Rak nosogardła – Diagnostyka i diagnoza

Rak nosogardła
Diagnostyka i diagnoza

Rak nosogardła (NPC) to złośliwy nowotwór nabłonka nosogardła, charakteryzujący się specyficzną epidemiologią i trudnościami diagnostycznymi wynikającymi z anatomicznej lokalizacji oraz niespecyficznych objawów we wczesnym stadium. Diagnostyka opiera się na szczegółowym wywiadzie, badaniu przedmiotowym, endoskopii (w tym z użyciem wąskopasmowego obrazowania NBI), badaniach obrazowych (MRI jako metoda z wyboru do oceny guza pierwotnego i naciekania, CT do oceny zmian kostnych, PET-CT do wykrywania przerzutów) oraz biopsji histopatologicznej. Warto podkreślić, że MRI wykazuje 100% negatywną wartość predykcyjną, co może ograniczyć konieczność inwazyjnych biopsji przy negatywnych wynikach endoskopii i MRI. Diagnostyka laboratoryjna, w tym oznaczanie przeciwciał przeciw EBV oraz wykrywanie DNA EBV w osoczu, stanowi uzupełnienie, jednak nie zastępuje metod obrazowych i histopatologicznych. Nowoczesne techniki, takie jak biopsja płynna i spektroskopia Ramana, wykazują obiecujące wyniki w wykrywaniu wczesnych zmian nowotworowych, z dokładnością diagnostyczną spektroskopii Ramana na poziomie 93,1% (czułość 93,6%, swoistość 92,6%).

Diagnostyka raka nosogardła

Rak nosogardła (ang. Nasopharyngeal carcinoma, NPC) to nowotwór złośliwy wywodzący się z nabłonka nosogardła. Jest to stosunkowo rzadki typ nowotworu głowy i szyi, który wyróżnia się specyficzną epidemiologią, histologią, przebiegiem naturalnym oraz odpowiedzią na leczenie w porównaniu do innych nowotworów tej okolicy¹². Wczesna diagnostyka raka nosogardła jest niezwykle istotna, ponieważ zwiększa szanse na skuteczne leczenie oraz poprawia rokowanie pacjentów. Niestety, ze względu na głębokie położenie nosogardła i niespecyficzne objawy we wczesnym stadium, rozpoznanie tego nowotworu często następuje w zaawansowanym stadium choroby³⁴.

Trudności w diagnostyce raka nosogardła

Diagnostyka raka nosogardła jest wyzwaniem z kilku powodów. Przede wszystkim nosogardło jest anatomicznie trudno dostępne do badania, a wczesne objawy choroby są często niespecyficzne lub nawet nieobecne³⁴. Dodatkowo, rak nosogardła może rozwijać się podśluzówkowo, co utrudnia jego wykrycie podczas rutynowego badania endoskopowego⁵. Objawy pojawiają się zazwyczaj dopiero wtedy, gdy nowotwór osiągnie znaczne rozmiary lub rozprzestrzeni się do okolicznych struktur czy węzłów chłonnych⁶.

Badanie przeprowadzone wśród pacjentów z rakiem nosogardła wykazało, że całkowity wskaźnik błędnych diagnoz wynosi 43,4%. Pacjenci, którzy zgłaszali tylko bóle głowy, mieli najwyższy wskaźnik błędnych diagnoz – aż 86,4%⁷. Badania wykazały również, że opóźnienie w diagnozie może wynosić średnio nawet 7 miesięcy⁸.

Proces diagnostyczny raka nosogardła

Proces diagnostyczny raka nosogardła obejmuje kilka etapów, począwszy od badania podmiotowego i przedmiotowego, poprzez badania endoskopowe, obrazowe, aż po badania histopatologiczne, które są niezbędne do postawienia ostatecznego rozpoznania⁹.

Badanie podmiotowe i przedmiotowe

Pierwszym krokiem w diagnostyce raka nosogardła jest zebranie dokładnego wywiadu medycznego oraz przeprowadzenie badania przedmiotowego⁹¹⁰. Lekarz zbiera informacje dotyczące objawów pacjenta, takich jak:

Jednostronna niedrożność nosa
Krwawienie z nosa
Zaburzenia słuchu lub szumy uszne
Jednostronne wysiękowe zapalenie ucha środkowego
Bóle głowy
Objawy neurologiczne (np. porażenie nerwów czaszkowych)
Obecność guza na szyi (powiększone węzły chłonne)¹¹¹²

Ponadto, lekarz pyta o czynniki ryzyka, takie jak zakażenie wirusem Epsteina-Barr (EBV), pochodzenie z regionów endemicznych (np. Azja Południowo-Wschodnia), stosowanie tytoniu i alkoholu oraz wywiad rodzinny¹³. Podczas badania przedmiotowego szczególną uwagę zwraca się na jamę nosową, gardło oraz węzły chłonne szyi¹⁰.

Endoskopia nosogardła

Badanie endoskopowe nosogardła (nazoendoskopia) jest kluczowym elementem diagnostyki raka nosogardła¹⁴. Jest to procedura, podczas której cienki, elastyczny endoskop z kamerą i źródłem światła jest wprowadzany przez nos w celu dokładnego obejrzenia nosogardła¹⁵. Badanie to umożliwia lekarzowi:

Dokładną ocenę błony śluzowej nosogardła
Uwidocznienie podejrzanych zmian (np. guzów, owrzodzeń)
Pobranie materiału do badania histopatologicznego⁹¹⁰

Należy jednak zauważyć, że niektóre guzy nosogardła, zwłaszcza we wczesnym stadium, mogą rozwijać się podśluzówkowo i nie być widoczne podczas rutynowego badania endoskopowego¹⁶. W takich przypadkach kluczowe znaczenie mają badania obrazowe, zwłaszcza rezonans magnetyczny (MRI)⁵.

Nowsze techniki endoskopowe, takie jak endoskopia z wąskopasmowym obrazowaniem (NBI – Narrow Band Imaging), mogą zwiększyć skuteczność wykrywania wczesnych zmian nowotworowych. NBI wykorzystuje światło o wąskim spektrum, które zapewnia lepszy kontrast między naczyniami krwionośnymi a otaczającymi tkankami, co pomaga wykryć małe zmiany nowotworowe we wczesnym stadium¹⁷.

Biopsja

Biopsja jest procedurą niezbędną do postawienia ostatecznego rozpoznania raka nosogardła¹⁸. Polega na pobraniu fragmentu tkanki do badania histopatologicznego. W przypadku raka nosogardła biopsja może być wykonana na kilka sposobów:

Biopsja endoskopowa – materiał pobierany jest podczas nazoendoskopii za pomocą specjalnych narzędzi wprowadzonych przez endoskop¹⁰
Biopsja cienkoigłowa węzłów chłonnych (FNA – Fine Needle Aspiration) – stosowana, gdy występuje powiększenie węzłów chłonnych szyi¹⁹
Biopsja gruboigłowa pod kontrolą endoskopii (CNB – Core Needle Biopsy) – szczególnie przydatna w przypadku guzów nieegzofitycznych (niepowodujących uwypuklenia błony śluzowej)²⁰

Pobrany materiał jest następnie badany przez patologa pod mikroskopem w celu potwierdzenia obecności komórek nowotworowych oraz określenia typu histologicznego raka¹⁹. Warto podkreślić, że nawet gdy nosogardło wygląda prawidłowo podczas badania endoskopowego, biopsja może wykazać obecność komórek nowotworowych, dlatego w przypadku podejrzenia klinicznego należy wykonać biopsję także z prawidłowo wyglądającej błony śluzowej¹⁶.

