Nasopharyngeal Cancer Workup

Updated: Nov 17, 2016
  • Author: Arnold C Paulino, MD; Chief Editor: Cameron K Tebbi, MD  more...
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Workup

Laboratory Studies

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  • Perform routine blood work, including a complete blood count and chemistry profile. Liver function test results may be abnormal in those rare cases with hepatic metastases. Uric acid levels may be elevated in patients with rapidly growing tumors.

  • Epstein-Barr virus (EBV) titers, including immunoglobulin A (IgA) and immunoglobulin G (IgG) antibodies to the viral capsid antigen, early antigen, and nuclear antigen should be performed. These titers may correlate with tumor burden and decrease with treatment. [8, 9] New data has emerged that plasma EBV-DNA levels may be a helpful marker for pretreatment risk categorization, initial treatment response, and at the time of relapse. [10]

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Imaging Studies

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  • CT scanning

    • CT scanning of the head and neck is used to determine tumor extent, base of skull erosion, and cervical lymphadenopathy.

    • CT scanning of the chest is used to search for distant metastases.

  • When intracranial extension is suspected, MRI of the head and skull base may better reveal the extent of the tumor.

    MRI of the head and neck in a patient with nasopha MRI of the head and neck in a patient with nasopharyngeal carcinoma showing the primary tumor and cervical lymph node metastases
  • Bone scans are used to search for distant bony metastatic disease.

  • Positron emission tomography (PET) imaging has been used to assess questionable neck nodes and evaluate for other sites of distant disease.

    Intensity modulated radiotherapy images for a pati Intensity modulated radiotherapy images for a patient with nasopharyngeal carcinoma
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Other Tests

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  • A baseline audiogram is helpful prior to platinum-based chemotherapy and radiotherapy.

  • Creatinine clearance rates (24-hour collection or nuclear GFR testing) should be obtained at baseline and during treatment for those patients being treated with platinum-based chemotherapy because decreases in renal function, requiring dose modifications, have been reported.

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Procedures

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  • A biopsy of the primary lesion or neck node is obtained for diagnosis.

  • Central line placement is recommended for those children receiving chemotherapy.

  • Because of severe oropharyngeal mucositis that can be seen with radiation therapy, strong consideration of gastrostomy tube placement should happen at diagnosis and/or prior to initiation of radiation therapy in order to sustain proper hydration and nutrition.

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Histologic Findings

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  • The World Health Organization (WHO) has classified nasopharyngeal carcinoma into 3 categories.

    • WHO-1 is defined as well–to–moderately differentiated squamous or transitional cell carcinoma with keratin production.

    • WHO-2 is nonkeratinizing carcinoma.

    • WHO-3 is undifferentiated carcinoma, including lymphoepithelioma. This entity consists of malignant epithelial cells with lymphocytic infiltration.

  • The vast majority of children are found to have WHO-3 disease. [11, 12]

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Staging

Various staging schema have been proposed for nasopharyngeal carcinoma in children. [13] No single system has proven satisfactory in correlating disease extent to prognosis.

Currently, the Seventh Edition of the American Joint Committee on Cancer (AJCC) Staging is used to stage patients with nasopharyngeal cancer. The staging system takes into account the tumor (T), nodal (N) and metastatic (M) extent of the nasopharyngeal cancer. [14]

Table 1. AJCC Staging for Nasopharyngeal Cancer (Open Table in a new window)

Stage

T

N

M

0

Tis

No

M0

I

T1

N0

M0

II

T1

N1

M0

T2

N0

M0

T2

N1

M0

III

T1

N2

M0

T2

N2

M0

T3

N0

M0

T3

N1

M0

T3

N2

M0

IVA

T4

N0

M0

T4

N1

M0

T4

N2

M0

IVB

Any T

N3

M0

IVC

Any T

Any N

MI

 

Table 2. Tumor (T) Staging (Open Table in a new window)

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ

T1

Tumor confined to the nasopharynx or extends to oropharynx and/or nasal cavity without parapharyngeal extension

T2

Tumor with parapharyngeal extension

T3

Tumor involves bony structures of skull base and/or paranasal sinuses

T4

Tumor with intracranial extension and/or involvement of cranial nerves, hypopharynx, orbit, or with extension to the infratemporal fossa/masticator space

 

Table 3. Nodal (N) Staging (Open Table in a new window)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Unilateral metastasis in cervical lymph node(s), less than or equal to 6 cm in greatest dimension, above the supraclavicular fossa, and/or unilateral or bilateral retropharyngeal lymph nodes, less than or equal to 6 cm in greatest dimension

N2

Bilateral metastasis in a cervical lymph node (s), less than or equal to 6 cm in greatest dimension, above the supraclavicular fossa

N3

Metastasis in a lymph node(s) greater than 6 cm and/or to supraclavicular fossa

N3a

Greater than 6 cm in dimension

N3b

Extension to supraclavicular fossa

Table 4. Metastasis (M) Staging (Open Table in a new window)

M0

No distant metastasis

M1

Distant metastasis

 

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