NASOPHARYNGEAL CANCER: CAUSES, DIAGNOSIS AND PREVENTION

What is oropharyngeal cancer?

Nasopharyngeal cancer is a disease that includes cancer of the nasopharynx (the upper part of the throat, just behind the nose), oropharyngeal cancer (the middle part of the throat) and cancer of the hypopharynx, also known as hypopharynx cancer (the lower part of the pharynx). end of the pharynx). This is a common disease in the group of “head and neck cancers”.

The pharynx is a hollow tube about 10cm long that begins behind the nose and ends at the upper end of the esophagus.

Nasopharyngeal cancer has different causes, symptoms, and prognosis depending on the location and stage of the malignancy. One thing the disease has in common, however, is that most are derived from squamous cell epithelium (thin, flat cells that look like fish scales).

Classification of nasopharyngeal cancer

There are 3 types of cancer in the oropharynx, including:

Nasopharyngeal cancer (NPC)

The nasopharynx is the upper part of the pharynx and behind the nose. NPC is the leading cancer among head and neck cancers, and ranks sixth among cancers in general. Incidence is high in some races, especially Asians. The prevalence of the disease in men is 2-3 times higher than in women. Nasopharyngeal cancer has a good prognosis if detected early and treated properly and promptly.

Oropharyngeal cancer

The pharynx is the middle part of the pharynx and behind the nose. Oropharyngeal cancer includes the base of the tongue, tonsils, soft palate, and posterior pharynx. This type of cancer is on the rise, and 70% of cases are caused by human papillomaviruses (such as HPV type 16) that are transmitted sexually during oral sex. HPV (+) oropharyngeal cancer has a better prognosis and has different treatment options than HPV (-) oropharyngeal cancer.

Men are twice as likely to develop oropharyngeal cancer as women.

Hypopharyngeal cancer (also known as hypopharyngeal cancer)

The hypopharynx (oropharynx) is the bottom part of the pharynx. Throat cancer is rare. The number of new cases is on a downward trend due to a decrease in smoking.

Signs of throat cancer

When nasopharyngeal cancer is present, there are often no symptoms in its early stages. In the locally advanced or late stages of the disease, patients often have one or more of the following symptoms:

  • Pain or bleeding in the mouth
  • Sore throat
  • Difficulty swallowing
  • Hoarseness
  • Persistent cough or coughing up blood
  • Ear pain, decreased interest or tinnitus
  • Nasal congestion, prolonged nosebleed
  • Blurry, double or double vision
  • Having a lump/node in the neck​

However, these symptoms may be indicative of other, less serious head and neck conditions than nasopharyngeal cancer. Therefore, if you have any of the above signs, visit your doctor for an examination and accurate diagnosis.

Causes of oropharyngeal cancer

Most cases of nasopharyngeal malignancies are caused by one of three causes: smoking, heavy alcohol consumption, and HPV infection.

Cigarette

When you smoke (actively) or breathe in secondhand smoke (passive), a number of cancer-causing chemicals enter your lungs. This is why smoking has become the leading cause of lung cancer. Not only that, other parts of the body exposed to tobacco, including the throat area, are also easily attacked by cancer cells.

Alcohol

If smoking increases the risk of oropharyngeal cancer, alcohol is likely to make the disease worse. Research shows that drinking alcohol while smoking significantly increases the risk of head and neck cancer compared to smoking or drinking only. The reason is that alcohol acts as an irritant in the mouth and throat, making it easier for the chemicals in tobacco to get into the cells.

Besides, alcohol also slows down the body’s ability to break down and remove harmful chemicals. These two things form an extremely beneficial “combo” for cancer cells to form and grow.

Human papillomavirus (HPV)

In the past, smoking was the leading cause of oropharyngeal cancer. In recent years, the human papillomavirus (HPV) has become the most common cause of this disease.

HPV is a group of about 100 viruses that are spread through anal and oral sex; Some of them are potentially carcinogenic. Experts believe that oral sex is linked to an increased risk of HPV-related throat cancer.

Head and neck cancers caused by HPV usually develop in the oropharynx, including the tonsils, the base of the tongue, the soft palate, and the back of the throat. Currently, this disease is the most common form of cancer related to the HPV virus.