Badania obrazowe

Badania obrazowe odgrywają kluczową rolę w diagnostyce i ocenie zaawansowania raka nosogardła⁹. Pozwalają one na określenie wielkości guza, jego lokalizacji, naciekania okolicznych struktur oraz obecności przerzutów. Do najważniejszych badań obrazowych w diagnostyce raka nosogardła należą:

Rezonans magnetyczny (MRI) – metoda z wyboru do oceny guza pierwotnego i jego miejscowego zasięgu ze względu na doskonałą rozdzielczość tkanek miękkich, czułość w wykrywaniu szerzenia się nowotworu drogą okołonerwową oraz naciekania wewnątrzczaszkowego⁵
Tomografia komputerowa (CT) – przydatna do oceny zmian kostnych, zwłaszcza podstawy czaszki⁵
Pozytonowa tomografia emisyjna (PET) lub PET-CT – umożliwia wykrycie ognisk nowotworu w całym ciele, szczególnie przydatna w ocenie przerzutów do węzłów chłonnych i przerzutów odległych⁹
Ultrasonografia szyi – stosowana do oceny węzłów chłonnych szyi¹⁹

Badanie MRI jest szczególnie wartościowe w przypadku guzów niewykazujących cech egzofitycznych, które mogą być niewidoczne podczas standardowej endoskopii²¹. Zaproponowano kryteria MRI do diagnostyki raka nosogardła, w tym: asymetrię błony śluzowej, utratę przegród migdałkowych oraz utratę integralności głębokiej białej linii błony śluzowej⁵.

W badaniu porównującym dokładność diagnostyczną MRI z endoskopią i biopsją endoskopową wykazano, że MRI ma 100% negatywną wartość predykcyjną dla raka nosogardła, co sugeruje, że inwazyjne biopsje nie są konieczne, gdy wyniki MRI są negatywne, szczególnie gdy badanie endoskopowe również nie wykazuje nieprawidłowości²¹.

Badania laboratoryjne

Badania laboratoryjne odgrywają rolę uzupełniającą w diagnostyce raka nosogardła, a niektóre z nich mogą mieć wartość w ocenie ryzyka zachorowania oraz monitorowaniu odpowiedzi na leczenie¹⁸. Najważniejsze badania laboratoryjne obejmują:

Testy związane z zakażeniem wirusem Epsteina-Barr (EBV):
- Oznaczanie przeciwciał przeciwko EBV (np. VCA IgA, EBNA-1 IgA, EA-IgA)²²
- Wykrywanie DNA EBV w osoczu – charakteryzuje się wyższą czułością i swoistością w porównaniu do testów serologicznych²²²³
Testy związane z zakażeniem wirusem brodawczaka ludzkiego (HPV)²⁴
Podstawowe badania krwi (morfologia, badania biochemiczne) – ocena ogólnego stanu zdrowia pacjenta przed rozpoczęciem leczenia²³

Należy podkreślić, że nie istnieje pojedynczy test laboratoryjny, który zapewniałby wysoką czułość i swoistość w wykrywaniu raka nosogardła, dlatego diagnostyka laboratoryjna powinna być traktowana jako uzupełnienie badań endoskopowych i obrazowych⁶.

Zaawansowane metody diagnostyczne raka nosogardła

Poza standardowymi metodami diagnostycznymi, rozwijane są również bardziej zaawansowane techniki, które mogą zwiększyć skuteczność wykrywania raka nosogardła, zwłaszcza we wczesnym stadium²².

Biomarkery molekularne

Badania nad biomarkerami molekularnymi w raku nosogardła koncentrują się na identyfikacji molekularnych zmian związanych z rozwojem i progresją nowotworu. Wśród potencjalnych biomarkerów wymienia się:

Markery epigenetyczne – metylacja promotorów genów supresorowych nowotworów (np. p16, RASSF1A, DAP-kinaza)²⁵²⁶
MikroRNA – np. miR-141, miR-18a/b, miR-9, miR-26a²⁶
Onkogeny – KIT, LMP1, PIKC3A²⁶

Ze względu na złożoność procesu kancerogenezy, proponuje się wykorzystanie panelu biomarkerów, a nie pojedynczych markerów. Na podstawie częstości występowania i wartości diagnostycznej zaproponowano 10-markerowy panel składający się z 5 biomarkerów onkogennych (KIT, LMP1, PIKC3A, miR-141, miR-18a/b) oraz 5 genów supresorowych nowotworów (p16, RASSF1A, DAP-kinasa, miR-9, miR-26a)²⁶.

Biopsja płynna

Biopsja płynna to obiecująca, mniej inwazyjna metoda diagnostyczna, która polega na wykrywaniu biomarkerów nowotworowych w płynach ustrojowych, najczęściej we krwi²⁷. W przypadku raka nosogardła badania koncentrują się na:

Wykrywaniu DNA EBV w osoczu²³
Analizie metylacji DNA krążącego bezkomórkowo (cfDNA)²²
Wykrywaniu specyficznych biomarkerów nowotworowych we krwi²⁸

Badania wykazały, że biopsja płynna może być czuła i swoista dla wczesnego wykrywania raka nosogardła, co może pomóc w jego wcześniejszej diagnostyce oraz odpowiednim monitorowaniu choroby²⁷.

Spektroskopia Ramana

Spektroskopia Ramana to technika, która wykorzystuje zjawisko rozpraszania światła do uzyskania informacji o cząsteczkach w tkance. W badaniu opisującym jednoczesną światłowodową spektroskopię Ramana odcisków palców (FP) i wysokiej liczby falowej (HW) wykazano, że metoda ta może być przydatna w diagnostyce raka nosogardła podczas badania endoskopowego²⁹.

Technika ta zapewnia dokładność diagnostyczną 93,1% (czułość 93,6%, swoistość 92,6%) w identyfikacji raka nosogardła, co jest lepszym wynikiem niż przy użyciu samej techniki FP lub HW²⁹. Spektroskopia Ramana może stanowić uzupełnienie standardowych metod endoskopowych i potencjalnie zwiększyć skuteczność wykrywania wczesnych zmian nowotworowych²⁹.

Ocena zaawansowania raka nosogardła

Po potwierdzeniu rozpoznania raka nosogardła konieczne jest określenie stopnia zaawansowania nowotworu, co ma kluczowe znaczenie dla wyboru optymalnej metody leczenia i przewidywania rokowania²⁴.

System TNM

Obecnie stosowany system oceny zaawansowania raka nosogardła opiera się na klasyfikacji TNM (Tumor-Node-Metastasis) według American Joint Committee on Cancer (AJCC) i International Union Against Cancer (UICC)¹⁴. System ten uwzględnia:

T – wielkość guza pierwotnego i jego naciekanie okolicznych struktur
N – obecność przerzutów do regionalnych węzłów chłonnych
M – obecność przerzutów odległych¹⁴

Na podstawie oceny parametrów T, N i M określa się stadium zaawansowania raka nosogardła, które może wynosić od 0 do IV. Niższy numer oznacza, że nowotwór jest mały i ograniczony głównie do nosogardła. Wraz ze wzrostem nowotworu lub jego rozprzestrzenianiem się poza nosogardło, stadia zaawansowania rosną³⁰.

