An Evidence-Based Approach to the Management of Nasopharyngeal Cancer: From Basic Science to Clinical Presentation and Treatment

Cover
An Evidence-Based Approach to the Management of Nasopharyngeal Cancer
Copyright
Dedication
Contents
List of Contributors
About the editors
Acknowledgment
1 Introduction
	Historical aspect
	Geographical distribution and familial clustering
	Association with Epstein–Barr virus
	Improvement in treatment outcomes in the last five decades
	Conclusion
	References
2 Risk factors and etiopathogenesis of nasopharyngeal carcinoma
	Introduction
		Risks factors of nasopharyngeal carcinoma
			Family history
			Ethnic and racial distribution
			Genetic factors
				Human leukocyte antigen
				Tumor oncogens and tumor suppressor genes
			The Epstein–Barr virus
			The dietary factors
		Salted fish
			Environmental carcinogens
			Tobacco smoking
			Alcohol consumption
	Interaction between the risk factors and pathogenesis of nasopharyngeal carcinoma
	Association between stages of nasopharyngeal carcinoma at diagnosis with risk factors of nasopharyngeal carcinoma
	Implications for the management of nasopharyngeal carcinoma
	Epstein–Barr virus as a screening biomarker
	How to identify and reduce risk
	Conclusion
	References
	Further reading
3 Genetics of nasopharyngeal carcinoma and molecular signaling pathways
	Genomic and epigenetic landscapes of nasopharyngeal carcinoma
		Introduction
		Genetic susceptibility to nasopharyngeal carcinoma
		Epigenetic alterations and nasopharyngeal carcinoma
			DNA methylation and nasopharyngeal carcinoma
			Histone modifications
			Long noncoding RNAs and nasopharyngeal carcinoma
			miRNAs and nasopharyngeal carcinoma
			Other Epstein–Barr virus genome products and nasopharyngeal carcinoma
		Molecular signaling pathways in nasopharyngeal carcinoma
		Role of genomic profiling
		Genetic and epigenetic screening
			Epstein–Barr virus DNA testing
			DNA methylation screening
			miRNAs screening
		Cost and efficacy
		Clinical implications
		Conclusions and future directions
	List of abbreviations
	References
	Further reading
4 Surgical anatomy of the nasopharynx
	Introduction
	Surgical anatomy of nasopharynx
	Important surgical adjacent structures
	Conclusion
	References
5 Pathology classification of nasopharyngeal carcinoma
	Introduction
	The evolved history of nasopharyngeal carcinoma pathology classifications
	WHO classifications
		Previous classifications
		Is carcinoma in situ universally accepted as a separate entity?
		Latest WHO classification
	Histomorphological features of nasopharyngeal carcinoma
		Nonkeratinizing squamous cell carcinoma
		Keratinizing squamous cell carcinoma
		Basaloid squamous cell carcinoma
	Ancillary studies
		Immunohistochemistry
		Nasopharyngeal carcinoma genetic predisposition
		Molecular diagnosis
	Nasopharyngeal carcinoma diagnostic problems
		Crush artifacts
		Morphological variations
		Mimickers
	Conclusions
	Acknowledgment
	References
6 Clinical presentation of nasopharyngeal carcinoma
	Introduction
	Four groups of clinical signs and symptoms of nasopharyngeal carcinoma
		Symptoms resulting from the tumor mass in the nasopharyngeal area
		Symptoms and signs related to dysfunction of the Eustachian tube
		Symptoms resulting from extension toward skull base involvement (erosion) with impairment of the fifth and sixth cranial ne...
