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MANAGEMENT
MANAGEMENT OFOF
NASOPHARYNGEAL
TYPE 1 DIABETES MELLITUS IN
CHILDREN & ADOLESCENTS
CARCINOMA
MinistryofofHealth
Ministry Health Malaysian Paediatric
Malaysian Malaysian Endocrine &
Society of Otorhinolaryngologist Academy
Academyofof
Malaysia
Malaysia Association Metabolic Society
- Head & Neck Surgeons (MSO-HNS) Medicine
MedicineMalaysia
Malaysia
QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NASOPHARYNGEAL CARCINOMA 2016
KEY MESSAGES
1. In Malaysia, nasopharyngeal carcinoma (NPC) is the fourth most common cancer.
NPC is predominant among Chinese, followed by natives of Sabah and Sarawak
(especially Bidayuh) and Malay.
2. Tobacco smoking is one of the important risk factors for NPC.
3. NPC is usually diagnosed late due to trivial presentation which leads to poor
survival outcome.
4. In patients presenting with cervical lymphadenopathy, full head and neck
assessment and fine needle aspiration cytological examination of the nodes should
be done.
5. NPC should be diagnosed by histopathological examination of the nasopharynx.
6. Staging of NPC is by using the tumour node metastasis (TNM) system American
Joint Committee on Cancer or AJCC Cancer Staging Manual 2010 (7th Edition).
7. Primary treatment for NPC is radiotherapy. Intensity modulated radiotherapy is the
preferred radiation technique.
8. Concurrent chemoradiotherapy should be offered in Stage II, III, IVA and IVB.
9. In recurrent NPC, nasopharyngectomy or re-irradiation may be offered.
10. Multimodality treatment including dental, supportive and palliative care should be
considered in the management of NPC.
This Quick Reference provides key messages and a summary of the main
recommendations in the Clinical Practice Guidelines (CPG) Management of
Nasopharyngeal Carcinoma.
Also available as a mobile app for Android & IOS platform: MyMaHTAS
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QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NASOPHARYNGEAL CARCINOMA 2016
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QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NASOPHARYNGEAL CARCINOMA 2016
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QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NASOPHARYNGEAL CARCINOMA 2016
Tinnitus Endocrinopathy
Hearing loss - primary hypothyroidism
Otorrhea - hypopituitarism
Trismus
Dysphagia Xerostomia
Subcutaneous fibrosis Second cancer within radiotherapy fields
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QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NASOPHARYNGEAL CARCINOMA 2016
Stage I (T1N0M0) Stage II, III, IVA and IVB Stage IVC (distant
Treatment with definitive Concurrent chemoradiotherapy metastasis)
radiotherapy (RT) to nasopharynx Palliative treatment
& elective RT to neck
Definitive RT:- Cisplatin + RT
Primary site: total of 66-70 Gy
Conventional fractionation: Consider clinical trial if
for 33-35 fractions, treated
Primary site: total of 66-70 Gy available
one fraction/day for 6-7
for 33-35 fractions, treated
weeks (1.8-2.0 Gy/fraction)
one fraction/day for 6-7 weeks Palliative chemotherapy to
Prophylactic neck: 54-60 Gy
(1.8-2.0 Gy/fraction) be considered in patients
for 30 fractions, treated one
Neck: 54-70 Gy for 30-35 with good ECOG
fraction/day for 6 weeks
fractions, treated one performance status (0-2)
(1.8- 2.0 Gy/fraction)
fraction/day for 6-7 weeks
(1.8-2.0 Gy/fraction) RT to palliate symptoms
IMRT recommended to
minimise dose to critical IMRT recommended to Referral to palliative care/
structure minimise dose to critical palliative home care
structures
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QUICK
QUICKREFERENCE
REFERENCE FOR
FOR HEALTHCARE PROVIDERS
HEALTHCARE PROVIDERS MANAGEMENT
MANAGEMENTOF
OFNASOPHARYNGEAL
NASOPHARYNGEALCARCINOMA
CARCINOMA2016
2016
ALGORITHM B : MANAGEMENT
CLINICAL OF AND
PRESENTATIONS PERSISTENT DISEASE
REFERRAL
OR RECURRENT NASOPHARYNGEAL CARCINOMA
Patients presenting with any of the following symptoms should be referred to
Otorhinolaryngologists as soon
Restage to assess recurrent as possible
or persistent to rule
disease MRI out
or CTNPC
scan :and PET/CT
painless
scan neck lump (unilateral/bilateral)
Biopsy of recurrent
blood-stained nasallesion(s), as clinically indicated
discharge/saliva
Treatment should be individualised based on patient performance status and extent
unilateral ear block or hearing loss
of disease
headache
facial numbness
diplopia
Local disease Regional disease Distant disease
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QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF NASOPHARYNGEAL CARCINOMA 2016
Carboplatin Myelosuppression
Nausea and vomiting
Hypersensitivity reaction
Alopecia
Docetaxel Myelosuppression
Fluid retention
Alopecia, cutaneous reaction, nails changes
Stomatitis, diarrhoea, nausea and vomiting
Hypersensitivity reaction