Why do tumors go unnoticed for a long time?
The nasopharynx is located deep, behind the nasal cavity, and is not visible during a normal examination of the throat. The tumor grows in a confined space and at first does not interfere with breathing or swallowing. The first to suffer is usually the mouth of the auditory tube, through which the middle ear is ventilated: it is blocked, fluid accumulates in the tympanic cavity, and a feeling of congestion and hearing loss on one side appears. This condition is often treated as otitis media, wasting time. Therefore, unilateral exudative otitis in an adult is always a reason to examine the nasopharynx with an endoscope.
- The nasopharynx is not visible during a routine examination of the throat
- The tumor blocks the mouth of the auditory tube
- Unilateral exudative otitis develops
- Symptoms can easily be mistaken for ordinary otitis media
- Unilateral otitis in an adult requires endoscopy
Causes and risk factors
The most important factor is infection with the Epstein-Barr virus, the genetic material of which is found in tumor cells. However, the majority of people on the planet are infected with the virus, and only a few develop the disease, so additional conditions are needed: hereditary predisposition, characteristics of the immune response and external influences. Among the latter are regular consumption of salted dried fish and meat, smoking, and professional contact with formaldehyde and wood dust. The incidence varies markedly among regions of the world, and familial cases are more common than with most tumors.
- Epstein-Barr virus
- Hereditary predisposition and family cases
- Salted dried fish and meat in the diet
- Smoking
- Formaldehyde and wood dust
- Male gender and average age range
Symptoms
Manifestations are divided into four groups. Ear - congestion, hearing loss, noise in the ear on one side. Nasal - one-sided congestion, bloody discharge, blood in saliva in the morning. Cervical - enlarged, dense, painless lymph nodes, often the first sign noticed. Neurological ones occur when they grow to the base of the skull: double vision, numbness of half the face, drooping eyelids, headache. The combination of a node in the neck with congestion in one ear is considered very characteristic and requires immediate examination.
- Unilateral ear congestion and hearing loss
- Noise in the ear
- Unilateral nasal congestion
- Bloody discharge from the nose and blood in saliva
- Dense painless nodes on the neck
- Double vision, facial numbness, drooping eyelid
- Headache in the back of the head
Diagnostics
The basis of diagnosis is endoscopy of the nasopharynx with a biopsy of the suspicious area: only histological examination confirms the diagnosis. The extent of the tumor is best demonstrated by contrast-enhanced MRI, as it shows in detail the soft tissue and extension to the base of the skull; CT complements this with bone assessment. The condition of the neck lymph nodes is assessed by ultrasound, with puncture if necessary. Determination of Epstein-Barr virus DNA in the blood is used as an auxiliary indicator. To exclude distant lesions, imaging of the chest, abdomen, and bones is used.
- Endoscopy of the nasopharynx with biopsy
- MRI of the nasopharynx and skull base with contrast
- CT scan to evaluate bone structures
- Ultrasound of neck lymph nodes and puncture
- Epstein-Barr virus DNA in blood
- Audiometry and eardrum examination
- Examination to exclude distant lesions
Treatment and observation
The nasopharynx is surrounded by vital structures, so surgical removal of the tumor is rarely used here. The main method is radiation therapy, to which this type of cancer is very sensitive; Modern techniques make it possible to precisely irradiate a tumor, sparing the salivary glands and other tissues. For advanced stages, radiation is combined with chemotherapy. Surgery is considered mainly for residual changes in the lymph nodes and for relapses. After treatment, regular examinations, monitoring of hearing, dental condition and function of the thyroid gland in the irradiation zone are important.
- Radiation therapy as the main method
- Combination with chemotherapy for advanced stages
- Lymph node surgery for residual tumor
- Sanitation of the oral cavity before irradiation
- Monitoring thyroid function after treatment
- Regular endoscopy and MRI during follow-up
- Caring for mucous membranes and combating dry mouth