Metody oceny zaawansowania

Ocena zaawansowania raka nosogardła wymaga kompleksowego podejścia diagnostycznego, obejmującego:

Badania obrazowe:
- MRI nosogardła, podstawy czaszki i szyi – metoda z wyboru do oceny zaawansowania miejscowego (T)¹²
- CT – uzupełnienie MRI, szczególnie w ocenie zmian kostnych⁵
- PET-CT – ocena przerzutów do węzłów chłonnych i przerzutów odległych (N, M)¹²
Badanie endoskopowe – ocena zasięgu guza w obrębie nosogardła¹⁴
Badanie histopatologiczne – określenie typu histologicznego raka i jego złośliwości¹⁹

Po określeniu stopnia zaawansowania raka nosogardła, zespół wielodyscyplinarny (multidisciplinary team, MDT) opracowuje plan leczenia dostosowany do indywidualnego przypadku pacjenta¹⁹.

Znaczenie wczesnej diagnostyki raka nosogardła

Wczesna diagnostyka raka nosogardła ma kluczowe znaczenie dla poprawy wyników leczenia i rokowania pacjentów²².

Wyzwania w diagnostyce wczesnego raka nosogardła

Diagnostyka wczesnego raka nosogardła napotyka na liczne wyzwania, takie jak:

Trudno dostępna lokalizacja anatomiczna nosogardła⁶
Brak specyficznych objawów we wczesnym stadium choroby⁶
Częste rozpoznawanie w zaawansowanym stadium, gdy objawy stają się bardziej wyraźne²⁶
Brak pojedynczego testu laboratoryjnego o wysokiej czułości i swoistości dla wykrywania raka nosogardła²⁶

Złożoność procesu diagnostycznego wymaga wieloaspektowego podejścia, obejmującego zastosowanie różnych metod diagnostycznych w celu zwiększenia skuteczności wykrywania wczesnego raka nosogardła²⁶.

Badania przesiewowe

W populacjach o wysokim ryzyku zachorowania na raka nosogardła, zwłaszcza w regionach endemicznych, takich jak południowe prowincje Chin, rozważa się wdrożenie programów badań przesiewowych⁴. Programy te mogą obejmować:

Badania serologiczne w kierunku przeciwciał przeciwko EBV⁴
Wykrywanie DNA EBV w osoczu²²
Badania endoskopowe z zastosowaniem wąskopasmowego obrazowania (NBI)²²
Analizę próbek pobranych szczoteczką z nosogardła²²

W Stanach Zjednoczonych i innych regionach, gdzie rak nosogardła występuje rzadko, nie przeprowadza się rutynowych badań przesiewowych⁴.

Znaczenie wczesnej diagnozy dla rokowania

Wczesna diagnostyka i leczenie raka nosogardła są związane z lepszym rokowaniem¹⁴. Według danych American Cancer Society, 85% pacjentów z miejscowo ograniczonym rakiem nosogardła żyje co najmniej 5 lat od rozpoznania³¹. Natomiast ogólny 5-letni wskaźnik przeżycia dla wszystkich stadiów raka nosogardła wynosi około 63%³.

Wykrycie raka nosogardła na wczesnym etapie pozwala na zastosowanie mniej intensywnego leczenia, co może zmniejszyć ryzyko powikłań i poprawić jakość życia pacjentów²². Ponadto, wczesne wykrycie i leczenie mogą zapobiec progresji choroby, zmniejszyć śmiertelność oraz zmniejszyć obciążenie systemu opieki zdrowotnej²².

Monitorowanie po leczeniu raka nosogardła

Po zakończeniu leczenia raka nosogardła konieczne jest regularne monitorowanie pacjenta w celu wczesnego wykrycia ewentualnej wznowy lub powikłań związanych z leczeniem¹⁹.

Metody monitorowania

Monitorowanie pacjentów po leczeniu raka nosogardła obejmuje różne metody diagnostyczne:

Regularne badania kliniczne – ocena objawów i badanie przedmiotowe¹⁹
Badania endoskopowe – ocena nosogardła pod kątem miejscowej wznowy¹⁹
Badania obrazowe (MRI, CT, PET-CT) – ocena miejsca pierwotnego guza i potencjalnych przerzutów⁵
Oznaczanie DNA EBV w osoczu – może dostarczyć informacji prognostycznych i być wykorzystane do wczesnego wykrywania wznów¹¹

PET-CT jest szczególnie przydatny w wykrywaniu wznowy raka nosogardła, ze względu na wysoką czułość tej metody⁵.

Znaczenie regularnego monitorowania

Regularne monitorowanie po leczeniu raka nosogardła jest niezwykle istotne, ponieważ:

Umożliwia wczesne wykrycie i leczenie wznowy¹⁹
Pozwala na ocenę i leczenie powikłań związanych z terapią³²
Daje możliwość dostosowania dalszego postępowania terapeutycznego¹⁹

Pacjenci powinni być edukowani na temat znaczenia regularnych wizyt kontrolnych po zakończeniu leczenia³². Jeśli między wizytami pojawią się jakiekolwiek problemy lub nowe objawy, pacjent powinien jak najszybciej skontaktować się z lekarzem¹⁹.

Podsumowanie diagnostyki raka nosogardła

Diagnostyka raka nosogardła wymaga kompleksowego podejścia, obejmującego badanie podmiotowe i przedmiotowe, badania endoskopowe, obrazowe oraz histopatologiczne⁹. Kluczowa jest wczesna diagnostyka, która znacząco poprawia rokowanie pacjentów²².

Obecnie złotym standardem diagnostycznym pozostaje badanie histopatologiczne materiału pobranego podczas biopsji¹⁴. Jednakże, ze względu na trudności w diagnostyce wczesnego raka nosogardła, rozwijane są nowe metody diagnostyczne, takie jak zaawansowane techniki obrazowania, biomarkery molekularne czy biopsja płynna²⁶²⁷.

Po postawieniu rozpoznania i określeniu stopnia zaawansowania raka nosogardła, konieczne jest opracowanie indywidualnego planu leczenia przez zespół wielodyscyplinarny¹⁹. Po zakończeniu leczenia pacjent wymaga regularnego monitorowania w celu wczesnego wykrycia ewentualnej wznowy lub powikłań związanych z leczeniem¹⁹.

Niezwykle ważna jest edukacja pacjentów i społeczeństwa na temat objawów raka nosogardła oraz czynników ryzyka, co może przyczynić się do wcześniejszego zgłaszania się pacjentów do lekarza i poprawy wyników leczenia⁸.

