1, radiotherapy:

Radiotherapy is recognized as the preferred treatment of nasopharyngeal carcinoma. 1979 NPC session of the NPC in Phase I of radiotherapy. Radiation therapy for nasopharyngeal carcinoma can be divided into radical radiotherapy and palliative radiotherapy.

Radiotherapy contraindications: ① Karnofski grading 60 points below ② extensive metastasis; ③ radioactive cerebral spinal cord injury; ④ other infectious diseases such as mental illness or have not yet control.

Application of nasopharyngeal carcinoma radiotherapy to kill tumor cells, but also normal tissues or organs inevitably produce radiation exposure and response. Radiation response and dose-dependent reduction, the scope of irradiation, irradiation treatment for normal tissues or organs closely related to tolerance.

Radiation response:

1) total-body irradiation reaction include: weakness, dizziness, Weina diminish, nausea, vomiting, mouth or Bianmei tasteless, such as insomnia or sleepiness. Although varying degrees, but the symptomatic treatment can be overcome in general, completed radiotherapy treatment.

2) mucosal reactions: oropharynx and nasopharynx, nasal cavity, paranasal sinus mucosa in the 40 Gy radiation mucosal edema can occur after or congestive, exudative increase in serious cases can cause at various points, or flake tunica albuginea. Often in the process of irradiation and throat pain, eating difficulties, such as stuffy nose. Serious cases should be suspended irradiation, proper rest, to be dissipated reaction after treatment. Usually available in 1 year after radiotherapy gradually absorbed receded, but there are a few cases in the 10 years after radiotherapy still exists.

3) salivary gland radiation reaction: Saliva secretion decreased significantly in patients with dry mouth, dry food into difficulties.

4) radiation reaction of the skin and subcutaneous tissue: a general irradiated skin erythema region, pigmentation, hair loss and dry and peeling, such as irradiation speed, skin edema also continue to irradiation can form blisters, integration into large moist peeling, and fluid, erosion become moist dermatitis.

5) radiotherapy for advanced radiation reaction: often face and neck skin and subcutaneous tissue atrophy, skin thinning, telangiectasia, such as pigment faded.

6) speaks difficulties: masticatory muscles, joints temporal maxillary exposure can cause varying degrees of difficulty mouth.

7), and radioactive radiation caries mandibular necrosis.

radioactive erysipelas skin and subcutaneous tissue.

9) radioactive otitis media.

10) radioactive brain and spinal cord injury.

Second, the surgical treatment:

Suitable for:

1) pathological types of well-differentiated adenocarcinoma and squamous cell carcinoma or other non-sensitive cancer radiotherapy, lesions confined to the anterior or posterior wall of the top, the body without surgery may be considered taboo in the original lesion excision. On Ⅱ, Ⅲ, Ⅳ patients are not surgical treatment.

2) after radiotherapy or neck nasopharyngeal residual or recurrent lesions, such as limitations in the anterior or posterior wall of the nasopharynx top, no cranial base bone destruction, the general situation, and recently made a radiotherapy, radiotherapy should no longer be considered resection of lesions.

3) residual or recurrent neck, such as limited scope of activities can be considered for cervical lymph node removal surgery.

Nasopharyngeal carcinoma patients with persistent residual lymph node surgery, as appropriate, after radiotherapy in 3-6 months time, a better prognosis.

Third, chemical treatment:

More than 95 per cent of nasopharyngeal carcinoma poorly differentiated carcinoma, and undifferentiated carcinoma type, the degree of malignancy, grow fast, easy blood or lymph node metastasis. Nasopharyngeal cancer diagnosed at 75% of the patients had Ⅲ and Ⅳ are, the more nights of view, the more opportunities for distant metastasis, the poorer the prognosis. Radiation therapy is a local treatment, not prevention of distant metastasis and therefore the merger of several drugs or chemicals in the treatment might reduce or eliminate the small tumor lesions, improve the treatment outcome. Main methods:

(1) combined with chemotherapy programme:

1) CF programme: cyclophosphamide and 5 - are broad-spectrum anti-cancer drug 5-fluorouracil, a certain effect on nasopharyngeal carcinoma.

2) PF programme: chlorine-ammonia combination of cisplatin and 5 - 5-fluorouracil a better effect on nasopharyngeal carcinoma, effectual fast, but for the shortcomings of the short duration of remission. Can be used before radiotherapy to tumor regression, or for patients with chemotherapy alone.

