鼻咽癌

null鼻 咽 癌鼻 咽 癌Nasopharyngeal Carcinoma (NPC) 耳鼻咽喉-头颈外科 杨新明 一、概述(outline)一、概述(outline)1、发病有一定的地区性(more common in south-east Asia in the world, more common in southern China) 我国头颈恶性肿瘤之冠(the top of the malignant tumor in head and neck)。某些高发区可能为全身恶性肿瘤之首，广东、广西、湖南和福建高发。null2、高发年龄（maximum age incidence)：40~60岁（86.62%） 3、性别(sex)：男多于女(male to female is 2:1) 二、病因（etiology) (three possible causal factors)二、病因（etiology) (three possible causal factors)1、遗传因素(genetic factors) 种族易感性 家族聚集性 (racial predilection, family tendency and HLA typing) null2、病毒因素----Epstein-Barr virus EB病毒 NPC患者血清中检测到EB病毒相关抗体(patients with NPC have high level of antibody against EBV(over 90% of patients) ， NPC活组织的癌细胞中存在EBV DNA特异性mRNA或基因表达产物(expression of gene products， (but whether the relationship between the two is causal or incidental is still unknown) null3、环境因素(environment factors) 微量元素(microelement)：镍(nickel) 维生素缺乏(vitamin lack) 性激素失调(hormonal factors) 亚硝胺 A combination of genetic, virus and environmental influences would best explain the occurrence of nasopharyngeal carcinoma)病理学(pathology)病理学(pathology)主要为低分化鳞癌。 少见腺癌、肉瘤等 Over 95% Squamous cell carcinoma( poorly differentiation) Adenocarcinoma, sarcoma, 好发部位 most tumors arise on the posterosuperior wall or fossa of Rosenmuller 好发部位 most tumors arise on the posterosuperior wall or fossa of Rosenmuller 图 咽隐窝 鼻咽顶后壁 临床表现 (clinical manifestations)临床表现 (clinical manifestations)1、鼻部症状: 涕血或后吸涕带血，鼻塞。 nasal symptoms such as epistaxis, bloody postnasal discharge, nasal obstruction 2、耳部症状：分泌性中耳炎 Secretory otitis media: conductive deafness, fluid in the middle ear, tympanic membrane indrawn nullnull3、颈淋巴结肿大（图） Metastases in the lymph nodes of the neck , regional nodal metastases are present in 60 to 80 per cent of patients, with bilateral spread being evident in almost half. Superior deep jugular nodes are most often noted 颈淋巴转移颈淋巴转移图nullnull4、颅神经症状:（图）involved cranial nerves: fifth and sixth nerve are the most frequently involved, Headache, internal strabismus. 4th , 3rd and 2nd cranial nerves are next most commonly affected. 9th, 10th 11th and 12th may also be involved null 舌下神经麻痹 外展神经麻痹 Hypoglossal paralysis abducens paralysis null5、远处转移：Distant metastases occur to bone, lung, liver and other sites 诊断(Diagnosis)诊断(Diagnosis)1、病史、症状和体征 History, symptoms and signs Early symptoms: bloody postnasal discharge fluid in the middle ear (unilateral) null2、鼻咽镜检查 The posterior rhinoscopy Fibreoptic nasopharyngoscopy 3、血清学检查 EBVCA-IgA, EBVEA-IgGnull4、影象学检查 Imaging CT, MRI null5、鼻咽活检——确诊的 Definitive diagnosis is made by biopsy鉴别诊断鉴别诊断图治疗(Treatment)治疗(Treatment)放射治疗: Radiotherapy is the method of choice. Prognosis: the overall 5-year survival rate is about 50% ranging from 75% for early tumors to 15% for late tumorsnull手术：Surgery 化疗 Chemotherapy 免疫治疗 Immnotherapy 谢谢 谢谢