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Materiały źródłowe

#1 Epidemiology, etiology, and diagnosis of nasopharyngeal carcinoma – UpToDate
https://www.uptodate.com/contents/epidemiology-etiology-and-diagnosis-of-nasopharyngeal-carcinoma
Epidemiology, etiology, and diagnosis of nasopharyngeal carcinoma […] This topic discusses the epidemiology, etiology, diagnosis, and staging of nasopharyngeal carcinoma. […] Nasopharyngeal carcinoma is the predominant tumor type arising in the nasopharynx, the tubular passage behind the nasal cavity that connects to the oropharynx below. It differs from other head and neck squamous cell carcinomas in epidemiology, histology, natural history, and response to treatment.
#2 Nasopharyngeal Carcinoma – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554588/
Nasopharyngeal carcinoma (NPC), previously known as lymphoepithelioma, is a malignancy arising from the epithelium of the nasopharynx. […] This activity describes the incidence, epidemiology, clinical manifestations, evaluation, and treatment of nasopharyngeal carcinoma in detail. It highlights the role of the interprofessional team in improving care for patients with this condition. […] Assess the appropriate history and physical and staging evaluation of nasopharyngeal carcinoma. […] Endoscopic biopsy should be the first and foremost step in evaluating the lesion. […] NPC has a high index of susceptibility to radiotherapy, and this forms the mainstay of treatment at nearly every stage. […] In advanced cases, chemotherapy is given concomitantly to produce optimum results. The drug of choice is cisplatin.
#3 Nasopharyngeal Cancer: Symptoms, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/21661-nasopharyngeal-cancer
Nasopharyngeal cancer (NPC), also known as nasopharyngeal carcinoma, is a rare type of head and neck cancer. […] If your healthcare provider thinks that you may have nasopharyngeal cancer, theyll ask about your family history and do a full physical exam. […] Providers use test results to stage nasopharyngeal cancer. Cancer staging systems help providers plan treatment and estimate prognosis. […] Specific treatment depends on the stage of cancer. Nasopharyngeal cancer treatment may include: […] NPC can be cured if healthcare providers diagnose the condition before it spreads. […] Data kept by the American Cancer Society show 63% of people with nasopharyngeal cancer in the U.S. were alive five years after diagnosis. […] If you have nasopharyngeal cancer, its important to remember that your experience may be different from other peoples experiences.
#4 Nasopharyngeal carcinoma – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/nasopharyngeal-carcinoma/symptoms-causes/syc-20375529
Nasopharyngeal carcinoma is hard to find early. That’s most likely because the nasopharynx isn’t easy to examine. And there may be no symptoms at first. […] In the United States and in other areas where the disease is rare, there’s no routine screening for nasopharyngeal carcinoma. […] In places where nasopharyngeal carcinoma is much more common, such as some areas of China, people at high risk of the disease may have screening. Screening may involve blood tests to detect the Epstein-Barr virus.
#5 Nasopharyngeal carcinoma | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/nasopharyngeal-carcinoma?embed_domain=hackmd.io%25252F%252540yipuafecsl2jsu8smr5njq%25252Fbnjhjgjghjghjgh&lang=us
Nasopharyngeal carcinomas (NPC) are the most common primary malignancy of the nasopharynx. They are of squamous cell origin. Some types are strongly associated with the Epstein-Barr virus (EBV). […] Diagnosis is usually achieved with endoscopic guided biopsy. A minority of patients have submucosal disease, with normal-appearing overlying mucosa. MRI is then essential in guiding biopsy. […] Imaging is crucial in delineating the extent of local tumor extension, as well as detecting nodal metastases which are present in the vast majority of patients at the time of diagnosis (75-90%). […] MRI is the modality of choice for tumor staging in nasopharyngeal carcinoma due to its exquisite soft tissue resolution, sensitivity to perineural spread and intracranial extension. […] MRI criteria have been proposed for diagnosis of NPC, including mucosal asymmetry, loss of adenoidal septa, and loss of integrity of the deep mucosal white line. […] F-18 FDG-PET is highly sensitive for nodal metastases and is the modality of choice to detect recurrence.
#6 Diagnostic and Prognostic Indications of Nasopharyngeal Carcinoma
https://pmc.ncbi.nlm.nih.gov/articles/PMC7554987/
The clinical presentation of NPC varies, ranging from unspecific epistaxis, auditory complaints, and unilateral nasal obstruction to cranial nerve palsies and nodal metastasis in the neck region. Most people diagnosed with NPC are often at mid or late stages of the disease when symptoms are much obvious. This underscores the need for early diagnosis. Sadly, the diagnosis of NPC at an early stage is quite challenging due to its deep location and lack of obvious clinical signs at an early stage. Furthermore, there is no single laboratory blood test that provides a highly sensitive and specific result for the screening and diagnosis of NPC. […] Even though the assessment of clinical symptoms and family history provides a good cue, nasopharyngeal endoscopy accompanied by histopathological examination of suspected lesions remains the gold standard method for NPC diagnosis. However, this method is mainly applicable for suspected NPC patients and unsuitable for early diagnosis, especially in asymptomatic patients.
#7
https://journals.lww.com/cancerjournal/fulltext/2016/12010/nasopharyngeal_carcinoma_with_headaches_as_the.39.aspx
The aim of this study was to investigate medical-related reasons for misdiagnosis of nasopharyngeal carcinoma (NPC) patients presenting with headaches alone or accompanied by other symptoms. […] The total misdiagnosis rate was 43.4%. Patients that only complained of headaches had the highest misdiagnosis rate of 86.4% (19/22 cases). […] Frequently, headaches are the only prominent symptom of NPC. Due to the various clinical manifestations, NPC patients encounter a high misdiagnosis rate, which leads to unsatisfactory treatment outcomes. Improved awareness of the various nonspecific symptoms of NPC by nonspecialist physicians will be a pivotal step in decreasing the misdiagnosis rate. […] The misdiagnosis rate of nasopharyngeal carcinoma (NPC) patients with headaches was 43.4%. Improved awareness of the various nonspecific symptoms of NPC is a pivotal step in decreasing the misdiagnosis rate.
#8 Nasopharyngeal Cancer (Nose Cancer)
https://www.healthhub.sg/a-z/diseases-and-conditions/nasopharyngeal-cancer
Nasopharyngeal cancer (nose cancer) is one of the more common cancers in Singapore with about 300 new cases diagnosed a year, but nose, or nasopharyngeal cancer (NPC), is often not detected till it’s in the late stages. […] However, one of the biggest challenges facing the diagnosis of nasopharyngeal cancer, he noted, is the difficulty in detecting it. […] The study revealed that a fifth of nasopharyngeal cancer (nose cancer) diagnoses were delayed for an average of seven months due to low awareness of the disease. […] This highlights the importance of awareness of the signs, symptoms and risk factors of nasopharyngeal cancer (nose cancer). […] Your doctor will assess if your signs and symptoms point to cancer. If nasopharyngeal cancer is suspected, a battery of tests may be needed.
#9 Diagnosis of nasopharyngeal cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/nasopharyngeal/diagnosis
Diagnosis is the process of finding out the cause of a health problem. Diagnosing nasopharyngeal cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for nasopharyngeal cancer or other health problems. […] The following tests are usually used to rule out or diagnose nasopharyngeal cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. […] A physical exam allows your doctor to look for any signs of nasopharyngeal cancer. […] An endoscopy is done when diagnosing and staging nasopharyngeal cancer. It allows a doctor to look inside the body using a flexible tube with a light and lens on the end.
