ber!alan normal( dan seberapa baik otot( indra( dan ker!a refleks. 3al ini
!uga dapat disebut u!ian neuro atau u!ian neurologis.
/ %epala dan rontgen dada+ $ebuah x&ray tengkorak dan tulang dan organ&organ di dalam
dada. 9&ray adalah !enis balok energi yang dapat masuk melalui tubuh dan ke film( membuat
gambar dari daerah di dalam tubuh.
/ 5*6 (magnetic resonance imaging)+ $ebuah prosedur yang menggunakan magnet(
gelombang radio( dan komputer untuk membuat serangkaian gambar detil dari daerah di
dalam tubuh. 0rosedur ini !uga disebut nuklir 5agnetic *esonance 6maging (N5*6).
/ ,T scan (,AT scan)+ $ebuah prosedur yang membuat serangkaian gambar detil dari daerah
di dalam tubuh( yang diambil dari sudut yang berbeda. 4ambar&gambar yang dibuat oleh
komputer yang terhubung ke mesin x&ray. $ebuah pewarna dapat disuntikkan ke dalam .ena
atau ditelan untuk membantu organ&organ atau !aringan muncul lebih !elas. 0rosedur ini !uga
disebut tomografi komputer( computeri8ed tomography( tomografi aksial atau komputerisasi.
/ 0'T scan (positron emission tomography scan)+ $uatu prosedur untuk menemukan sel&sel
tumor ganas dalam tubuh. $e!umlah kecil glukosa radioaktif (gula) yang disuntikkan ke
pembuluh darah. 0emindai 0'T berputar di sekitar tubuh dan membuat gambar dari mana
glukosa sedang digunakan dalam tubuh. $el tumor ganas muncul terang dalam gambar
karena mereka lebih aktif dan mengambil glukosa lebih dari sel normal. 0'T scan dapat
digunakan untuk menemukan kanker nasofaring yang telah menyebar ke tulang.
/ Tes laboratorium+ prosedur medis yang mengu!i sampel !aringan( kencing darah(( atau 8at
lain dalam tubuh. Tes ini membantu mendiagnosa penyakit( rencana dan memeriksa
pengobatan( atau monitor penyakit dari waktu ke waktu.
/ -iopsi+ 0enghapusan sel atau !aringan sehingga mereka dapat dilihat di bawah mikroskop
oleh seorang ahli patologi untuk memeriksa tanda&tanda kanker.
The prognosis (chance of reco.ery) and treatment options depend on the following+
The stage of the cancer (whether it affects part of the nasopharynx( in.ol.es the whole
nasopharynx( or has spread to other places in the body).
The type of nasopharyngeal cancer.
The si8e of the tumor.
The patient7s age and general health.
After nasopharyngeal cancer has been diagnosed( tests are done to find out if cancer cells ha.e
spread within the nasopharynx or to other parts of the body.
The process used to find out whether cancer has spread within the nasopharynx or to other parts
of the body is called staging. The information gathered from the staging process determines the
stage of the disease. 6t is important to know the stage in order to plan treatment. The results of
the tests used to diagnose nasopharyngeal cancer are often also used to stage the disease.
0rognosis (kesempatan pemulihan) dan pilihan pengobatan bergantung pada hal berikut+
/ Tahap kanker (apakah itu mempengaruhi bagian dari nasofaring( melibatkan seluruh
nasofaring( atau telah menyebar ke tempat lain dalam tubuh).
/ :enis kanker nasofaring.
/ "kuran dari tumor.
/ "sia pasien dan kesehatan umum.
$etelah kanker nasofaring telah didiagnosa( tes dilakukan untuk mengetahui apakah sel kanker
telah menyebar di dalam nasofaring atau ke bagian lain dari tubuh.
0roses yang digunakan untuk mengetahui apakah kanker telah menyebar dalam nasofaring atau
ke bagian lain dari tubuh disebut pementasan. 6nformasi yang dikumpulkan dari proses
pementasan menentukan tahap penyakit. 3al ini penting untuk mengetahui panggung dalam
rangka untuk merencanakan pengobatan. 3asil tes yang digunakan untuk mendiagnosa kanker
nasofaring sering !uga digunakan untuk stadium penyakit.
