鼻咽癌专题知识讲座培训课件

1、鼻咽癌专题知识讲座鼻咽癌专题知识讲座一、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。鼻咽癌专题知识讲座2一、概述(outline)1、发病有一定的地区性(more 2、高发年龄（maximum age incidence)：4060岁（86.62%）3、性别(se

2、x)：男多于女(male to female is 2:1)鼻咽癌专题知识讲座32、高发年龄（maximum age incidence)：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) 鼻咽癌专题知识讲座4二、病因（etiology)(three possible2、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

3、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或基因表达产物(expression of gene products， (but whether the relationship between the two is causal or incidental is still unknown)鼻咽癌专题知识讲座52、病毒因素-Epstein-Barr virus E3、环境因素(environment factors) 微量元素(microel

4、ement)：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 explain the occurrence of nasopharyngeal carcinoma)鼻咽癌专题知识讲座63、环境因素(environment factors)鼻咽癌病理学(pathology)主要为低分化鳞癌。 少见腺癌、肉瘤等 Over 95% Squamous cell carcinoma( poorly

5、 differentiation)Adenocarcinoma, sarcoma, 鼻咽癌专题知识讲座7病理学(pathology)主要为低分化鳞癌。 少见腺癌、好发部位most tumors arise on the posterosuperior wall or fossa of Rosenmuller 图 咽隐窝 鼻咽顶后壁鼻咽癌专题知识讲座8好发部位most tumors arise on the 临床表现(clinical manifestations)1、鼻部症状: 涕血或后吸涕带血，鼻塞。nasal symptoms such as epistaxis, bloodypostna

6、sal 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 鼻咽癌专题知识讲座9临床表现(clinical manifestations)鼻咽癌专题知识讲座10鼻咽癌专题知识讲座10鼻咽癌专题知识讲座培训课件颈淋巴转移图鼻咽癌专题知识讲座12颈淋巴转移图鼻咽癌专题知识讲座12鼻咽癌专题知识讲座13鼻咽癌专题知识讲座134、颅神经症状:（图）involved cranial ne

7、rves: fifth and sixth nerve are the most frequently involved, Headache, internal strabismus. 4th , 3rd and 2nd cranial nerves are next most commonly affected. 9th, 10th 11th and 12th may also be involved 鼻咽癌专题知识讲座144、颅神经症状:（图）involved cranial ne 舌下神经麻痹 外展神经麻痹 Hypoglossal paralysis abducens paralysis

8、 鼻咽癌专题知识讲座15 舌下神经麻痹 外展神经麻痹 鼻咽癌专5、远处转移：Distant metastases occur to bone, lung, liver and other sites 鼻咽癌专题知识讲座165、远处转移：Distant metastases occu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)鼻咽癌专题知识讲座17诊断(Diagnosis)1、病史、症

9、状和体征鼻咽癌专题知识2、鼻咽镜检查The posterior rhinoscopyFibreoptic nasopharyngoscopy3、血清学检查EBVCA-IgA, EBVEA-IgG鼻咽癌专题知识讲座182、鼻咽镜检查鼻咽癌专题知识讲座184、影象学检查Imaging CT, MRI鼻咽癌专题知识讲座194、影象学检查鼻咽癌专题知识讲座195、鼻咽活检确诊的方法Definitive diagnosis is made by biopsy鼻咽癌专题知识讲座205、鼻咽活检确诊的方法鼻咽癌专题知识讲座20鉴别诊断图鼻咽癌专题知识讲座21鉴别诊断图鼻咽癌专题知识讲座21治疗(Treatment)放射治疗: Radiotherapy is the method of choice. Prognosis: the overall 5-year survival rate is about 50% ranging from 75% for early tumors to 15% for late