#9 Diagnosis of nasopharyngeal cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/nasopharyngeal/diagnosis
During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will show whether or not cancer cells are found in the sample. […] A CT scan is used to: find out the size and location of a tumour, find out how far the tumour has grown into surrounding tissues, see if the cancer has spread to structures or lymph nodes in the neck, help decide whether the tumour can be removed with surgery. […] An MRI is used to: examine soft tissues in the head and neck, such as the base of the tongue, find out if an abnormal area is cancerous (malignant), non-cancerous (benign) or just inflamed. […] A PET scan is used to see if the cancer has spread (metastasized) to the lymph nodes in the neck or other distant sites. […] A PET-CT scan combines a CT scan and a PET scan. It may give the healthcare team more information about the tumour, including its location and size, if it has spread and if the cancer cells are growing quickly.
#10 Nasopharyngeal carcinoma – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/nasopharyngeal-carcinoma/diagnosis-treatment/drc-20375535
Nasopharyngeal carcinoma diagnosis often begins with an exam by a healthcare professional. The health professional may use a special scope to look inside the nasopharynx for signs of cancer. To confirm the diagnosis, a sample of tissue might be removed for testing. […] A healthcare professional may do a physical exam to look for signs of cancer. This might include looking in your nose and throat. The health professional also may feel your neck for swelling in the lymph nodes. The health professional may ask about your symptoms and your habits. […] A healthcare professional who suspects nasopharyngeal carcinoma may do a procedure called a nasal endoscopy. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. For nasopharyngeal carcinoma, a healthcare professional might take the sample during a nasal endoscopy procedure. To do this, the health professional puts special tools through the endoscope to remove some tissue. If there is swelling in the lymph nodes in the neck, a needle might be used to draw out some cells for testing. […] Once the diagnosis is confirmed, other tests can find the extent, called the stage, of the cancer. […] Your healthcare team uses the stage and other factors to plan your treatment and understand the likely course of the cancer, called the prognosis.
#11 Nasopharyngeal cancer – Symptoms, diagnosis and treatment | BMJ Best Practice US
https://bestpractice.bmj.com/topics/en-us/3000314
Nasopharyngeal cancer (NPC) most commonly presents with a neck mass. Epistaxis, nasal obstruction, unilateral otitis media with effusion (serous otitis media), tinnitus, or impaired hearing in one ear should raise suspicion of NPC, particularly in an Asian patient. […] Confirm the diagnosis with endoscopic biopsy of the primary tumor and/or fine-needle aspiration/core biopsy of neck nodal metastasis. […] Plasma EBV after treatment can provide prognostic information and it can also be used for early detection of recurrences. […] Key diagnostic factors include neck mass, epistaxis or bloody nasal discharge, nasal obstruction, tinnitus or impaired hearing, unilateral otitis media with effusion, and cranial nerve palsy. […] 1st tests to order include nasopharyngoscopy, tumor biopsy, MRI of the nasopharynx, skull base, and neck (to clavicles), and 18F-FDG-PET/chest CT. […] Tests to consider include plasma Epstein-Barr virus (EBV) DNA and Epstein-Barr virus-encoded RNA in situ hybridization (EBER ISH).
#12 Nasopharyngeal cancer – Symptoms, diagnosis and treatment | BMJ Best Practice
https://bestpractice.bmj.com/topics/en-gb/3000314
Nasopharyngeal cancer (NPC) most commonly presents with a neck mass. Epistaxis, nasal obstruction, unilateral otitis media with effusion (serous otitis media), tinnitus, or impaired hearing in one ear should raise suspicion of NPC, particularly in an Asian patient. […] Confirm the diagnosis with endoscopic biopsy of the primary tumour and/or fine-needle aspiration/core biopsy of neck nodal metastasis. […] Diagnostic investigations include nasopharyngoscopy, tumour biopsy, MRI of the nasopharynx, skull base, and neck (to clavicles), and 18F-FDG-PET/chest CT. […] Plasma EBV after treatment can provide prognostic information and it can also be used for early detection of recurrences.
#13 Diagnosing Nasopharyngeal Cancer | NYU Langone Health
https://nyulangone.org/conditions/nasopharyngeal-cancer/diagnosis
Diagnosing Nasopharyngeal Cancer […] NYU Langone doctors are experienced at diagnosing nasopharyngeal cancer, which develops in the nasopharynx, the top part of the throat. […] To diagnose nasopharyngeal cancer, the doctor performs a physical exam, in which he or she looks for any abnormal growths in the head and neck area. He or she also asks about your medical history, including whether you’ve had an HPV infection, an EBV infection, or have lived in a country in which there is a higher risk of developing nasopharyngeal cancer. […] Your doctor may also conduct several tests. […] To examine the nasopharynx, the doctor may use an endoscopeâa thin, lighted tube with a lens at the tip that transmits images to a monitor. […] If a doctor identifies a suspicious growth in the nasopharynx during an endoscopy, he or she performs a biopsy either in the office or in the hospital.
#14 Diagnosis and Therapy of Nasopharyngeal Carcinoma | IntechOpen
https://www.intechopen.com/chapters/78042
Nasopharyngeal carcinoma (NPC) is a malignancy with unique biological and clinical characteristics. It has highly associated with EpsteinBarr virus (EBV) infection and is sensitive to radiotherapy. Due to the extreme relevance between EBV infection and incidence of NPC, testing antibodies against EBV has been applied to screening high-risk populations of NPC. The pathological diagnosis of nasopharyngeal biopsy is the gold standard for the diagnosis of NPC. […] At present, the pathological diagnosis of nasopharyngeal biopsy remains the golden standard for NPC. […] The detection of NPC is based on clinical symptoms and physical examination, but a definitive diagnosis requires a biopsy of the lesion. The first choice of the diagnosis of the primary NPC is biopsy under the nasopharynx endoscope.
#14 Diagnosis and Therapy of Nasopharyngeal Carcinoma | IntechOpen
https://www.intechopen.com/chapters/78042
Currently, the staging system of NPC is the eighth edition of the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC) TNM Classification, based on the tumor-node-metastasis (TNM) criteria. […] Early diagnosis and early therapy is the most effective method to improve the curative effect of NPC.
#15 Nasopharyngeal cancer
https://www.nhs.uk/conditions/nasopharyngeal-cancer/
If you go to a GP with symptoms like those of nasopharyngeal cancer, they’ll usually ask about your symptoms and carry out some examinations. […] The GP will refer you to a head and neck cancer specialist (oncologist) if they think further tests are necessary. […] At hospital, a number of different tests may be carried out to check for nasopharyngeal cancer and rule out other conditions. […] Some of the tests you may have include: a nasendoscopy a thin, flexible telescope (endoscope) is put in your nose and passed down your throat to look for any abnormalities; you’re usually conscious but local anaesthetic can be used to numb your nose and throat […] imaging scans MRI scans, CT scans or PET-CT scans can be used to look for tumours and check if the cancer has spread […] a panendoscopy a more detailed examination of your nose and throat carried out under general anaesthetic (where you’re unconscious) using a series of small, rigid telescopes connected together
#16 How to Diagnose Nasopharyngeal Cancer | American Cancer Society
https://www.cancer.org/cancer/types/nasopharyngeal-cancer/detection-diagnosis-staging/how-diagnosed.html
