耳鼻咽喉头颈外科学：鼻咽癌

1、鼻 咽 癌Nasopharyngeal Carcinoma(NPC)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。2、高发年龄（maximum age incidence)：4060岁（86.62%）3、性别(sex)：男多于女(male to female i

2、s 2:1)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) 2、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

3、达产物(expression of gene products， (but whether the relationship between the two is causal or incidental is still unknown)3、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 expl

4、ain the occurrence of nasopharyngeal carcinoma)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 图 咽隐窝 鼻咽顶后壁临床表现(clinical manifestations)1、鼻部症状: 涕血或后吸涕带血，鼻塞。nasa

5、l symptoms such as epistaxis, bloodypostnasal discharge, nasal obstruction2、耳部症状：分泌性中耳炎Secretory otitis media: conductivedeafness, fluid in the middle ear, tympanic membrane indrawn 3、颈淋巴结肿大（图） 颈淋巴结肿大为首发症状60%，部位：颈深上淋巴结，先单侧后双侧。颈淋巴转移图4、颅神经症状:肿瘤咽隐窝破裂孔颅内/ /脑神经头痛，面部麻木，眼球外展受限等/软腭瘫痪，呛咳，声嘶，伸舌偏等。 舌下神经麻痹 外展神经

6、麻痹 Hypoglossal paralysis abducens paralysis 5、远处转移：Distant metastases occur to bone, lung, liver and other sites 诊断(Diagnosis)1、病史、症状和体征History, symptoms and signsEarly symptoms: bloody postnasal discharge fluid in the middle ear (unilateral)2、鼻咽镜检查The posterior rhinoscopyFibreoptic nasopharyngoscop

7、y3、血清学检查EBVCA-IgA, EBVEA-IgG4、影象学检查Imaging CT, MRI5、鼻咽活检确诊的方法Definitive diagnosis is made by biopsy鉴别诊断(differenciate diagnosis)图鼻咽纤维血管瘤(angiofibroma of nasopharynx)1. 1025y的青年男性；2. 鼻出血或口中吐血；3. 鼻阻塞；4. 其他；5. 禁活检6.鼻镜和影像学检查治疗(Treatment)放射治疗: Radiotherapy is the method of choice. Prognosis: the overall 5-year survival rate is