3) PFA programme: platinum-chlorine and ammonia 5 - 5-fluorouracil, hydroxyl and Tali-such as doxorubicin. Significantly reduce the role of tumor.

4) CBF programme: The main use of cyclophosphamide, adriamycin honour and 5 - 5-fluorouracil.

2) chemotherapy and radiotherapy in the treatment: The treatment effects were relatively good, and 5-year survival rate higher.

NPC their own difficult to discover, until found some symptoms to the hospital for an examination, it is already 80% advanced. But if using serological examination, 90% of the patients in the early detection. One patient after radiation treatment, five-year survival rates can reach 90 percent. Located in the Guangxi Wuzhou Cangwu and nasopharyngeal carcinoma Institute, found after years of study, the incidence of nasopharyngeal carcinoma in the first five to 10 years, in patients with the anti-EB virus antigen-antibody shell are there. Check this virus can be found in advance nasopharyngeal carcinoma. Under normal circumstances, early the following four kinds of nasopharyngeal carcinoma often performance, though not self-discovery, but some careful can still be found from the many clues: 1, such abnormal bleeding even with the exception of a few bleeding from the nose, basically not consciously symptoms, the highest number of the morning bleeding. 2, stubbornly otitis media performance for the discharge side of the canal, tinnitus, hearing loss, attic effusion. 3, unilateral headache for the performance of intractable headache, facial paralysis with diplopia and Drug difficult to relieve suffering. 4, cervical lymphadenopathy According to statistics, the early symptoms of nasopharyngeal carcinoma in the lymph nodes in the neck rate of 70 per cent to 90 per cent, of which 38.5 per cent for the first symptoms. Its exact location of the cervical approach the top of the mastoid muscle beneath a hard painless nature, location fixed mass, rapid growth. All of the above symptoms and continued more than two weeks, the patient can be regarded as suspicious should immediately to the hospital for an examination. Nasopharyngeal carcinoma there is a common clinical symptoms are nausea Cypriot flu ear, middle ear and the nasopharynx and the anatomical characteristics of the cavity.

(A) The history and clinical manifestations: Clinical case of 30 ~ 50-year-old blood T, stuffy nose, headache, tinnitus, deafness, the symptoms of patients with neck mass, first consider the possibility of nasopharyngeal carcinoma, a comprehensive positive check. 　　

(B) nasopharyngeal examination: nasopharyngeal cancer diagnosis is extremely important common method, where suspected nasopharyngeal carcinoma patients with nasopharyngeal mirror must be carefully examined repeatedly, can be found in nasopharyngeal lateral or nose or nasopharynx top after hole etc. mucosal surfaces was gray, rough, erosion and ulcers, or see nodular mass patchy uplift, and other desirable biopsy to confirm the diagnosis. 　　

(C) cytology examination: direct smear, using cotton-wipe (positive rate of 88%), special keys blowing scraps of nasopharyngeal smears, nylon brush collection cells (positive rate of 92.4%), the suction method ( positive rate of 91%), a simple, convenient, can be added biopsy deficiencies. 　　

(D) nasopharyngeal biopsy: clamp nasal or oral lesions from living tissues for histological examination. 　　

(5) X-ray examinations. X-ray include: nasopharyngeal lateral skull base and films. Observation of the top wall of the nasopharynx after soft tissue shadow of submucosal invasion and expansion of the base of skull bone damage. 2. Mortar contrast barium X money: Barium mortar infusion nasal cavity. Submucosal lesions on contrast-more clearly than the nose, nasopharynx can be found under the original can not be found smaller and submucosal carcinoma invasion. 　　

(6) CT scans: CT can show that the nasopharynx small soft tissue uplift, and help determine the direction of biopsy site, to early diagnosis, can be found by the occupying nasopharyngeal carcinoma arising from the early signs, such as muscle thickening, pharynx recess occlusion or disappeared, after the pharyngeal opening of the eustachian tube of lip uplift, thickening to plug. Also observed violations of parapharyngeal space cancer caused by the soft tissue shadow, parapharyngeal fat between the muscle and fat layer Gap signs disappeared. 　

(7) luciferase test: NPC luciferase absorb more than the normal tissue. After oral or intravenous injection, to a certain intensity of ultraviolet radiation, can display different fluorescence reaction, normal mucosa were purple blue, yellow or dark yellow cancer. 　　