In addition to the three main causes of tobacco, alcohol, and HPV, there are several other risk factors for nasopharyngeal melanoma, including:

  • Ethnicity: Researchers have not been able to explain why, but it seems that people of Asian (yellow skin) descent, especially those of Chinese descent, are at higher risk. Meanwhile, black and white people are more likely to get cancer of the pharynx and larynx.
  • Epstein-Barr virus: Epstein-Barr virus infection is a risk factor for nasopharyngeal cancer.
  • Nutrition: A diet low in vitamins A and E may increase the risk of oropharyngeal, laryngeal, and oropharyngeal cancers.
  • Occupation: Some toxic chemicals such as asbestos, wood dust, paint fumes… are agents that increase the risk of developing malignant tumors. As a result, people working in construction, metalworking, textile, ceramics, logging and food industries are more likely to get this disease.
  • Chewing betel nut: Many Vietnamese people still have the habit of chewing betel nut, and they don’t know that the mixture of betel leaf, areca and quicklime is closely related to an increased risk of cancer.
  • Plummer-Vinson syndrome: This rare condition, which is associated with iron deficiency and causes difficulty swallowing, increases the risk of throat cancer.

Stages of nasopharyngeal malignancy

For nasopharyngeal cancer, the doctor must perform a clinical examination, determine the causative agent (with or without HPV) combined with a number of laboratory tests to estimate the spread of the disease. The tumor must be identified by histological findings.

Imaging tests also play a role in staging the disease. Stages of nasopharyngeal cancer can be classified from stage 0 to stage IV or from stage I to stage IV depending on the location of the lesion and the causative agent.

Methods of diagnosing cancer

To diagnose nasopharyngeal cancer, the primary tumor must be thoroughly examined and evaluated in conjunction with endoscopy. The adjacent lymph nodes should be similarly examined. The detected tumor must be identified by histological findings. Any other pathological data obtained from biopsies or imaging studies should be considered carefully in conjunction with staging.

  • PET-CT scan: In addition to assisting CT scan/MRI in supplementing information for the primary tumor, PET-CT scan can assist in identifying cervical lymph nodes, but not microscopic lesions. However, PET-CT is superior to both CT and MRI in detecting regional lymph node metastases, as well as distant metastatic lesions, or secondary primary tumors.
  • CT scan: This method helps to evaluate head and neck tumors by detecting anatomical deformation and increased absorption of contrast in the tumor. Invasive damage to the bones and cartilage of the head and neck, a factor influencing the staging of the disease, can also be detected by CT scan. Contrast-enhanced CT scan can confirm the extent of tumor invasion and spread to the cervical lymph nodes and adjacent organs and also to metastatic lesions to other parts of the body.
  • Magnetic Resonance MRI: An MRI can better examine soft tissue than a CT scan and often provides additional information in addition to a CT scan. But CT scan can provide better information about bone invasion than MRI.
  • Endoscopy: This procedure is done using a small, flexible tube with a camera on the end to look inside the nasopharynx and look for abnormalities. Tissue sampling for biopsy is also done through this endoscope.
  • Biopsy: This method is often used to get the first histological diagnosis as soon as a patient has a tumor in the neck. There are biopsies:
    • Open Biopsy: Surgical removal of a tissue sample for biopsy.
    • Fine needle aspiration biopsy (FNA): A fine needle is inserted into a tumor or lymph node to obtain a tissue sample for biopsy.
    • Endoscopic Biopsy: Taking a biopsy tissue sample with the help of a laparoscope.
  • HPV-p16 . test
  • EBV-DNA test

Methods of treating oropharyngeal cancer

Like many other types of cancer, treatments for oropharyngeal cancer include surgery, radiation, chemotherapy, and targeted therapy. Depending on the condition and a number of other factors, the doctor will come up with a treatment plan with an appropriate method.

Surgery

Surgery is a treatment that can be performed at all stages of the disease. The doctor performs surgery to remove the tumor or lymph nodes in the neck and some surrounding healthy tissue. After surgery, the patient can be continued with radiation therapy or chemotherapy.

Radiotherapy

Radiation therapy is a treatment that uses high-energy X-rays or other rays to kill cancer cells or stop the growth of cancer cells. There are 2 methods of radiation therapy

  • External radiation therapy: Using a machine outside the body to direct a beam of light towards the cancer.
  • Internal radiation therapy: Using radioactive materials to be placed directly inside or near the cancer.

Indications for internal or external radiation therapy depend on the type and stage of the cancer. Currently, thanks to the great advancement of external radiotherapy, some internal radiotherapy techniques can be replaced by external radiation therapy.

Valence

Chemotherapy is a cancer treatment that uses oral or intravenous drugs to stop the growth of cancer cells and kill cancer cells. Chemotherapy for nasopharyngeal cancer can be given at the same time as radiation therapy (concurrent chemoradiotherapy) or after radiation therapy is completed or before radiation therapy. The type of chemotherapy your doctor will decide on depends on the type and stage of the disease.