Stage Information for Nasopharyngeal Cancer
;efinitions of TN5
This $tage 6nformation section has been updated to include information from the se.enth edition
(<=>=) of the American :oint ,ommittee on ,ancer?s AJCC Cancer Staging Manual. The 0;@
Adult Treatment 'ditorial -oard( which is responsible for maintaining this summary( is currently
re.iewing the new staging categories to determine whether additional changes need to be made
to other parts of the summary. Any necessary changes will be made as soon as possible.
$taging systems are all clinical staging and are based on the best possible estimate of the extent
of disease before treatment. Assessment of the primary tumor is based on inspection and
palpation( when possible( and by both indirect mirror examination and direct endoscopy when
necessary. The tumor must be confirmed histologically( and any other pathologic data obtained
on biopsy may be included. '.aluation of the function of the cranial ner.es is especially
appropriate for tumors of the nasopharynx. The appropriate nodal drainage areas are examined
by careful palpation. 6nformation from diagnostic imaging studies may be used in staging.
5agnetic resonance imaging offers an ad.antage o.er computed tomographic scanning in the
detection and locali8ation of head and neck tumors and the distinction of lymph nodes from
blood .essels. 0ositron emission tomography scans may be useful in detecting skeletal
metastases in patients with ad.anced nasopharyngeal cancer. 6f a patient has a relapse( a
complete reassessment must be done to select the appropriate additional therapy.
Tahap 6nformasi untuk %anker Nasofaring
;efinisi TN5
Tahap ini bagian 6nformasi telah diperbarui untuk menyertakan informasi dari edisi ketu!uh
(<=>=) dari American %omite -ersama manual $taging A:,, %anker %anker. Adult 0;@
0engobatan ;ewan 'ditorial( yang bertanggung !awab untuk men!aga ringkasan ini( saat ini
sedang menin!au kategori pementasan baru untuk menentukan apakah perubahan tambahan perlu
dilakukan untuk bagian lain dari ringkasan. $etiap perubahan yang diperlukan akan dibuat
sesegera mungkin.
$istem pementasan semua stadium klinis dan didasarkan pada estimasi terbaik dari luasnya
penyakit sebelum pengobatan. 0enilaian dari tumor primer didasarkan pada inspeksi dan palpasi(
bila mungkin( dan oleh cermin pemeriksaan langsung dan tidak langsung endoskopi bila
diperlukan. Tumor harus dikonfirmasi secara histologis( dan data lainnya yang diperoleh
patologis pada biopsi dapat dimasukkan. '.aluasi fungsi saraf kranial terutama cocok untuk
tumor nasofaring. 0ara nodal sesuai daerah drainase diperiksa oleh palpasi hati&hati. 6nformasi
dari studi pencitraan diagnostik dapat digunakan dalam pementasan. 5agnetic *esonance
6maging menawarkan keuntungan lebih dari dihitung tomografi pemindaian dalam deteksi dan
lokalisasi tumor kepala dan leher dan perbedaan kelen!ar getah bening dari pembuluh darah.
$can tomografi emisi positron mungkin berguna dalam mendeteksi metastase tulang pada pasien
dengan kanker nasofaring lan!ut. :ika pasien memiliki kambuh( penilaian ulang yang lengkap
harus dilakukan untuk memilih terapi tambahan yang sesuai.
Definitions of TNM
The American :oint ,ommittee on ,ancer (A:,,) has designated staging by TN5 classification
to define nasopharyngeal cancer
Table >. 0rimary Tumor (T)
T9 0rimary tumor cannot be assessed.
T= No e.idence of primary tumor.
Tis ,arcinoma in situ.
T> Tumor confined to the nasopharynx( or tumor extends to oropharynx andAor nasal ca.ity
without parapharyngeal extension.
a
T< Tumor with parapharyngeal extension.
a
TB Tumor in.ol.es bony structures of skull base andAor paranasal sinuses.