(8) immunological tests: In patients with nasopharyngeal carcinoma in a decisive anti-EB virus antigen (VCA, EA, MA, CF / S and EBNA) high antibody titer, EB virus shell antigen antibody immunoglobulin A (EBV - VCA-IGA) on the specific diagnosis of nasopharyngeal cancer, lymphatic epithelial type, squamous cell carcinoma positive rate of 81.5% to 97.3 X. In addition it can also be used for the monitoring of clinical conditions.

(1) primary carcinoma (T) phases: T1 primary cancers confined to the nasopharynx. T1a minimal invasive lesions. T1b confined to the nasopharynx a wall or two at the junction of the walls of the limitations of lesions. T1c including two primary foci wall or two walls above. T2 primary tumor invasion and the nasal cavity, oropharynx or involved in the vicinity of the skull base following muscles and nerves. T3 original invasion and bone cancer, brain or paranasal sinuses. T2 and T3 are T4 involvement, or transgression and the next Yuanqiang, orbital or temporal fossa

  (2) cervical lymph node metastasis (N) phases: N0 no palpable lymph nodes. N1 neck area or fixed lymph nodes, 3 CM in diameter within. N2 neck diameter of 3-8 CM district activities next cervical lymph node or area within a diameter of 8 CM activities lymph nodes. N3 neck area under the CM in diameter, 8 fixed within lymph nodes, neck area any CM in diameter, more than 8 or supraclavicular lymph nodes within Waterloo or supraclavicular lymph nodes by the skin infiltration.

  (3) distant metastasis (M) phases: M0 without distant metastasis. M1 with distant metastasis or subclavian below the skin or lymph node involvement. (4) clinical stages: Stage Ⅰ T1N0M0 Ⅱ period T2N0M0, T1N1M0 Ⅲ period T3N0M0, T3N1M0, T3N2M0, T1N2M0, T2N2M0 Ⅳ period T4N0-3M0, T1-3N3M0 Ⅳ b period or Ⅴ-phase T1-4N0

     Drug treatment
     The mechanism of different medication may be different, local and systemic drug administration. The following is a list of commonly used clinical trials of the drug.
     Antihistamine drugs
     Chlorpheniramine, such as Le-Min
     Against histamine, the body allergens in the stimulation of the release of histamine, which cause a series of allergy symptoms.
     Prevention and treatment
     Chlorpheniramine can cause drowsiness, drivers, pilots and other banned, the new generation of antihistamines without drowsiness. But there are side effects Astemizole and cautiously uses.
     Mast cell stabilizer
      Sodium Cromoglicate eye drops and oral, Qu
      Allergens in a situation to prevent the body to release histamine organizations.
     Prevention
     Can cause drowsiness.
     By decongestant
     Ephedrine, it Qualcomm, epinephrine, Ceftiofur Ma Mixture
     Relieve nasal obstruction.
     The short-term treatment
     Use no more than three days, the longest week. Long-term use will cause drug rhinitis.
     Bromide
      Histamine reduced by more than symptoms caused by aldicarb.
     Treatment
     Clinical not commonly used.
     Hormone Drugs
     Dexamethasone Ophthalmic Solution, Burke sodium, special Renault test
     Reduce the allergic reaction and inhibit the inflammatory response.
     Treatment
     Long-term use of hormones may lead to systemic side effects, but generally minor side effects, in particular last for clinical drugs.
     Nasal wetlands agent
     Chouhou help alleviate nasal secretions and the callus Paper.

    Radiation therapy is preferred. There are three reasons:

(1) special anatomical location. NPC in the position of concealment, Chui only 5.5-6.0 cm in diameter, the shape of a small matchbox, the rectangular cavity. For its posterior cervical spine, the top wall for the base of the skull, a broken-sublingual, glossopharyngeal, vagus, nerve and important arteriovenous access Lu Qiang, which also invasive intracranial nasopharyngeal carcinoma, both sides wall artery, vein and lymphatic organizations. By the great vessels, enveloping the tiny cranial nerve tumor is difficult to radical surgery, not damage it more difficult for these important structures, “The Anatomy of the restrictions, nasopharyngeal cancer surgery non-ideal approach” concluded that the There are objective basis. 　　

