Induction Chemotherapy Regimens For Advanced Nasopharyngeal Carcinoma

Creator: Dr. Y Gayathri
Published: 2022-09-26T15:48:35

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Nasopharyngeal carcinoma is a rare cancer that develops from the cells of the nasopharynx in the upper part of the throat. Read the article to know more.

Written by

Dr. Y Gayathri

Medically reviewed by

Dr. Nagaraj

September 26, 2022

March 7, 2023

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Contents

What Is Nasopharynx?
What Is Nasopharyngeal Carcinoma?
What Is the Cause for Nasopharyngeal Carcinoma?
What Are the Signs and Symptoms of Nasopharyngeal Carcinoma?
How Can Nasopharyngeal Carcinoma Be Diagnosed?
What Is the Treatment for Nasopharyngeal Carcinoma?

Introduction:

Nasopharyngeal cancer is rare among head and neck cancers. It develops due to the abnormal multiplication and accumulation of abnormal cells that line the nasopharynx. It was first described in the year 1921. It accounts for one-third of all nasopharyngeal carcinomas occurring in childhood. It is commonly found in the Chinese and Tunisian populations. It is also common in Southeast Asia, the Mediterranean basin, and Alaska. It is rare in childhood. It is commonly found between the ages of 15 and 19.

What Is Nasopharynx?

It is the backward continuation of the nose which opens on either side into the ears. It is located in the upper part of the throat. It is part of the pharynx that acts like a connection between the windpipe and lungs that allows the man to breathe. It is 2 to 3 centimeters wide and 3 to 4 centimeters long.

What Is Nasopharyngeal Carcinoma?

It is the most common cancer developing in the nasopharynx and rare among all head and neck cancers. It is different from other cancers occurring in the head and neck region, attributing to its signs and symptoms, and causes, and also displays a distinguishing difference in treatment required. The clinical features of this cancer differ according to geographical location. Nasopharyngeal carcinoma develops due to abnormal proliferation of cells that line the nasopharynx. It is found in two age groups, one in early childhood and the other in the elderly. Males are more likely to develop this cancer when compared to females.

What Is the Cause for Nasopharyngeal Carcinoma?

The cause of the nasopharyngeal carcinoma is yet to be determined. It occurs due to multiple factors.

They are:

Viral Causes: Epstein-Barr virus is considered a causative agent for nasopharyngeal carcinoma. It is one of the most common viruses. This virus can affect the cells that line the nasopharynx, capable enough to develop cancer. EBV spreads very fast, and it is present worldwide.
Genetic Susceptibility: Individuals with immediate relatives with this cancer and cytogenetic abnormalities are identified as causative agents for this cancer.
Environmental Factors: Geographical location, bimodal age distribution (early childhood and elderly age groups), and preserved food also play a role in causing this cancer.

Also, few studies are underway if chronic sinusitis can cause nasopharyngeal cancer.

What Are the Signs and Symptoms of Nasopharyngeal Carcinoma?

Nasopharyngeal carcinoma is difficult to identify as its signs and symptoms are similar to other conditions too. It cannot be detected till it reaches the regional lymph nodes. Most of the time, the patient can be without any symptoms till the cancer has reached its advanced stage.

Congestion (Nose Block): It is due to the growing tumor mass in the nasopharynx.
Nasal Discharge: Infections cause a runny nose due to mucus formation.
Bleeding: Growing tumors damage adjacent tissues leading to a bleeding nose.
Trismus: It is also called lockjaw. When there is spam in the jaw muscles, it will be difficult to open the mouth.
Otitis Media: It is an infection of the middle ear.
Tinnitus: It is the ringing sound in one or both ears. This sound is not there; others cannot hear the sound except for the affected individual.
Headache: If there is a headache, it could be due to intracranial tumor invasion.
Hearing Problems: There are hearing problems like ringing ears (tinnitus) or issues in hearing soft-pitched or high-pitched sounds.
Hoarseness of Voice: A voice that sounds to be very strained and of very less volume.
Paresis: It is a muscular weakness leading to impaired movements. Ears and mouth are commonly affected.
Neck Swelling: A lump on the back of the neck causes neck swelling. These lumps are not painful but can be in advanced stages where cancer has already spread to regional lymph nodes. Swelling of the lymph nodes may be the initial presentation of cancer.