TC Tumor with intracranial extension andAor in.ol.ement of cranial ner.es( hypopharynx( orbit(
or with extension to the infratemporal fossaAmasticator space.
a
Parapharyngeal extension denotes posterolateral infiltration of tumor.
Table <. *egional #ymph Nodes (N)
b
N9 *egional lymph nodes cannot be assessed.
N= No regional lymph node metastasis.
N> "nilateral metastasis in cer.ical lymph node(s)( DE cm in greatest dimension( abo.e the
supracla.icular fossa( andAor unilateral or bilateral( retropharyngeal lymph nodes( DE cm in
greatest dimension.
c
N< -ilateral metastasis in cer.ical lymph node(s)( DE cm in greatest dimension( abo.e the
supracla.icular fossa.
d
NB 5etastasis in a lymph node(s)
c
FE cm andAor to supracla.icular fossa.
d
NBa FE cm in dimension.
NBb 'xtension to the supracla.icular fossa.
d
b
The distribution and the prognostic impact of regional lymph node spread from nasopharyngeal
cancer, particularly of the undifferentiated type, are different from those of other head and neck
mucosal cancers and ustify the use of a different ! classification scheme.
c
Midline nodes are considered ipsilateral nodes.
d
Supracla"icular #one or fossa is rele"ant to the staging of nasopharyngeal carcinoma and is the
triangular region originally described by $o. %t is defined by three points& '() the superior
margin of the sternal end of the cla"icle, '*) the superior margin of the lateral end of the
cla"icle, '+) the point ,here the neck meets the shoulder. !ote that this ,ould include caudal
portions of le"els %- and -.. All cases ,ith lymph nodes ',hole or part) in the fossa are
considered !+b.
bThe distribusi dan dampak prognostik dari node getah bening regional menyebar dari kanker
nasofaring( terutama dari !enis dibeda&bedakan( yang berbeda dari kepala lainnya dan kanker
leher mukosa dan membenarkan penggunaan skema klasifikasi N yang berbeda.
node node c5idline dianggap ipsilateral.
8ona d$upracla.icular atau fosa rele.an dengan pementasan karsinoma nasofaring dan
merupakan wilayah segitiga awalnya digambarkan oleh 3o. 3al ini ditentukan oleh tiga poin+ (>)
margin superior sternalis akhir kla.ikula( (<) margin superior dari u!ung lateral kla.ikula( (B)
titik di mana leher memenuhi bahu. ,atatan bahwa ini termasuk bagian caudal tingkat 61 dan
1-. $emua kasus dengan kelen!ar getah bening (keseluruhan atau sebagian) di fosa dianggap
NBb.
Table B. ;istant 5etastasis (5)
5= No distant metastasis.
5> ;istant metastasis.
Table C. Anatomic $tageA0rognostic 4roups
Stage T N M
= Tis N= 5=
6 T> N= 5=
66 T> N> 5=
T< N= 5=
T< N> 5=
666 T> N< 5=
T< N< 5=
TB N= 5=
TB N> 5=
TB N< 5=
61A TC N= 5=
TC N> 5=
TC N< 5=
61- Any T NB 5=
61, Any T Any N 5>
The following stages are used for nasopharyngeal cancer+
Stage 0 (Carcinoma in Situ)
6n stage =( abnormal cells are found in the lining of the nasopharynx. These abnormal cells may
become cancer and spread into nearby normal tissue. $tage = is also called carcinoma in situ.
Stage I
6n stage 6( cancer has formed and is found in the nasopharynx only.
Stage II
$tage 66 nasopharyngeal cancer is di.ided into stage 66A and stage 66- as follows+
$tage 66A+ ,ancer has spread from the nasopharynx to the oropharynx (the middle part of
the throat that includes the soft palate( the base of the tongue( and the tonsils)( andAor to
the nasal ca.ity.
$tage 66-+ ,ancer is found in the nasopharynx and has spread to lymph nodes on one side
of the neck( or has spread to the area surrounding the nasopharynx and may ha.e spread
to lymph nodes on one side of the neck. The in.ol.ed lymph nodes are E centimeters or
smaller.