(2) to the rapid development of surgical lesions difficulties and limitations. Tumor expand upward into the middle cranial fossa, many cranial nerve damage to the deep cervical lymph node metastasis, its transfer rate is as high as 60 percent to 80 percent, at the same time intracranial and cervical metastasis, but also to the distant liver and metastasis. Nasopharyngeal carcinoma is more vicious high degree of poorly differentiated or undifferentiated carcinoma, the early diagnosis was only 4% -7%, in the treatment of advanced patients. 　　

(3) radiotherapy good effect. Its five-year survival rate up to 49.5%, radiotherapy may be the original structure, less trauma, the depth of X-ray and cobalt 60, the accelerator has become the principal means of treatment. Of course, there are individual cases of the use of surgical resection, tumor limitations such as no signs of metastasis, or residual tumor after radiotherapy were.

         Nasopharyngeal carcinoma (Nasopharyngeal Carclnoma, NPC) disease susceptibility has obvious racial, regional and family gathered tendentious. In most parts of the world the incidence rate is low, in general, the incidence of 1 / IO million the following. China is a high incidence area, the annual incidence rate of 10 ~ 25/10 million, is one of China common malignancy, accounting for the death of the National Cancer 2.81 percent, ranking No. 8, the incidence ratio was 3.5:1 men and women, the peak age is 40 ~ o 6-year-old. In China, the incidence rate of NPC from the south to the north to gradually reduce, in the south such as Guangdong, Guangxi, Hunan, Fujian, Jiangxi, the annual incidence rate can be as high as 30 ~ 50/10 million, the most northern incidence of not more than 2 ~ 3 / 100,000. According to statistics, Zhongshan Medical University Cancer Hospital, NPC accounted for 31.77 percent of local cancer, the cancer deaths of three. Central Pearl River Delta in Guangdong and Hong Kong have high incidence of family NPC report.

            As part of nasopharyngeal carcinoma hidden, often there are no symptoms of early cancer. In a small number of patients with T sucking blood or nose, the mouth can spit out T solution with bloodshot, or the side of tinnitus symptoms. Easily ignore these symptoms patients. Even to see a doctor, often by non-specialist doctors suspected the flu, or just inflammation symptomatic treatment. Little for the need to examine the nasopharynx. NPC common clinical manifestations are as follows:
          (I) eyes, ears, nose symptoms: As nasopharyngeal tumors increased, the surface rupture tumor necrosis caused bleeding, the patient can occur repeatedly Caledonia blood, epistaxis, and occasionally also have massive bleeding. After blocking tumor nostrils are blocked at the phenomenon. If the Eustachian tube extrusion nasopharyngeal tumors mouth, have tinnitus, hearing loss, earache or tympanic membrane invagination. When violations of the nearby orbital tumors, or to affect the cranial nerves at the orbital patients have diplopia, visual impairment, or eyeball process.
          (Ii) headache: migraine often mainly to the top of the temporal The most common headache. Pillow also have the pain. Headache causes and nasopharyngeal nearby blood vessels, nerves, bone or the tumor effects. Fixed, sustained, severe headache should pay special attention to, it may be due to damage caused by the base of skull bone.
           (Iii) cranial nerve damage: people have 12 pairs of cranial nerves, which, most likely be affected is the abducens nerve, patients will have symptoms of diplopia. This was followed by the trigeminal nerve, and the pulley oculomotor nerve involvement is manifested mainly as a disease lateral eye fixed on the eyelid ptosis, the pupil to expand, face and body felt numb tongue, mouth opening today jaw deflection. In addition, the hypoglossal nerve, the vagus nerve and also due to the parapharyngeal space has been invaded or neck lymph node metastasis oppression caused dysfunction, expressed as lateral tongue muscle atrophy disease, Shen She preferred tongue disease, the side of the sound dumb, dysphagia, Song Jian unable disease side.
          (Iv) cervical lymphadenopathy: NPC higher rate of cervical lymph node metastasis, and earlier there. Cervical lymph node metastasis common position is on the level of the neck muscles earlobe deep. Slightly larger than the beginning of lymph nodes, can be slightly activities, painless, after lymph node size of the increase, the increase in the number, and the gradual integration fixed. Cervical lymph node top-down development until supraclavicular area. About half of nasopharyngeal carcinoma patients left neck mass Hospital.

