Nasopharyngeal Cancer (NPC)

As some of you already know that i'm currently doing my clinical placement with the ENT department. Through out my internship in the department, I learned that the amount of Bruneian suffering with NPC is getting higher and higer. Hence, i'm gonna elaborate to you guys on what is NPC and is it treatable.

What is NPC?
Nasopharyngeal cancer develops in the nasopharynx, an area in the back of the nose toward the base of skull. The nasopharynx is a box-like chamber about 1½ inches on each edge. It lies just above the soft palate, just in back of the entrance into the nasal passages. Although it is considered an oral cancer, nasopharyngeal cancer is different from most oral cancers. It tends to spread widely, is not often treated by surgery, and has different risk factors from most oral cancers.
Several types of tumors can develop in the nasopharynx. Some of these tumors are benign (non-cancerous). Others are malignant (cancerous), and these can penetrate into surrounding tissues and spread to other parts of the body.

Benign nasopharyngeal tumors: Benign tumors of the nasopharynx are relatively rare and tend to occur in children and young adults. They include tumors or malformations of the vascular (blood-carrying system) such as angiofibromas and hemangiomas, and benign tumors of the minor salivary glands that are found within the layers of the nasopharynx. It is important to discuss what type of tumor you might have with your doctor.

Malignant nasopharyngeal tumors: Although other types of cancers can arise from the tissues that make up the nasopharynx, nasopharyngeal carcinoma (NPC) is the most common malignant tumor of the nasopharynx. The remaining sections of this document refer exclusively to NPC.

There are 3 types of NPC: keratinizing squamous cell carcinoma (type 1), non-keratinizing carcinoma (type 2); and undifferentiated carcinoma (type 3). The frequency of these different types varies with geographical area. Most NPC in the United States is the keratinizing type. In Southeast Asia, where NPC is much more common, most cases are the undifferentiated type. Although these types look different under a microscope, studies have shown they arise from the same cell type – the lining cell of the nasopharynx. The treatment is also usually the same for all types. How far the NPC has spread locally and throughout the body (stage) is often more important than its type in predicting the outlook for chances of survival (prognosis).

All subtypes of NPC develop from the epithelial cells that cover the surface lining of the nasopharynx. Many nasopharyngeal carcinomas also contain lots of immune system cells, especially lymphocytes. The term lymphoepithelioma is sometimes used to describe an NPC with many immune system cells (lymphocytes) among the cancer cells. The presence of these immune system cells does not usually affect the choice of treatment options. But they may be a clue to developing new treatments since they may represent the body’s attempt to “reject” the tumor.

Lymphomas can also be found in the nasopharynx. They are cancers of immune system cells called lymphocytes, cells that are normally found in the nasopharynx. These cancers are discussed in the American Cancer Society document on "Non-Hodgkin Lymphoma in Adults."
Adenocarcinoma and adenoid cystic carcinoma may develop in the minor salivary glands found in the nasopharynx but are more commonly found in the nasal or oral cavities. These minor salivary gland cancers are discussed in the American Cancer Society documents on "Oral Cavity and Oropharyngeal Cancer" and "Nasal Cavity and Paranasal Cancer."

Latest Research & Treatment for NPC:
Important research into nasopharyngeal cancer (NPC) is under way in many university hospitals, medical centers, and other institutions around the world. Each year, scientists find out more about what causes the disease, how to prevent it, and how to improve treatment.

Causes: Many studies are being done to learn more about how Epstein-Barr virus (EBV) infection and other risk factors cause cells of the nasopharynx to become cancerous. Researchers are optimistic that these studies may eventually lead to vaccines to prevent NPC by avoiding EBV infection. Recent discoveries concerning EVB, its interaction with nasopharyngeal cells, and the immune system's reaction to EVB have led to new blood tests for early detection of NPC and to better predict the response to treatment. These tests are now being studied in areas of the world where this cancer is common.

Scientists have recently discovered exciting information about how certain mutations (DNA changes) in nasopharyngeal cells cause them to become cancerous. Clinical trials are now testing the possibility of replacing damaged tumor suppressor genes in the cancer cells through gene therapy.

New chemotherapy: Researchers continue to develop new chemotherapy drugs, new drug combinations, and new ways to administer drugs that might be more effective against advanced NPC. Clinical trials are also testing ways to best combine chemotherapy with radiation therapy. For example, studies are comparing the effectiveness of chemotherapy given before, during, or after radiation therapy.

New radiation therapy techniques: Recent advances in radiation therapy have contributed significantly to improving the outlook for patients with NPC. Radiation oncologists can now use 3-dimensional images (obtained by CT or MRI scans) to perform computerized analyses that point out how best to target multiple external and internal radiation sources at the cancer while minimizing exposure of normal tissue to radiation. High cure rate with sparing of the salivary gland to reduce permanent dry mouth has been obtained with Intensity Modulated Radiotherapy (IMRT).

Other studies are testing the effectiveness of combining several types of radiation beams (photons, electron, etc.). External beam radiation treatments are usually given once a day in one fraction, but studies are now comparing the standard practice to accelerated and hyperfractionated radiation therapy, in which radiation is given faster or in smaller doses each time but to higher total dose.

New surgical techniques: The field of skull base surgery now permits tumor removal from difficult areas such as the nasopharynx. This type of surgery requires a specialized team that has developed expertise in this field. This type of surgery offers hope to patients with recurrent NPC and even patients with small primary keratinizing cancer type.

T Lymphocyte treatment: NPC seems to be in part caused by the EB virus. Although patients can be shown to have immunity to EBV, this doesn't seem to be enough to kill the cancer. To overcome this, researchers removed T lymphocytes from the blood of 10 patients with NPC and manipulated them in the laboratory to increase their numbers and their power to kill EBV virus. The cells were then put back into a series of 10 patients by intravenous injection. Four patients who were in remission remained in remission. Two out of the remaining 6 with advanced NPC had complete disappearance of their tumor and one other had partial disappearance of the tumor. Another patient had stable disease -- no further growth -- and the remaining 2 patients did not benefit.

With Love: Amirul010