How Can Nasopharyngeal Carcinoma Be Diagnosed?

After checking for the signs and symptoms, if the doctor doubts the presence of nasopharyngeal cancer, further tests shall be conducted, that includes blood tests and imaging studies.

Blood Tests: Blood tests checks for liver enzymes, complete blood count, and uric acid levels.
Epstein-Barr Virus Titres: These titers may explain the tumor burden that helps in understanding the infection.
Biopsy: In order to study the tumor mass, a small amount of tissue is collected from the tumor with the help of a needle. This procedure is performed under anesthesia. The sample is then sent to the laboratory for investigation.
Nasendoscopy: A thin, flexible tube that has a camera is inserted into the nose and passed down into the throat to look for any abnormalities. To avoid discomfort, the doctor may perform this procedure under anesthesia.
Panendoscopy: In this series of rigid tubes are sent into the throat via the nose under anesthesia.
Imaging Studies: Scans like magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) are performed to locate and estimate the size of tumors. These studies also help to determine if the cancer is spread to adjacent areas.

What Is the Treatment for Nasopharyngeal Carcinoma?

Chemotherapy: It uses drugs to treat cancer. But it is used along with radiotherapy. Drugs like Cisplatin and 5-Fluorouracil are used along with radiotherapy for better results. Similarly, Cisplatin and Gemcitabine, when given along with radiotherapy, gave good results in advanced nasopharyngeal carcinoma.
Radiotherapy: It is the most common choice of treatment for nasopharyngeal cancers. Radiotherapy alone can treat early-stage cancers. A combination of chemotherapy and radiotherapy is generally prescribed for advanced-stage cancers. In advanced cancers, intensity-modulated radiation therapy (IMRT) is performed. IMRT, along with platinum-based chemotherapy, stands as a backbone of treatment for advanced nasopharyngeal carcinomas.

Recently, there were studies conducted to bring out a better treatment modality that would give a favorable prognosis. It was proved that induction chemotherapy followed by concurrent chemotherapy significantly controlled the disease, thereby increasing the survival rate.

Induction Chemotherapy (IC): Several studies were conducted recently, displaying promising results in treating nasopharyngeal carcinoma. It improved the quality of life of the patient, was cost-effective, and also showed a favorable prognosis. Initially, there were eight regimens in induction chemotherapy with concurrent chemoradiotherapy (CCRT). They are as follows:

Docetaxel + Cisplatin (DC).
Cisplatin + Epirubicin + Paclitaxel (PET).
Gemcitabine + Carboplatin + Paclitaxel (GCP).
Docetaxel + Cisplatin + Fluorouracil (TPF).
Mitomycin + Epirubicin + Cisplatin + Fluorouracil + Leucovorin (MEPFL).
Cisplatin + Fluorouracil (PF).
Cisplatin + Capecitabine (PX).
Gemcitabine + Cisplatin (GP).

Of these eight regimens of induction chemotherapy, the most appropriate one is yet to be identified, though it gave a better chance to patients than earlier, good quality of life. DC, GP, and PX have shown promising results during studies on the overall survival rate. These three regimens, however, showed positive results in the disease-free and overall survival rate of cancer. One of the studies also proved that the gap between induction chemotherapy and radiotherapy should not be more than 30 days. Patients treated with induction chemotherapy had rapid clearance for EBV from the body. Depending on the recurrence risk and treatment-related toxicologies, a careful clinical judgment has to be made. At last, it has been proved that the most effective induction chemotherapy regimens are DC, GP, and PX.

Conclusion:

Nasopharyngeal carcinoma cannot be prevented totally. Studies are still being conducted to obtain a favorable prognosis. The outcome depends on the stage of cancer, age, and other health factors of the patient. About 50 people out of 100 can survive for five years after the diagnosis. Radiotherapy can be used as the first line of treatment if the cancer is detected in its early stages. But a combination of chemotherapy and radiotherapy in advanced cancers showed much better disease outcomes. For now, induction chemotherapy can be assumed as the most effective treatment for nasopharyngeal carcinoma.

