20th June 2023

Nasopharynx

Nasopharyngeal carcinomas (NPC) are common in South-East Asia and male to female ratio is 3:1. The most common site of origin for NPC is the lateral wall of the nasopharynx, especially the fossa of Rosenmüller, followed by the superior posterior wall. Viral infection (e.g. Epstein-Barr virus), genetic predisposition and environmental factors are associated with the incidence of NPC. Unilateral deafness is the most common local symptom, followed by epistaxis and nasal obstruction. Cranial nerve involvement is common in NPC and 5th nerve involvement is frequent owing to the tumour in or around the foramen ovale. Tumour in the cavernous sinus can lead to diplopia secondary to compression of the III, IV, or VI nerves. The posterior cranial nerves (IX to XII) can be involved by direct parapharyngeal spread or compression by retropharyngeal lymph nodes. The majority of patients have a metastatic neck node at presentation (70%). Radiation therapy is the treatment of choice. Neck dissection is usually only indicated for radiotherapy failures. Concurrent chemoradiotherapy with induction or subsequent chemotherapy improved survival. Stage of the disease is the most important prognostic factor in terms of survival and other prognostic features include cranial nerve palsies, involvement of skull base, advanced age, male sex, and involvement of the lymph nodes in the supraclavicular fossa.