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SynopsisNasopharyngeal cancer is the formation of a malignant epithelial tumor in the nasopharynx. Histopathology includes keratinizing squamous cell carcinoma, differentiated nonkeratinizing carcinoma, undifferentiated nonkeratinizing carcinoma (endemic form), and basaloid squamous cell carcinoma. Common findings include headache, neck or nose mass, epistaxis, nasal obstruction, serous otitis media, tinnitus, otalgia, pharyngitis, and dyspnea.
The condition carries significant mortality, with approximately 50 000 deaths out of 86 000 cases each year, worldwide. It is rare in the United States and Western Europe but causes 25% of all cancer-related deaths in Southern China. It is also endemic to Southeast Asia, North Africa, and the Arctic. This regional distribution suggests varied etiology and significant risk factors including Epstein-Barr virus infection (EBV), genetic inheritance, male sex, smoking, marijuana use, high alcohol consumption, high consumption of salt-cured fish and meats, age older than 45 years, occupational exposure to hardwood dust and formaldehyde, and rarely, human papillomavirus infection (HPV).
The most common signs of nasopharyngeal carcinoma are unilateral hearing loss, a persistent lump in the upper neck, tinnitus, nosebleeds, unilateral nasal congestion, headaches, double vision, hoarse voice, and unintentional weight loss. Cranial nerve involvement and facial numbness can also be seen, dependent on location; the 3rd, 5th, 6th, and 12th cranial nerves are most affected.
Symptoms vary depending on which adjacent structures are impacted, but any of the above should be checked out if persistent for 3 or more weeks. Onset is gradual and most symptoms present at very advanced stages of the cancer.
Radiotherapy is the mainstay of treatment options.
C11.9 – Malignant neoplasm of nasopharynx, unspecified
722529000 – Primary malignant epithelial neoplasm of nasopharynx
Differential Diagnosis & Pitfalls
- Nasopharyngeal papilloma – presents as an irregular, polypoid mass that is pink in color and tends to bleed
- Nasopharyngeal cyst – MRI will show hypointense signal on T1 and hyperintense on T2
- Prominent normal adenoidal tissue – MRI will show a striped appearance on T1 and T2 weighted images
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.