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NASOPHARYNX

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NASOPHARYNX anatomy

The nasopharynx is located at the back of the nose and the top of the throat—basically the corner that air turns when inhaling through the nose. It contains the openings to the Eustachian tubes (which are air passages to the ears) and the adenoid pad. View the anatomy here.

evaluation of nasopharyngeal masses

The nasopharynx is not visible without special instruments available to a doctor. For this reason, a growth or mass in the nasopharynx is occasionally noted incidentally when a doctor is looking in this area for other reasons, and often noted when a different problem, like an enlarged neck lymph node or persistent fluid in one ear in an adult is noted. Because of the various ways a mass of the nasopharynx may come to attention, the order of tests performed may be different in one case versus another. Typically, evaluation includes performing endoscopy to look at the nasopharynx in the clinic. A biopsy of the mass may be performed in the clinic (when the situation is favorable) or in the operating room. Imaging with a CT or MRI scan may be done, reserving the PET-CT scan for situations in which cancer is proven and other types of imaging do not provide all the information needed.

CAUSES OF NASOPHARYNGEAL CARCINOMA

Nasopharyngeal carcinoma (NPC), or nasopharynx cancer, is the most common cancer originating in the nasopharynx. . NPC differs significantly from other cancers of the head and neck in its occurrence, causes, clinical behavior, and treatment. It is much more common in regions of East Asia and Africa than elsewhere, with viral, dietary and genetic factors implicated in its causation. 

The viral influence is associated with infection with Epstein-Barr virus (EBV), but since this virus is so common (with 95% of all people in the U.S. are exposed to it by age 40), we know other factors play a role in development of NPC. Other likely causes include genetic susceptibility, consumption of food (in particular salted fish) containing carcinogenic volatile nitrosamines. Human papilloma virus (HPV) appears to cause a minority of cases of NPC.

The World Health Organization (WHO) has identified three subtypes of nasopharyngeal carcinoma: 

  • type 1: squamous cell carcinoma, typically found in older adults

  • type 2: non-keratinizing carcinoma

  • type 3: undifferentiated carcinoma

Type 3 is most commonly found among younger children and adolescents, with a few type 2 cases. Both type 2 and 3 have been found to be associated with elevated levels of Epstein-Barr virus titers, but not type 1.

Treatment of nasopharyngeal carcinoma

Because of it’s location, surgery is not the mainstay treatment of nasopharyngeal carcinoma (NPC). Radiation therapy (± chemotherapy) is used for the cancer in the nasopharynx and for any lymph nodes at risk or definitely involved with cancer spread (metastasis). Surgery typically unnecessary, and reserved for situations in which cancer is spread to the neck lymph nodes and is not completely cleared with radiation (±chemotherapy). The Eustachian tube air passage from the nasopharynx to the ear usually does not function well in patients with NPC, and so a pneumatic ventilation tube in the ear(s) is often needed. As with all throat cancer treatments, working with speech pathology to maintain jaw and throat function is highly advisable.

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