Nasopharyngeal cancer (NPC) is most often diagnosed when a person goes to a doctor because of symptoms such as a lump in the neck or stuffy nose, but no other signs of a cold. […] If you have signs or symptoms that suggest you might have NPC, the doctor will want to get your complete medical history. […] The nasopharynx is deep inside the head and isn’t easily seen, so special techniques are needed to examine this area. […] In a biopsy, the doctor removes a small piece of tissue or a sample of cells, so it can be tested in the lab for cancer cells. A biopsy is the only way to know for sure that NPC is present. […] NPC cannot always be seen during an exam. If a person has symptoms suggesting NPC but nothing looks abnormal on exam, the doctor may biopsy normal-looking tissue, which may be found to contain cancer cells when looked at and tested by a pathologist.
#17 Early detection and diagnosis of Nasopharyngeal Carcinoma – Bá»nh Viá»n AIH
https://aih.com.vn/en/tin-tuc/early-detection-and-diagnosis-of-nasopharyngeal-carcinoma
EBV testing or other blood tests can also be performed. […] The ENT Department of American International Hospital (AIH) is fully equipped with diagnostic tools, including the NBI (Narrow Banding Imaging) Endoscopy system. This is a painless technique that can make patients feel comfortable during the endoscopic process. NBI is currently applied in many countries around the world. The advanced endoscopic technique utilizing a narrow spectrum light (monochromatic light) can provide a significantly higher contrast between blood vessels and the surrounding tissue. Since small tumors are often surrounded by many blood vessels, NBI helps detect these tumors at an early stage and analyze these areas accordingly. Thus, NBI supports the early and precise optical diagnosis of very small ENT cancer lesions, which as a result allows better treatment and more accurate follow-ups.
#18 Nasopharyngeal Cancer | MD Anderson Cancer Center
https://www.mdanderson.org/cancer-types/throat-cancer/nasopharyngeal-cancer.html
Nasopharyngeal cancer diagnosis is important for nasopharyngeal cancer to be diagnosed as early and accurately as possible. This helps increase your chance for a successful treatment while maintaining your quality of life, including the ability to speak and swallow. […] The following tests can be used to diagnose nasopharyngeal cancer and find out if it has spread. Tests also may be used to monitor the disease and how it is responding to treatment. […] A biopsy is the only way to definitively diagnose nasopharyngeal cancer. […] Doctors use blood tests to help diagnose the disease and monitor how the patient is responding to treatment. […] Imaging exams can help locate the suspected cancer and show whether it has spread. […] Doctors use swallowing tests to understand how the patients throat is performing and help them plan treatment.
#19 Nasopharyngeal cancer | Macmillan Cancer Support
https://www.macmillan.org.uk/cancer-information-and-support/head-and-neck-cancer/nasopharyngeal-cancer
A doctor who specialises in analysing cells (pathologist) looks at the sample under a microscope to check for cancer cells. […] If you have a lump or a swelling in your neck you usually have an ultrasound scan of the area. This uses soundwaves to produce a picture of your neck and nearby lymph nodes. […] You may have a fine needle aspiration test to see whether there are any cancer cells in the lymph nodes in the neck. The doctor passes a fine needle into the lump. They withdraw (aspirate) some cells into the syringe. Sometimes they use an ultrasound scan to help the doctor to guide the needle into the correct area. […] Your specialist may arrange further tests. These may help diagnose nasopharyngeal cancer or be used to check the size of the cancer and whether it has spread (staging).
#19 Nasopharyngeal cancer | Macmillan Cancer Support
https://www.macmillan.org.uk/cancer-information-and-support/head-and-neck-cancer/nasopharyngeal-cancer
The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging. The grade of the cancer gives an idea how quickly it may develop. […] Knowing the stage and grade of the cancer helps doctors plan the best treatment for you. […] A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). […] Your cancer doctor or specialist nurse will explain the different treatments, any possible side effects and the support you have. […] Treatment for nasopharyngeal cancer may include: […] Radiotherapy uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. This is usually the main treatment for nasopharyngeal cancer.
#19 Nasopharyngeal cancer | Macmillan Cancer Support
https://www.macmillan.org.uk/cancer-information-and-support/head-and-neck-cancer/nasopharyngeal-cancer
Chemoradiation is when you have chemotherapy and radiotherapy together. Chemotherapy can make the cancer cells more sensitive to radiotherapy treatment. […] Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is usually given with radiotherapy for nasopharyngeal cancer. […] Surgery is sometimes used to remove cancer that comes back, or that or has not completely gone with chemoradiation or radiotherapy treatment. […] You will have regular follow-up appointments after treatment. These may continue for several years. […] If you have any problems or notice new symptoms between appointments, let your doctor know as soon as possible.
#20 Diagnosis of nonexophytic nasopharyngeal lesion with endoscopy-guided core needle biopsy after narrow band imaging | Oncotarget
https://www.oncotarget.com/article/18475/text/
Due to the obstruction of the surrounding structures or stiff mucosa, the primary and recurrent nonexophytic nasopharyngeal carcinoma (NE-NPC) patients are difficult to be diagnosed histologically by traditional forceps biopsy. […] CNB is able to get adequate biopsy specimens and thus the diagnosis accuracy of CNB is high for NE-NPC. Nasal endoscope-guided CNB is the direct approach with a short distance in the tissue before reaching the tumor. It has the advantages of minimal trauma, short operative time, and no serious complications. It is simple, safe, and worth of application in clinic. […] The primary tumors usually do not breach the mucosal surface of the cavum nasopharyngeum. Nasoendoscopy and flexible nasopharyngoscopy are sensitive, popular and easy ways to detect exophytic types but not NE-NPC.
#21 Detection of Nasopharyngeal Carcinoma by MR Imaging: Diagnostic Accuracy of MRI Compared with Endoscopy and Endoscopic Biopsy Based on Long-Term Follow-Up | American Journal of Neuroradiology
http://www.ajnr.org/content/36/12/2380
Nasopharyngeal carcinoma (NPC) is a radiosensitive tumor that can often be cured when detected early, but the nasopharynx is a clinically silent region and patients often present in the later stages of the disease. Currently, the investigations for confirmation of NPC entail a nasopharyngeal endoscopy followed by an endoscopically directed biopsy at the site of an abnormality or sampling biopsies from an endoscopically normal nasopharynx. These methods may miss small nasopharyngeal carcinomas, however, because they are typically submucosal tumors or tumors located at the lateral aspect of the pharyngeal recess. […] MR imaging has been used to stage biopsy-proved NPC for nearly 20 years, but it is also ideally suited for the initial detection of the primary tumor. In a previous prospective NPC-detection study, we compared the diagnostic accuracy of nasopharyngeal MR imaging with that of nasopharyngeal endoscopy and endoscopic biopsy. The results of that study showed that MR imaging is a highly sensitive technique for NPC detection and one that has a significantly higher sensitivity for NPC detection than endoscopy.
#21 Detection of Nasopharyngeal Carcinoma by MR Imaging: Diagnostic Accuracy of MRI Compared with Endoscopy and Endoscopic Biopsy Based on Long-Term Follow-Up | American Journal of Neuroradiology
http://www.ajnr.org/content/36/12/2380