Stage III
6n stage 666 nasopharyngeal cancer( the cancer+
is found in the nasopharynx and has spread to lymph nodes on both sides of the neck and
the lymph nodes are E centimeters or smallerG or
has spread into the soft tissues (oropharynx andAor nasal ca.ity) and to lymph nodes on
both sides of the neck and the lymph nodes are E centimeters or smallerG or
has spread beyond the soft tissues into areas around the pharynx and to lymph nodes on
both sides of the neck and the lymph nodes are E centimeters or smallerG or
has spread to nearby bones or sinuses and may ha.e spread to lymph nodes on one or
both sides of the neck and the in.ol.ed lymph nodes are E centimeters or smaller.
Stage IV
$tage 61 nasopharyngeal cancer is di.ided into stage 61A( stage 61-( and stage 61, as follows+
$tage 61A+ ,ancer has spread beyond the nasopharynx and may ha.e spread to the
cranial ner.es( the hypopharynx (bottom part of the throat)( areas in and around the side
of the skull or !awbone( andAor the bone around the eye. ,ancer may also ha.e spread to
lymph nodes on one or both sides of the neck( and the in.ol.ed lymph nodes are E
centimeters or smaller.
$tage 61-+ ,ancer has spread to lymph nodes abo.e the collarbone andAor the in.ol.ed
lymph nodes are larger than E centimeters.
$tage 61,+ ,ancer has spread beyond nearby lymph nodes to other parts of the body.
There are different types of treatment for patients with nasopharyngeal cancer
;ifferent types of treatment are a.ailable for patients with nasopharyngeal cancer. $ome
treatments are standard (the currently used treatment)( and some are being tested in clinical trials.
-efore starting treatment( patients may want to think about taking part in a clinical trial. A
treatment clinical trial is a research study meant to help impro.e current treatments or obtain
information on new treatments for patients with cancer. Hhen clinical trials show that a new
treatment is better than the standard treatment( the new treatment may become the standard
treatment.
Three types of standard treatment are used+
!adiation therapy
*adiation therapy is a cancer treatment that uses high&energy x&rays or other types of radiation to
kill cancer cells or keep them from growing. There are two types of radiation therapy. 'xternal
radiation therapy uses a machine outside the body to send radiation toward the cancer. 6nternal
radiation therapy uses a radioacti.e substance sealed in needles( seeds( wires( or catheters that
are placed directly into or near the cancer. The way the radiation therapy is gi.en depends on the
type and stage of the cancer being treated.
'xternal radiation therapy to the thyroid or the pituitary gland may change the way the thyroid
gland works. The doctor may test the thyroid gland before and after therapy to make sure it is
working properly. 6t is also important that a dentist check the patient7s teeth( gums( and mouth(
and fix any existing problems before radiation therapy begins.
Chemotherapy
,hemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells( either by
killing the cells or by stopping them from di.iding. Hhen chemotherapy is taken by mouth or
in!ected into a .ein or muscle( the drugs enter the bloodstream and can reach cancer cells
throughout the body (systemic chemotherapy). Hhen chemotherapy is placed directly into the
spinal column( an organ( or a body ca.ity such as the abdomen( the drugs mainly affect cancer
cells in those areas (regional chemotherapy). The way the chemotherapy is gi.en depends on the
type and stage of the cancer being treated.
Surgery
$urgery is a procedure to find out whether cancer is present( to remo.e cancer from the body( or
to repair a body part. Also called an operation. $urgery is sometimes used for nasopharyngeal
cancer that does not respond to radiation therapy. 6f cancer has spread to the lymph nodes( the
doctor may remo.e lymph nodes and other tissues in the neck.
New types of treatment are being tested in clinical trials. These include the following+
"iologic therapy
-iologic therapy is a treatment that uses the patient7s immune system to fight cancer. $ubstances
made by the body or made in a laboratory are used to boost( direct( or restore the body7s natural
defenses against cancer. This type of cancer treatment is also called biotherapy or
immunotherapy.
Intensity#modulated radiation therapy
6ntensity&modulated radiation therapy (65*T) is a type of B&dimensional radiation therapy that
uses computer&generated images to show the si8e and shape of the tumor.