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单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,鼻 咽 癌,Nasopharyngeal Carcinoma,(NPC),耳鼻咽喉-头颈外科 杨新明,一、概述(outline),1、发病有一定旳地域性(more common in south-east Asia in the world,more common in southern China),我国头颈恶性肿瘤之冠(the top of the malignant tumor in head and neck)。某些高发区可能为全身恶性肿瘤之首，广东、广西、湖南和福建高发。,2、高发年龄（maximum age incidence)：4060岁（86.62%）,3、性别(sex)：男多于女(male to female is 2:1),二、病因（etiology)(three possible causal factors),1、遗传原因(genetic factors),种族易感性,家族汇集性,(racial predilection,family tendency and HLA typing),2、病毒原因-Epstein-Barr virus EB病毒,NPC患者血清中检测到EB病毒有关抗体(patients with NPC have high level of antibody against EBV(over 90%of patients)，,NPC活组织旳癌细胞中存在EBV DNA特异性mRNA或基因体现产物(expression of gene products，,(but whether the relationship between the two is causal or incidental is still unknown),3、环境原因(environment factors),微量元素(microelement)：镍(nickel),维生素缺乏(vitamin lack),性激素失调(hormonal factors),亚硝胺,A combination of genetic,virus and environmental influences would best explain the occurrence of nasopharyngeal carcinoma),病理学(pathology),主要为低分化鳞癌。少见腺癌、肉瘤等,Over 95%Squamous cell carcinoma(poorly differentiation),Adenocarcinoma,sarcoma,好发部位,most tumors arise on the posterosuperior wall or fossa of Rosenmuller,图 咽隐窝 鼻咽顶后壁,临床体现(clinical manifestations),1、,鼻部症状:涕血或后吸涕带血，鼻塞。,nasal symptoms such as epistaxis,bloody,postnasal discharge,nasal obstruction,2、耳部症状：分泌性中耳炎,Secretory otitis media:conductive,deafness,fluid in the middle ear,tympanic membrane indrawn,3、颈淋巴结肿大（图）,Metastases in the lymph nodes of the neck,regional nodal metastases are present in 60 to 80 per cent of patients,with bilateral spread being evident in almost half.Superior deep jugular nodes are most often noted,颈淋巴转移,图,4、颅神经症状:（图）involved cranial nerves:fifth and sixth nerve are the most frequently involved,Headache,internal strabismus.4,th,3,rd,and 2,nd,cranial nerves are next most commonly affected.9,th,10,th,11,th,and 12,th,may also be involved,舌下神经麻痹 外展神经麻痹,Hypoglossal paralysis abducens paralysis,5、远处转移：Distant metastases occur to bone,lung,liver and other sites,诊疗(Diagnosis),1、病史、症状和体征,History,symptoms and signs,Early symptoms:bloody,postnasal discharge,fluid in the middle ear(unilateral),2、鼻咽镜检验,The posterior rhinoscopy,Fibreoptic nasopharyngoscopy,3、血清学检验,EBVCA-IgA,EBVEA-IgG,4、影象学检验,Imaging CT,MRI,5、鼻咽活检确诊旳措施,Definitive diagnosis is made by biopsy,鉴别诊疗,图,治疗(Treatment),放射治疗:Radiotherapy is the method of choice.,Prognosis:the overall 5-year survival rate is about 50%ranging from 75%for early tumors to 15%for late tumors,手术：Surgery,化疗 Chemotherapy,免疫治疗 Immnotherapy,谢谢,
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