Nasopharyngeal

Cancer

Paranasal sinuses

Oral cavity
Hypopharynx

Larynx

Oropharynx

Nasopharynx
Epithelial
carcinoma
Squamous cell origin

Everett E.Vokes. Head and neck cancer. Harrisons Hematology and Oncology 2nd Edition. 2013

Anteriorly -- nasal cavity

Posteriorly -- skull base and
vertebral bodies
Inferiorly -- oropharynx and soft
palate
Laterally - Eustachian tubes and tori
Fossa of Rosenmuller - most
common location

Everett E.Vokes. Head and neck cancer. Harrisons Hematology and Oncology 2nd Edition. 2013

USA (2010) 36540 cases

3% of adult malignancies
Mortality 7880 pt
NPC (nasopharyngeal cancer) 80% in
Asia, 5% in Europe
Asia annual incidence of 15-50/100000
cases
EBV related NPC can occur in all ages

Everett E.Vokes. Head and neck cancer. Harrisons Hematology and Oncology 2nd Edition. 2013
Zhang, et all. Emerging treatment options for nasopharyngeal carcinoma. Drug Design, Development and Therapy. 2013

GLOBOCAN2008 map for global NPC incidence in male (A) and female (B).

Sun X, Tong L-P, Wang Y-T, Wu Y-X, et al. (2011) Can Global Variation of Nasopharynx Cancer Be Retrieved from the Combined
Analyses of IARC Cancer Information (CIN) Databases?. PLoS ONE 6(7): e22039. doi:10.1371/journal.pone.0022039
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0022039

National incidence (red) and mortality (blue) of NPC demonstrated as ASR per 100,000
people-years from GLOBOCAN2008 database.

Sun X, Tong L-P, Wang Y-T, Wu Y-X, et al. (2011) Can Global Variation of Nasopharynx Cancer Be Retrieved from the Combined
Analyses of IARC Cancer Information (CIN) Databases?. PLoS ONE 6(7): e22039. doi:10.1371/journal.pone.0022039
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0022039

EBV

for NPC

Tobacco
Alcohol
HPV infection
Diet low fruits and vegetables

Everett E.Vokes. Head and neck cancer. Harrisons Hematology and Oncology 2nd Edition. 2013

H
E
A
D C
A
A N
N C
D E
R
N
E
C
K

Who
Classification

Histopathological
grading
Head and neck cancer. NCCN. 2014

Type I
: keratinizing
squamous cell carcinoma
Type II
: nonkeratinizing
squamous cell carcinoma
Type III : undifferentiatied
carcinoma

Gx. Grading have not yet

determined
G1. Well differentiated
G2. Moderately differentiated
G3. Poorly differentiated
G4. Undifferentiated

Stage

Tis

N0

M0

T1

N0

M0

IIA

T2a

N0

M0

IIB

T1
T2a
T2b

III

N1
N1 M0
N0/1

T1-2b N2
M0
T3
N0-2

IVA

T4

N0-2 M0

IVB

Any

N3

M0

IVC

Any

Any

M1

Staging

Early symptoms
-

Unilateral hearing impairment serous otitis

Painless, slowly enlarging neck mass

Late symptoms
Nasal obstruction
- Nasal discharge
- Epistaxis
- Cranial nerve involvement III, IV,V, VI
- Xeropthalmia, Proptosis,Trismus
- Horners syndrome (cervical sympathetics)
- CNs IX, X, XI, XII (extensive skull base invasion)
-

Edwin PH, Anthony, et akk. Epidemiology, etiology and diagnosis of nasopharyngeal carcinoma. Up To Date 20.3

Everett E.Vokes. Head and neck cancer. Harrisons Hematology and Oncology 2nd Edition. 2013