		Palpable neck masses
	Sign and symptoms related to extension of disease out of the nasopharynx
		Diagnoses
	Conclusion
	References
	Further reading
7 Assessment and staging of nasopharyngeal carcinoma
	Assessment
		History
			Clinical presentation
			Social history
		Physical examination
			Lymph node levels of the neck
		Neurological examination
		Endoscopic examination
			Endoscopic examination with biopsy
			High definition-endoscopic imaging and narrow-band imaging endoscopy
			Office-based ultrasound examination and fine-needle aspiration of the neck
		Laboratory test
			Serological markers
			Plasma Epstein–Barr virus DNA
			NP screen
		Radiological assessment
			Ultrasonography
			Computed tomography and magnetic resonance imaging
			Positron emission tomography/computed tomography
		Quality of life
			Functional assessment of cancer therapy-nasopharyngeal cancer
			European Organisation for Research and Treatment of Cancer core quality-of-life questionnaire
			Quality of life-radiation therapy instrument-head and neck
	Staging
		American Joint Committee on Cancer tumor, node, and metastasis system
			Recurrent AJCC/UICC TNM stage system rTNM system
		Other staging systems
			Ho staging system
			Chinese staging system
	Summary and concluding remarks
	References
8 Laboratory investigation for nasopharyngeal carcinoma diagnosis
	Introduction
	Epstein–Barr virus serology
	Histopathological evaluation
		Histopathology of nonkeratinizing carcinoma
			Histopathology of undifferentiated and differentiated nonkeratinizing carcinoma
			Immunoprofile and Epstein–Barr virus detection nonkeratinizing carcinoma
		Histopathology of keratinizing squamous cell carcinoma
			Immunoprofile and Epstein–Barr virus detection keratinizing squamous cell carcinoma
		Basaloid squamous cell carcinoma
	Application of brush cytology versus tissue biopsy
	Conclusion
	References
9 Open surgical salvage procedures for nasopharyngeal carcinoma
	Introduction
		Open nasopharyngectomy for salvaging local recurrence
			Transpalatal approach
			Transcervico-manibulo-palatal approach
			Midfacial degloving approach
			Maxillary swing approach
			Infratemporal fossa approach
			Extended resection for advanced locally recurrent nasopharyngeal carcinoma
			Oncological results of salvage nasopharyngectomy
		Surgery for salvaging persistent or recurrent disease in the neck
	Assessment of nodal failures of nasopharyngeal carcinoma for surgical salvage
	Neck dissection for salvaging nodal failures in nasopharyngeal carcinoma
	Reirradiation of the neck with brachytherapy after neck dissection
	References
10 Radiation therapy and chemotherapy in early and advanced nasopharyngeal cancer
	Principles of radiation therapy
		Radiation dosimetry
		Accelerated radiation therapy
		Image registration in radiotherapy planning
		Target volume and organs at risk delineation
		Organs at risk delineation
			Temporal lobes
			Brainstem
			Optic apparatus
		Target volume delineation
			Target volumes are described as per ICRU 50
	Intensity modulated radiotherapy plan approval
		Organ preservation protocol
	Types of radiation therapy specifically including intensity modulated radiotherapy in nasopharyngeal cancer
		Intensity-modulated radiotherapy
		Brachytherapy and stereotactic boost
		Stereotactic radiotherapy in recurrent disease
	Role of radiation in early disease
	Management of the neck
		Role of chemotherapy and radiation in intermediate stage nasopharyngeal cancer
	Complications of radiation
		Acute toxicity
		Late toxicity
		Additional toxicity with concurrent chemotherapy
	Reirradiation in nasopharyngeal cancer recurrence
	Treatment of locally advanced disease
		Concurrent chemoradiation
		Adjuvant chemotherapy
		Induction chemotherapy followed by concurrent chemoradiation
	Systemic therapy
		Metastatic nasopharyngeal cancer
	Role of radiation in metastatic disease
	Conclusion
	References
	Further reading
11 Role of endoscopic endonasal surgery in recurrent nasopharyngeal carcinoma: endoscopic endonasal transpterygoid nasophar...
	Introduction
	Patient selection
	Preoperative workup
	Surgical technique
		Sinonasal corridor
		Nasoseptal flap
		Inferior sphenoidectomy
		Pterygopalatine fossa dissection
		Transpterygoid dissection
		Tumor extirpation
		Nasopharyngeal reconstruction
	Postoperative care and complications
	Conclusion
	References
12 Nasopharyngeal carcinoma screening and prevention programs
	Introduction to screening
	Rationale for screening
	Epstein–Barr virus serology as a screening tool
	Epstein–Barr virus DNA for screening
	Nasendoscopy
	Circulating biomarkers
	Effectiveness of screening
	Rationale for prevention
	High-risk group
	Education programs targeting dietary habits
	Low-risk groups
	General population-based programs
	Conclusion
	References
	Further reading
13 Survival rates and quality of life of nasopharyngeal carcinoma patients
	Introduction
	Survival rates of nasopharyngeal carcinoma patients
		Health-related quality of life in nasopharyngeal cancer
	Effect of patient-related factors
		Effect of tumor-related factors
	Effect of treatment-related factors
	Effect of addition of chemotherapy on quality of life
	Effect of surgery on quality of life
	Quality of life as prognostic marker in patients with nasopharyngeal cancer
	Conclusion
	References
	Further reading
14 New developments in nasopharyngeal cancer
	Early diagnosis by Epstein–Barr virus biomarkers
	Imaging modality of nasopharyngeal cancer
		Local disease
		Regional nodes
		Distant metastases
	Treatment of nasopharyngeal cancer
	Primary treatment for nasopharyngeal cancer
	New emerging treatments in nasopharyngeal cancer
	Local failures in nasopharyngeal cancer
	Surgical treatment of recurrent or persistent nasopharyngeal cancer
	Photodynamic therapy in nasopharyngeal cancer
	Photodynamic therapy versus surgery and radiotherapy for local failures of nasopharyngeal cancer
	Immunotherapy for nasopharyngeal cancer
	Conclusion
	References
	Further reading
Index
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