1. Nasopharyngeal Carcinoma N P C Mai Hai-Qiang ( 麦海强 ) Department of NPC Sun Yat-Sen University Cancer Center
2. What is NPC ? ★ A very special type of head and neck cancer ★ Different from other malignancies of the upper aerodigestive tract with regard to - Epidemiology, -Histology, -Clinical presentations and -Treatment strategies.
9. The High and Relatively High NPC Incidence Areas The Arctic Ocean Pacific Europe Asian Middle East Africa Oceania North America South America Latin America
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11. ⑵ Specific susceptible population 特定的易感人群 North America Eskimos
12. NPC incidence rates between Chinese immigrants and other racial residents in Los Angeles and Singapore 0.2 0.2 Vietnamese 0.5 0.5 Indian 2.0 6.5 Malayan 7.3 18.5 Chinese Singapore 0.3 0.2 Japanese 0.3 3.8 Philippine 2.8 9.8 Chinese 0.2 1.0 Ethiopian 0.2 0.5 Caucasian Los Angeles female male incidence rates (/10 5 /year) country race
13. NPC incidence Rate of Chinese in Sigapore(/10 5 ) 4.7 14.1 FuJian 1.3 6.2 ShangHai 4.8 12.6 KeJia 6.2 18.3 ChaoZhou 11.0 29.1 Cantonese Incidence Rate of NPC Male Female language
14. Death Rates in different dialectal populations in GuangDong Province(10 5 ) 1.96 5.32 KeJia 2.89 6.18 ChaoZhou 4.32-5.84 12.08-15.96 Cantonese Death Rate of NPC Male Female language
18. 4 Stable Incidence Rate and Men to Women Ratio: 2 ~ 3.8 :1 发病率相对稳定 Changes of Cancer Incidence Rate during 30 Years
19. 5 Differences Between High and Low Incidence Areas Two frequency age peaks: 16-19 and 50-59 Quickly increase after the age of 30, and reaches the peak between 50-59 Age of disease onset The Low Incidence Areas The High Incidence Areas
20. 5 Pathology differences between high and low incidence areas Type I: Well-differentiated squamous carcinoma 角化性鳞状细胞癌 Type II: Differentiated Non-keratinising Carcinoma 分化型非角化性癌 Type III: Undifferentiated Non-keratinising Carcinoma 未分化型非角化性癌 WHO histological classification of nasopharyngeal carcinoma Type I Type II Type III
21. 5 Differences Between High and Low Incidence Areas Type II and III Type II and III The Low Incidence Areas The High Incidence Areas Well-differentiated squamous carcinoma accounts for 25% Type I Well-differentiated squamous carcinoma accounts for 1.67% Type I Pathology Type
27. Environmental Factors Nitrosamines 亚硝胺 salted fish laboratory mice cancer of nasal cavity cancer of nasopharynx Cantonese-style salted fish and other preserved foods
45. Exit of cranial nerves through bony base of skull Middle cranial fossa Posterior cranial fossa
46. Exit of cranial nerves through bony base of skull Optic foramen: II Cribriform plate: I Superior orbital fissure: III, IV, V 1 , VI
47. Exit of cranial nerves through bony base of skull Hypoglossal canal: XII Foramen rotundum: V 2 Foramen ovale: V 3 Internal auditory meatus: VII, VIII Jugular foramen: IX, X, XI
48. ☺ Optic foramen 视神经孔 : II ☺ Superior orbital fissure 眶上裂 : III, IV, V 1 , VI ☺ Foramen rotundum 圆孔 : V 2 ☺ Foramen ovale 卵圆孔 : V 3 (Middle cranial fossa 中颅窝 ) ☺ Internal auditory meatus 内耳门 : VII, VIII ☺ Jugular foramen 颈静脉孔 : IX, X, XI ☺ Hypoglossal canal 舌下神经孔 : XII (Posterior cranial fossa 后颅窝 ) Exit of cranial nerves through bony base of skull
49. Cranial nerves III-VI are affected within the Cavernous sinus 破裂孔 III IV V 1 VI V 2 (Situated beside sella turcica)
82. MRI of NP ---- better than CT MRI is more sensitive than CT in detecting tumors of the nasopharynx and its possible spread to nearby tissues or lymph nodes.
89. 六 Clinical Types of NPC ▲ Ascending Type 上行性 ----- Type of Cranial Nerves damage ▲ Descending Type 下行性 ----- Type of Lymphatic Metastasis ▲ Mixed Type 混合性 ▲ Metastasis Type: 转移性
90. Ascending Type (Type of Cranial Nerves) Damages of II 、 III 、 IV 、 V cranial Nerves and/or skull base But No lymph node Metastasis !
108. Brachytherapy is most often used to manage cancers that have recurred (come back) after treatment. It may also be used to treat the small original tumor. Intensity Modulated Radiation Therapy (IMRT) A new method of external radiation, known for delivering more effective doses of radiation while reducing the damage to healthy cells, thus causing fewer side effects. Stereotactic radiosurgery delivers radiation therapy precisely to the tumor using a machine called a gamma knife . This can be used to treat tumors that have invaded the base of the skull, or tumors that have recurred at the base of the brain or skull.