Frequently Asked Questions

1. What Is the Function of the Nasopharynx?

The function of the nasopharynx is to serve as a passageway for air during breathing. It serves the respiratory system by connecting the nasal cavity to the rest of the respiratory tract. Additionally, the nasopharynx helps filter, warm, and humidify the inhaled air, ensuring it reaches the lungs in optimal condition. It also produces mucus to trap dust, pollutants, and pathogens, protecting the respiratory system from potential harm.

2. What Is Another Term for the Nasopharynx?

Another term for the nasopharynx is the upper part of the throat, located behind the nose. It is the uppermost segment of the pharynx and is specifically designed to facilitate air passage. The nasopharynx allows efficient air transfer during breathing by connecting the nasal cavity to the rest of the respiratory system. Its location and structure make it an important component of the respiratory system's functionality.

3. What Is the Relevance of the Nasopharynx in a 10th-Grade Context?

In a 10th-grade context, the relevance of the nasopharynx lies in understanding its role in the respiratory system and overall health. Students can learn about how the nasopharynx functions as a vital pathway for air, its role in filtering and conditioning inhaled air, and its connection to respiratory health. This knowledge helps students understand how the nasopharynx contributes to proper breathing and the importance of maintaining its health. Understanding the nasopharynx also provides a foundation for comprehending related topics, such as respiratory infections and disorders that may affect this area.

4. What Is the Understanding of the Nasopharynx?

The nasopharynx is a part of the upper respiratory system behind the nasal cavity. It connects the nose to the rest of the respiratory system and helps to filter, warm, and humidify the inhaled air. Its role is to ensure that the air one breathes reaches the lungs in a conditioned state. It also plays a role in producing mucus to trap particles and pathogens, helping to protect the respiratory system.

5. What Is the Nasopharynx in Children?

The nasopharynx in children serves the same functions as in adults. However, there are some notable differences. The nasopharynx is typically smaller and less developed in children than in adults. This anatomical difference can make children more prone to issues such as adenoid hypertrophy, which is the adenoid enlargement in the nasopharynx. Additionally, children may experience more frequent infections in the nasopharynx, such as ear infections. Monitoring and addressing nasopharyngeal issues in children is important for their respiratory health and well-being.

6. What Is the Origin of the Nasopharynx?

The nasopharynx originates from the embryonic pharynx during development. The fusion of multiple pharyngeal arches and pouches forms it. Specifically, the nasopharynx arises from the posterior part of the primitive pharynx. As the embryo develops, the nasopharynx undergoes further growth and maturation to assume its final anatomical structure, connecting the nasal cavity to the rest of the respiratory system. Understanding the origin of the nasopharynx provides insights into its developmental significance and its integration within the overall anatomy of the respiratory system.

7. Is the Tongue Considered Part of the Nasopharynx?

No, the tongue is not considered part of the nasopharynx. The tongue is a muscular organ present in the oral cavity, while the nasopharynx is a part of the upper respiratory system. The nasopharynx is situated behind the nasal cavity and is responsible for conducting air during breathing. Although the tongue and nasopharynx are both involved in swallowing, they are distinct anatomical structures with different bodily functions and locations.

8. How Many Nasopharynxes Are There?

There is only one nasopharynx in the human body. The term "nasopharynx" refers to a specific anatomical structure in every individual. It is considered a part of the upper respiratory system behind the nasal cavity. The nasopharynx is a passageway for air, connecting the nasal cavity to the rest of the respiratory tract. It plays a vital role in filtering, warming, and humidifying the inhaled air before it reaches the lungs. Understanding that only one nasopharynx helps clarify its singular presence and function in the body.

9. What Type of Tissue Comprises the Nasopharynx?

The nasopharynx is lined with respiratory epithelium, a tissue specialized for respiration. This tissue consists of columnar epithelial cells with cilia and goblet cells. The cilia help move mucus and trapped particles toward the throat for removal, while goblet cells secrete mucus to moisturize and protect the lining of the nasopharynx. The respiratory epithelium also contains immune cells, such as lymphocytes, to help defend against infections. Overall, the tissue composition of the nasopharynx is optimized for its role in respiratory function and defense.