Head and neck cancer. NCCN. 2014

Surgery
Chemotherapy
Radiotherapy

NPC radio and

chemosensetivity

Head and neck cancer. NCCN. 2014

Early stage

Stage I

Radiation alone

Intermediate stage

Stage II

Concurrent
chemoradiotherapy

Advanced stage

Stage III, IVA, IVB

Concurrent
chemoradiotherapy
adjuvant chemotherapy

Problematic radiaton
therapy planning e.g.
Tumour abutting chiasm

Stage IVA, IVB

Induction
chemotherapy followed
by concurrent
chemoradiotherapy

Head and neck cancer. ESMO Guidelines. 2013

Small local
recurrence

Zhang, et all. Emerging treatment options for nasopharyngeal

carcinoma. Drug Design, Development and Therapy. 2013

Regional
recurrence

Radical neck resection (if

resectable)

Platinum based combinations

as first line therapy

Palliative
chemotherapy

Polychemotherapy
active

is

more

Treatment should be based

on prior treatment and
anticipated toxicity
Head and neck cancer. ESMO Guidelines. 2013

Head and neck cancer.

NCCN. 2014

Epidermal growth factor receptor EGFR

is
highly expressed in NPC, and strong expression is associated with
poor survival outcome. Combination of the monoclonal antibody
against EGFR, cetuximab, with carboplatin in patients
with metastatic NPC who have failed prior platinum based
therapies achieved a

respon rate of 12% and clinical

benefit rate of 60%. Cetuximab with cisplatin and IMRT in
Brand TM, et al. Nuclear EGFR as a molecular
target in cancer. Radiother Oncol. 2013

locoregionally advanced NPC, demonstrating good tolerability

despite a significant incidence of radiation dermatitis, mucositis and
dysphagia. EGFR blockade results in radiation sensitization.

Brand TM, et al. Nuclear EGFR as a molecular

target in cancer. Radiother Oncol. 2013

5 Years Survival
I

100%

II

93,3%

III

62,7%

IVA

42,2%

IVB

40,6%

Esam ES, Hesham R. Prognostic Factors in Patients with

Nasopharyngeal Carcinoma Treated in Hospital Kuala Lumpur.
Asian Pacific J Cancer Prev. 2011

Patient

Disease

Age

TNM classification

Gender

WHO histopathological subtype

Race

Cranial Involvement
Plasma EBV DNA, EGFR

Esam ES, Hesham R. Prognostic Factors in Patients with

Nasopharyngeal Carcinoma Treated in Hospital Kuala Lumpur. Asian
Pacific J Cancer Prev. 2011

Outcome and Prognosis : plasma EBV DNA

Predicting factors for relapse

Posttreatment plasma EBV DNA >
Pretreatment plasma EBV DNA

Chan, J Natl Cancer Inst 2002

Lin, N Engl J Med. 2004

SIMULASI KASUS

KNF

PRIA, 48 TAHUN, DATANG KE KLINIK DENGAN KELUHAN HIDUNG SERING

TERSUMBAT DAN PENDENGARAN TELINGA KANAN SEMAKIN BERKURANG
SEJAK DUA BULAN TERAKHIR.
Anamnesis apa yang perlu ditambahkan?
Langkah diagnostik apa yang harus dilakukan?
Differential diagnosis yang mungkin ada pada pasien?

DILAKUKAN PEMERIKSAAN NASOENDOSKOPI DAN

DITEMUKAN MASSA YANG MENUTUPI TUBA
EUSTACHIUS KIRI.
Langkah diagnostik lanjutan apakah yang Anda rencanakan?

HASIL BIOPSI MASSA MEYIMPULKAN KARSINOMA TIDAK

BERDIFERENSIASI, MRI KEPALA MENUNJUKKAN MASSA NASOFARING SISI
KIRI DENGAN EKSTENSI PERINEURAL KE BASIS KRANIUM MELUAS HINGGA
BATAS INFERIOR SINUS KAVERNOSA KIRI. HASIL RADIOGRAFI LAIN TIDAK
MENUNJUKKAN METASTASIS JAUH.
Pada stadium berapakah pasien saat ini?
Apakah program penatalaksanaan yang Anda rencanakan kepada pasien?
Apakah target pengobatan pada pasien?

Edukasi apa yang Anda berikan pada pasien dan keluarganya?

Sebutkan efek samping yang sering terjadi pada pemberian kemoterapi/radiasi pada KNF?

Sebutkan faktor risiko KNF.

Sebutkan keganasan lain yang juga sering dikatkan dengan EBV.

TERIMA KASIH