Nasopharyngeal cancer refers to the cancer of the nasopharynx. It is the most common type of cancer that occurs in the nasopharynx. It is mostly seen to originate in the postero-lateral part of the nasopharynx and in the pharyngeal recess that is also known as the fossa of Rosenmuller. This cancer can occur both in the children as well as in adults. Most of the cases that are diagnosed with nasopharyngeal cancer are found to be from Africa and East Asia. It belongs to the squamous cell type of carcinoma. This type of cancer is not like other cancers that occur in the head and neck region as it has different causes, symptoms, treatment and clinical behavior. (1)
What Is Stage-3 Nasopharyngeal Cancer?
Stage 3 nasopharyngeal cancer is an advanced stage of cancer. In this stage, the tumor mass is visualized in the nasopharynx but there might be oropharyngeal extension also seen. Sometimes it might extend into the nasal cavity also. Sometimes, the tumor is not visualized but there is evidence of lymph node involvement along with positive results for Epstein-Barr virus. There is no evidence of distant metastasis at this stage. The lymph nodes on both the left and right sides of the neck are involved.
Nasopharyngeal cancer has been categorized into five stages and the staging system that is most widely used is the American Joint Committee on Cancer (AJCC) and the TNM system of staging. The staging is done on the basis of three basic components that are a tumor (T), lymph nodes (N) and metastasis (M).
- In tumor (T)- the extent and spread of the tumor are described.
- In lymph nodes (N)- the involvement of lymph nodes is seen.
- In metastasis (M)- the spread of cancer to different parts of the body from the site of origin is described.
Using the information regarding these three factors is gained; the stage of the cancer is determined based on it. There are five stages of cancer- stage 0, stage I, stage II, stage III and stage IV.
Stage 0- in this, the cancerous changes in the cells are seen only in the topmost layer of the cells that line the nasopharynx from within. The tumor has not extended to the deeper layers of the tissue. There is no lymph node involved in this stage. There is no metastasis either. This stage is known as carcinoma in situ.
Stage I- there is an occurrence of tumors in the nasopharyngeal that are in this stage. The tumor might also extend into the oropharyngeal area or into the nose. There is no lymph node involvement and there is no evidence of metastasis either.
Stage II- the tumor mass is seen in the nasopharynx and it may or may not extend into the oropharynx or into the nasal cavity. Another possibility is that the tumor mass may not be visualized but cancer has spread to the lymph nodes that are present in the neck and the patient might show positive results for the presence of Epstein-Barr virus.
There is lymph node involvement at this stage; the number of lymph nodes involved might be one or more on either left or right side of the neck. The lymph nodes present at the back of the throat might also be involved. There is no distant metastasis evidenced.
Stage III- the tumor is visualized in the nasopharynx that may extend into the oropharynx or into the nasal cavity. Sometimes there is no tumor visible but there is lymph node enlargement with positive for Epstein-Barr virus. The lymph nodes on both the left and right sides of the neck are involved. There is no distant metastasis present.
Stage IVA- the tumor mass extends into other tissues like hypopharynx and into the skull or into the salivary glands. The lymph nodes on both sides of the neck and those behind the throat might or might not be involved. There is no evidence of distant metastasis.
Stage IVB- the tumor may or may not be extending into the adjacent tissues. The surrounding lymph nodes might or might not be involved. But there is evidence of distant metastasis. (2)
How Is Nasopharyngeal Cancer Diagnosed?
History And Physical Examination: The nasopharyngeal cancer patient is asked about the history of similar illness in the past or amongst any other family members. Proper physical examination includes an examination of lymph nodes in the neck and other signs.
Neurological Examination: To rule out the possibility of the spread of cancer into the brain, the nasopharyngeal cancer patient should be examined for the presence of any neurological signs. The patient’s mental status and coordination are examined. The senses and reflexes are carefully examined.
Biopsy Of The Tumor Mass: Biopsy is a process in which a small part of the tumor mass is excised and observed under the microscope in the lab. The tumor mass can be excised with the help of a procedure called nasoscopy or with the help of upper endoscopy. In nasoscopy, the scope is inserted into the neck to look for tumor mass. In an upper endoscopy, the scope is inserted via mouth and it is extended till the stomach and duodenum. The structures visualized are nose, esophagus, duodenum, and stomach.
CT Scan (Computed Tomography): In this scan, a series of pictures are taken of the target part of the body like neck and head and thorax and abdomen. These are basically x-rays of the parts of the body. The scan can be plain or with contrast. In contrast, a special kind of dye is injected into the nasopharyngeal cancer patient’s body that makes the images clearer.
MRI (Magnetic Resonance Imaging): In these magnetic waves are used to create images of the organs present inside the body. The tumor mass can be seen in these images. (3)
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