10. Which Four Muscles Make Up the Nasopharynx?

The nasopharynx is primarily a passageway for air and does not contain muscles within its structure. However, four muscles surrounding the nasopharynx play a role in its function. These muscles include the levator veli palatini, tensor veli palatini, salpingopharyngeus, and superior pharyngeal constrictor. These muscles work together to aid in the opening and closing of the nasopharynx during activities such as swallowing and yawning. Their coordinated actions contribute to proper functioning and regulating airflow through the nasopharynx.

11. What Is the Size of the Nasopharynx?

The size of the nasopharynx can vary among individuals, but on average, it has dimensions of approximately two to four centimeters in length and two to three centimeters in width. The size of the nasopharynx can also change with age, as it tends to be larger in children compared to adults. Factors such as individual anatomy and development can influence the specific dimensions of the nasopharynx. Understanding the nasopharynx's size helps assess its functionality and potential implications for respiratory health.

12. What Bacteria Can Be Found in the Nasopharynx?

The nasopharynx can harbor various types of bacteria, both beneficial and potentially harmful. Some commonly found bacteria in the nasopharynx include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. These bacteria are part of the normal flora of the nasopharynx and usually do not cause any harm. However, under certain conditions, they can contribute to respiratory infections, particularly in individuals with weakened immune systems or in cases of bacterial overgrowth. The presence of these bacteria in the nasopharynx does not necessarily indicate an active infection but rather a natural colonization of the respiratory tract.

13. How Common Is Nasopharyngeal-Related Issues?

Nasopharyngeal-related issues, such as infections or disorders, can vary in prevalence depending on various factors. Nasopharyngeal infections, including viral and bacterial infections, are relatively common, particularly in children. Factors such as exposure to pathogens compromise immune function, and close contact with infected individuals can increase the likelihood of nasopharyngeal infections. Nasopharyngeal-related disorders, such as adenoid hypertrophy or nasopharyngeal cancer, are less common but can still occur.

14. Are the Tonsils Part of the Nasopharynx?

No, the tonsils are not part of the nasopharynx. The tonsils are clusters of lymphoid tissue located in the throat, specifically in the area known as the oropharynx. They include palatine, lingual, and adenoids (pharyngeal tonsils). While both the tonsils and the nasopharynx are involved in the immune response and play a role in defending against infections, they are separate structures with distinct locations within the throat. The nasopharynx is situated behind the nasal cavity, while the tonsils are found in the oropharynx.

15. What Type of Tissue Is Found in the Nose?

The nose is lined with a specialized type of tissue called respiratory epithelium. This tissue consists of ciliated columnar epithelial cells and goblet cells. The cilia in the respiratory epithelium help to move mucus and trapped particles out of the nose, while goblet cells produce mucus to moisturize and protect the nasal passages. The respiratory epithelium also contains immune cells, such as lymphocytes, which help defend against pathogens. This specialized tissue in the nose ensures efficient airflow, filtration, and respiratory system protection.

16. How to Maintain Nasal Hygiene?

To clean the nasopharynx, one can practice nasal hygiene techniques. One common method is nasal irrigation using a saline solution. This involves gently flushing the nasal passages with a saline solution using a neti pot or nasal irrigation device. It helps to remove excess mucus, allergens, and irritants, promoting nasal health. Regular hand hygiene, avoiding exposure to pollutants, and maintaining a clean living environment can also contribute to keeping the nasopharynx clean and reducing the risk of infections.

17. What Does a Nasopharynx Infection Entail?

A nasopharynx infection is in the nasopharynx (upper part of the throat) behind the nose. Common causes of nasopharynx infections include viral infections such as the common cold or influenza and bacterial infections like strep throat. Symptoms of a nasopharynx infection may include nasal congestion, sore throat, coughing, sneezing, and a runny nose. Treatment for a nasopharynx infection typically involves rest, staying hydrated, over-the-counter medications to relieve symptoms, and, in some cases, prescription medications like antibiotics if the infection is bacterial.

Sources

Dr. Nagaraj

Diabetology

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