The updated diagnostic performances of MR imaging, endoscopy, and endoscopic biopsy are shown in Table 2 and are based on data from 203 patients, comprising 78 patients with biopsy-proved NPC (77 detected during the previous study and 1 during follow-up) and 125 patients without NPC based on re-examination of the nasopharynx after a minimum of 3 years. […] The present study confirmed that MR imaging had a 100% negative predictive value for NPC, which supports the previous conclusion that invasive biopsies are not required when MR imaging findings are negative, especially when the endoscopic examination findings are also negative. […] MR imaging should be used more widely as a complementary tool to endoscopy and endoscopic biopsy for the detection of nasopharyngeal carcinoma. MR imaging identifies small tumors that cannot be identified through the endoscope, especially those in the pharyngeal recess, where MR imaging may identify a tumor several years before it becomes endoscopically visible.
#22
https://link.springer.com/article/10.1007/s12672-024-01242-3
The use of plasma anti-EBV antibody, EBV-DNA detection, nasopharyngeal exocytology, and cell-free DNA (cfDNA) methylation for early screening of NPC is gaining increasing interest. […] Currently, there are three primary targets for detecting anti-EBV antibodies in clinical settings: anti-EBV capsid antigen (VCA IgA), anti-EBV nuclear antigen (EBNA-1 IgA), and early antigen EA-IgA. […] Plasma EBV-DNA detection offers higher sensitivity and specificity compared to IgA serologic testing for detecting EBV. […] The primary epigenetic occurrence is hypermethylation of the polychromosomal 3p TSG. […] The study suggests that endoscopic nasopharyngectomy is a viable option for treating early-stage NPC. […] The main objective, regardless of the chemotherapy regimen used, is to enhance survival rates while reducing the incidence of adverse events.
#22
https://link.springer.com/article/10.1007/s12672-024-01242-3
The advancement of health education and the introduction of early cancer screening techniques like narrow band imaging, plasma EBV DNA screening, and nasopharyngeal brushing samples detection have significantly enhanced the detection of early-stage NPC in high-risk populations, leading to a notable rise in the incidence of stage II NPC. […] Early detection and timely treatment of NPC are important for preventing disease progression, improving patient prognosis, reducing mortality, and reducing the healthcare burden. […] Nasopharyngeal endoscopy, along with histological analysis of suspicious lesions, remains the most reliable way for diagnosing NPC. […] Imaging assessment is advised to ascertain the cancer stage prior to diagnosis, utilizing techniques including multislice computed tomography (CT), magnetic resonance imaging (MRI), and Positron emission tomography-computed tomography (PETCT).
#23 Nasopharyngeal Cancer
https://www.parkwaycancercentre.com/mm/learn-about-cancer/types-of-cancer/cancer-details/nasopharyngeal-cancer
Nasopharyngeal cancer is often difficult to detect and is diagnosed late for several reasons: […] If you have symptoms or signs that suggest nasopharyngeal cancer, your doctor will investigate further to determine if you have cancer. Nasopharyngeal cancer may be detected through the following procedures and tests: […] Your doctor will ask about symptoms, risk factors and family history as well as perform a physical examination including feeling your neck for any enlarged lymph nodes. […] Blood tests to check your overall health including your blood count, kidney, liver and thyroid function will be done. Epstein-Barr virus (EBV) DNA test is a blood test to check for EBV DNA markers that are found in the blood of people who have been infected with EBV. […] During this procedure, the doctor puts an endoscope (a long flexible tube with a camera and light at the end) through the nose into the back of the throat to visualise the nasopharynx and look for abnormalities.
#24 Nasopharyngeal Cancer Treatment – NCI
https://www.cancer.gov/types/head-and-neck/patient/adult/nasopharyngeal-treatment-pdq
Human papillomavirus (HPV) test is a laboratory test used to check a sample of tissue for certain types of HPV infection. […] You may want to get a second opinion to confirm your nasopharyngeal cancer diagnosis and treatment plan. […] The prognosis and treatment options depend on: the size of the tumor, the stage of the cancer, including whether cancer has spread to one or more lymph nodes in the neck. […] Treatment of stage I nasopharyngeal cancer is usually radiation therapy to the tumor and lymph nodes in the neck. […] Treatment of stage II, III, and IVA (nonmetastatic) nasopharyngeal cancer may include: radiation therapy to the tumor and lymph nodes in the neck, chemotherapy given with radiation therapy, followed by more chemotherapy. […] Treatment of stage IVB (metastatic) or recurrent nasopharyngeal cancer may include: intensity-modulated radiation therapy, stereotactic radiation therapy, or internal radiation therapy.
#25 CpG methylation as epigenetic biomarkers for nasopharyngeal carcinoma diagnostics – Li – Annals of Nasopharynx Cancer
https://anpc.amegroups.org/article/view/6694/html
CpG methylation at gene promoters or regulatory regions, as one of the well-studied epigenetic modifications, plays essential roles in normal physiology and the pathogenesis of nasopharyngeal carcinoma (NPC). […] Clinically, tumor-specific methylation of TSG promoters can be used as epigenetic biomarkers. […] In this review, we summarized the recent development of TSG CpG methylation-based biomarkers for NPC diagnostics. […] We believe that CpG methylation-based biomarkers using cell-free circulating DNA and NP brushing samples should have a great perspective for NPC diagnostics in future. […] Thus, developing useful biomarkers for the early diagnosis of NPC is in good need. […] Therefore, genetic and epigenetic alterations are complementary to each other during early NPC pathogenesis, and potentiate NPC initiation and progression altogether.
#26 Diagnostic and Prognostic Indications of Nasopharyngeal Carcinoma
https://www.mdpi.com/2075-4418/10/9/611
The identification of multiple methylated TSGs has also been utilized as a prognostic cue in NPC. A study that investigated a panel of six hypermethylated genes (WIF1, UCHL1, RASSF1A, CCNA1, TP73, and SFRP1) in NPC revealed that high methylation level is associated with poor disease-free survival. Overall, these data support the utilization of some specific hypermethylated TSGs as key indicators of NPC and could be targeted in the prediction, diagnosis, and prognosis of the disease. […] As delineated above, there are several potential oncogenes and tumor suppressors that could be further explored to develop a less invasive and dependable diagnostic assay for the early detection of NPC. Because the use of a single biomarker has been shown to be unreliable for the detection and prognosis of NPC, we recommend a multilevel screening or the development of an assay that would encompass these main identified biomarker domains (oncogene and tumor suppressors) to enhance better specificity in the detection of NPC. Based on the frequencies and diagnostic values demonstrated, we propose here a 10-biomarker panel for the duo: KIT, LMP1, PIKC3A, miR-141, and miR-18a/b (oncogenic biomarkers) and p16, RASSF1A, DAP-kinase, miR-9 and miR-26a (tumor suppressors). It is hoped that these biomarkers, if properly harnessed and standardized, would enable a more conclusive and dependable NPC diagnosis. If carefully exploited, we strongly believe they can as well serve as potent indicators in the prognosis and determination of the metastatic stage of NPC.
#26 Diagnostic and Prognostic Indications of Nasopharyngeal Carcinoma
https://www.mdpi.com/2075-4418/10/9/611