Targeted therapy

This is a treatment that uses drugs to attack specific cancer cells. Monoclonal antibodies are a form of targeted therapy. These monoclonal antibodies work to kill cancer cells, blocking the way cancer cells grow or spread.

Cetuximab is a monoclonal antibody that works by binding to a cancer cell surface protein that stops the cell’s growth and division. It is used in the treatment of recurrent and metastatic cancer.

How to prevent nasopharyngeal cancer

Cancer prevention is the key to reducing the risk of cancer. To prevent new cancer cases, we must consider risk factors and protective factors. Anything that increases your chance of developing cancer is called a risk factor; Anything that reduces the chance of developing cancer is called a protective factor.

Some risk factors can be avoided but some are not. For example, smoking and carrying a cancer-causing gene are both risk factors, but only smoking can be avoided.

Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors can reduce your risk, but doesn’t mean you won’t get cancer.

There are different ways to prevent cancer:

  • Changes in lifestyle or eating habits;
  • Avoid cancer-causing factors such as:
  • Quit smoking
  • Reduce alcohol consumption
  • Reduce the risk of HPV infection: by following a safe sex life (not having multiple sexual partners at the same time, using condoms). The HPV vaccine is also an effective way to prevent this virus.
  • Treat precancerous lesions (usually detected by screening and routine physical examination).
  • Maintaining a healthy lifestyle and diet is an effective cancer prevention measure

What to eat – what to avoid when diagnosed with the disease?

A balanced diet is one that provides the right nutrients at the right time. The ingredients we need to provide enough:

  • Carbohydrates (starch): Bread, potatoes, rice, noodles, vermicelli … are foods belonging to the starch group, providing energy for muscles and brain.
  • Protein (protein): found in fish and seafood, lean meat, poultry, eggs, legumes, nuts…
  • They provide amino acids, build and develop muscle cells, skin and hair cells, nerve cells, etc.
  • Lipids (fats): This is an indispensable component for the immune system, brain and many other organs. A balanced diet requires enough saturated fat, unsaturated fat, and cooking oil. All meats are rich sources of saturated fat. Unsaturated fats are abundant in oily fish (tuna, salmon, mackerel, herring …) and good oils for cancer patients include fish oil, soybean oil, sesame oil, sunflower oil. positive…
  • Fruits and vegetables: provide us with fiber, vitamins, minerals, antioxidants and fluids.
  • Milk and dairy products (cheese, butter, whey…): considered a mixture of proteins, fats, and carbohydrates. Choose low-fat or skim milk, no/low sugar.
  • Water: In addition to tolerating nutrient-rich foods, cancer patients need to add 1.5-2 liters of water per day, which can be filtered water, pure fruit juice, smoothies, etc.

A diet is considered balanced when all of the above ingredients are used at the right time, in the right amount, and at the right frequency.

Patients with nasopharyngeal cancer often experience effects before treatment (caused by the disease), during treatment (due to immediate side effects), and after treatment stops (due to long-term side effects). . Good nutrition will help patients have good health to pass the treatment time, as well as quickly recover after treatment. Some common side effects are dry mouth, changes in taste, or difficulty swallowing.

Some foods should be limited in the patient’s diet:

  • Citrus fruits: Oranges, lemons, grapefruits, tangerines, kumquats… contain a lot of acid, which can easily cause sore throat. In addition, other sour fruits such as strawberry, pineapple, green mango… are also not suitable for patients.
  • Foods that are dry, difficult to swallow, difficult to digest such as sticky rice, nuts, whole grains, etc., because they will cause difficulties in the process of swallowing and digesting food for the patient.
  • Processed foods, baked goods, fried foods, smoked meats/fish… They not only have little nutritional value, but also contain many active ingredients that are not beneficial for the treatment process.
  • Food that is too hot or too cold will directly affect the throat area, making the patient uncomfortable and painful.
  • Caffeinated drinks such as coffee, cappuccino, latte…
  • Beer, wine and alcoholic beverages.

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MOBILE EMERGENCY BOXES located at the DEPARTMENT are fully equipped with medical tools, including electric shock machines to serve the emergency work of patients.

In particular, in order to ensure the privacy of patients, blood collection for testing as well as drug dispensing and meal service are arranged at the ward.

At the boarding area, the standard of a high-class hotel is put on top with full amenities: minibar, LED screen TV, Internet, equipment connecting medical staff 24/24; 100% medical gas system and emergency equipment arranged at the bed; toilets fitted with equipment connecting medical staff…