The clinical presentation of NPC varies, ranging from unspecific epistaxis, auditory complaints, and unilateral nasal obstruction to cranial nerve palsies and nodal metastasis in the neck region. Most people diagnosed with NPC are often at mid or late stages of the disease when symptoms are much obvious. This underscores the need for early diagnosis. Sadly, the diagnosis of NPC at an early stage is quite challenging due to its deep location and lack of obvious clinical signs at an early stage. Furthermore, there is no single laboratory blood test that provides a highly sensitive and specific result for the screening and diagnosis of NPC. The consequence of poor test results cannot be overemphasized. Tests with low sensitivity could give rise to false-negative results, leading to missed diagnosis, and thus, promotion of disease progression. On the other hand, false-positive results can ensue from tests with low specificity, amounting to unnecessary nasoendoscopies, biopsy collection, and follow-up visits. Even though the assessment of clinical symptoms and family history provides a good cue, nasopharyngeal endoscopy accompanied by histopathological examination of suspected lesions remains the gold standard method for NPC diagnosis. However, this method is mainly applicable for suspected NPC patients and unsuitable for early diagnosis, especially in asymptomatic patients.
#26 Diagnostic and Prognostic Indications of Nasopharyngeal Carcinoma
https://www.mdpi.com/2075-4418/10/9/611
Given that tumorigenesis is a complex process stimulated by many factors, including environment (work hazard, physical exposure, microorganisms, etc.), genetics, and epigenetics, a multifaceted diagnostic approach may help address the challenges of early diagnosis. Notable mechanisms underlying tumorigenesis encompass epigenetic changes, genetic codes mutation, chromosome stability, DNA repair, and cell growth process (differentiation, apoptosis, movement, etc.). […] A study was conducted to screen targeted therapy-related oncogenic mutations in NPC using SNaPshot assay. Among 70 patients, 12 harbored mutations in five oncogenes (KIT, EGFR, PIK3CA, KRAS, EGFR/BRAF) with KIT mutation being the most prevalent. […] However, in NPC, the oncogeneâTSG regulatory relationship as it impacts tumorigenesis is not well understood.
#27 Biomarkers Being Identified for Improved Diagnosis of Nasopharyngeal Carcinoma Via Liquid Biopsy
https://www.targetedonc.com/view/biomarkers-being-identified-for-improved-diagnosis-of-nasopharyngeal-carcinoma-via-liquid-biopsy
Nasopharyngeal carcinoma (NPC) is predominantly diagnosed using invasive testing methods like endoscopic biopsy or tissue biopsy. However, new research presented at the 2019 ASCO Annual Meeting demonstrated that biomarkers have been identified for the early detection and monitoring of NPC using liquid biopsy. […] The researchers were able to conclude that liquid biopsy was sensitive and specific for early detection of NPC. […] We demonstrated that the markers are very sensitive and specific for the detection of nasopharyngeal carcinoma. […] We believe having our test will help for the early detection and monitoring of the disease. […] Due to the minimal and the non-specific local symptoms and the inaccessibility of the nasopharynx for routine examination, we believe that applying this liquid biopsy-based test will greatly increase the chances of effective treatment and appropriate monitoring of the disease.
#28 Blood biomarkers in the application of diagnosis and prediction of overall survival for 1089 patients with nasopharyngeal carcinoma | Scientific Reports
https://www.nature.com/articles/s41598-023-42216-9
Previous studies have indicated that some blood metrics play a crucial role in the diagnostic and prognostic values of various solid tumours. […] We selected 1089 patients with NPC and analyzed the relationship between these metrics, clinical characteristics, and overall survival (OS). […] Blood metrics as non-invasive biomarkers are valuable tools for clinical management. Among these indicators, PNI is the most ideal indicator to distinguish NPC from healthy and nasal polyps. The LMR has good prognostic value. […] The purpose of this study is to determine which blood-related indices are most suitable for the diagnosis and prediction of NPC. […] The accuracy of each metric for distinguishing the NPC and healthy populations was compared using the area under the curve (AUC). […] Therefore, only ALB and PNI can achieve an ideal effect on the test performance.
#29 Real-time In vivo Diagnosis of Nasopharyngeal Carcinoma Using Rapid Fiber-Optic Raman Spectroscopy
https://www.thno.org/v07p3517.htm
We report the utility of a simultaneous fingerprint (FP) (i.e., 800-1800 cm-1) and high-wavenumber (HW) (i.e., 2800-3600 cm-1) fiber-optic Raman spectroscopy developed for real-time in vivo diagnosis of nasopharyngeal carcinoma (NPC) at endoscopy. […] The simultaneous FP/HW Raman spectroscopy technique together with PCA-LDA and LOO-CV modeling provides a diagnostic accuracy of 93.1% (sensitivity of 93.6%; specificity of 92.6%) for nasopharyngeal cancer identification, which is superior to using either FP (accuracy of 89.2%; sensitivity of 89.9%; specificity of 88.4%) or HW (accuracy of 89.7%; sensitivity of 89.0%; specificity of 90.5%) Raman technique alone. […] This work demonstrates for the first time that simultaneous FP/HW fiber-optic Raman spectroscopy technique has great promise for enhancing real-time in vivo cancer diagnosis in the nasopharynx during endoscopic examination.
#29 Real-time In vivo Diagnosis of Nasopharyngeal Carcinoma Using Rapid Fiber-Optic Raman Spectroscopy
https://www.thno.org/v07p3517.htm
The receiver operating characteristic (ROC) curve is further generated to assess the clinical performance of simultaneous FP/HW Raman spectroscopy for improving in vivo diagnosis of NPC at endoscopy. […] We demonstrate for the first time that the simultaneous fingerprint (FP) and high-wavenumber (HW) fiber-optic Raman spectroscopy can be performed in real-time during endoscopic screening of NPC patients. […] Significant FP and HW Raman spectral differences between normal and NPC tissue are observed in vivo, affirming that the rapid FP/HW fiber-optic Raman spectroscopy has potential for enhancing real-time, in vivo cancer diagnosis in the nasopharynx at the molecular level during endoscopic examination.
#30 Nasopharyngeal carcinoma | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/nasopharyngeal-carcinoma
Once the diagnosis is confirmed, other tests can find the extent, called the stage, of the cancer. These might include imaging tests such as: CT scan, MRI scan, Positron emission tomography scan, also called a PET scan, X-ray. […] The stages of nasopharyngeal carcinoma range from 0 to 4. A lower number means the cancer is small and is mostly in the nasopharynx. As the cancer grows larger or spreads beyond the nasopharynx, the stages go up. […] Your healthcare team uses the stage and other factors to plan your treatment and understand the likely course of the cancer, called the prognosis.
#31 Nasopharyngeal Cancer Symptoms, Causes & Treatments
https://www.cancercenter.com/cancer-types/head-and-neck-cancer/types/nasopharyngeal-cancer
Treatment for nasopharyngeal cancer depends on the stage at which its diagnosed. […] The earlier, the better, for both survival rates and treatment options. […] Five years after diagnosis, 85 percent of patients diagnosed with localized nasopharyngeal cancers are still alive, according to the American Cancer Society, which uses the NCIs SEER database. […] The nasopharyngeal cancer survival rate may be improving with new treatment optionsand as with every cancer, new approaches are being tested all the time in clinical trials.
#32 Nasopharyngeal Cancer: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/384425-overview
Viral DNA in nasopharyngeal carcinoma has revealed that Epstein-Barr virus (EBV) can infect epithelial cells and is associated with their transformation to cancer. […] The results of clinical trials that include both radiation therapy and chemotherapy generally report long-term survival rates of 50-80% overall. […] When radiotherapy is used alone, survival rates range from 40-50%. Use of combination radiation therapy and chemotherapy allows long-term survival rates of 55-80%. […] Patients and parents should be educated regarding the importance of follow-up after completion of all therapy.