          Overall, the NPC has seven major symptoms and signs of the three. Seven symptoms were epistaxis, nasal obstruction, tinnitus, deafness, headache, face Ma Tei, diplopia; three signs is a new biological nasopharyngeal, cervical lymphadenopathy, or cranial nerve in a branch of Paralysis. In each of the patients who have mentioned above is not the full levy

[Outlined]
    Nasopharyngeal sarcoma than NPC rare.
[Diagnosis]
     Nasopharyngeal sarcoma diagnosis based mainly on history, clinical manifestations and nasopharyngeal examination, the final diagnosis by biopsy. Nasopharyngeal cranial base bone sarcoma caused less damage. Lymphatic sarcoma of the high rate of cervical lymph node metastasis, and more for both sides of cervical lymph node metastasis, a soft texture, deep cervical lymph node involvement of each group.
[Treatment]
     Nasopharyngeal lymph sarcoma sensitive to radiation therapy, according to statistics more than five years survival rate of about 50 percent. Chemotherapy on lymph sarcoma have better efficacy. For the radiotherapy and chemotherapy or not sensitive to local recurrence of cases, if the general situation without surgery patients contraindications, considering surgical resection of the primary tumor. Surgical methods with nasopharyngeal cancer surgery.
【Pathological changes:
     Nasopharyngeal sarcoma is the most common malignant lymphoma, nasopharyngeal sarcoma about the 2 / 3 above, the other for fibrosarcoma, vascular endothelial sarcoma, melanoma, and so on.
Clinical manifestations】 【
     Nasopharyngeal sarcoma with rapid growth, metastasis late age of onset small features. Early symptoms similar arising from the proliferation of mast caused by the nasopharynx occupying the performance, such as nasal obstruction, the eustachian tube plug symptoms are bleeding after cervical lymph node metastasis, or metastasis, last appears cachexia deaths.

1. NPC claimed to be “Guangdong cancer”, occurred in the provinces in South China, the world’s 80 percent of nasopharyngeal carcinoma occurred in China.
2. The high rate of nasopharyngeal cancer misdiagnosis, the early diagnosis of only about 10%, almost 30 years ago, although CT ﹑ MRI instrument to enter advanced clinical checkups, but no symptoms of nasopharyngeal carcinoma lesions characteristic of ﹑ concealed location, and other factors, could easily lead to delayed diagnosis , individual reports misdiagnosis rate of 48.2 percent to 82.4 percent, so early diagnosis ﹑ early biopsy is to improve the survival rate of nasopharyngeal carcinoma and an important measure to reduce the mortality rate.
3. NPC common symptoms for blood T ﹑ epistaxis ﹑ nasal ﹑ tinnitus and hearing loss ﹑ headache ﹑ neck mass, and so on, may be advanced with a skull and cranial nerves violations, a corresponding symptoms, distant metastasis to the Chen Shui-bian bone metastases largest, followed by the liver and other lung ﹑.
4. Because of nasopharyngeal carcinoma in intracranial deeper cavity ﹑ gap ﹑ around the neck, complex anatomical structure, it is quite difficult surgery, radiation therapy is the preferred means of local treatment.
5.95% above the NPC is a squamous cell carcinoma, and poor differentiation, radiation sensitive, can serve to “instantly” by the recent results, it is worth mentioning that systemic therapy is the long-term effect was nasopharyngeal carcinoma clinical treatment pursuit of the main objective.
6. Nasopharyngeal cancer is a systemic disease partial performance, early detection ﹑ systemic anticancer treatment ﹑ specific individualized treatment of nasopharyngeal cancer treatment is the basic principle of systemic therapy has been effectively control the disease and prevent distant metastasis in patients with long-term survival is and the key to the clinical treatment.
7. Vigilance neck mass ﹑ clinical symptoms disappeared after the patient alleviate psychological paralysis to prevent excessive radiotherapy and chemotherapy is not appropriate to the harm caused to patients.
8. In the development of long-term treatment programs should be detailed understanding of the specific conditions, including clinical analysis ﹑ dose radiation therapy after ﹑ ﹑ partial response ﹑ other state organs, reasonable long-term treatment program directly related to the prognosis of the patients.
9. Nasopharyngeal cancer prognosis and found sooner or later ﹑ pathological types ﹑ individual differences in age ﹑ ﹑ treatment-related factors such as selection, with long-term survival and the survival of all patients with nasopharyngeal carcinoma is the goal pursued.
10. Pharyngeal cancer patients should be reviewed every two to March a head and neck CT ﹑ abdominal ultrasonography ﹑ nasal cavity inspection.
11. Nasopharyngeal cancer after radiotherapy to the care, maintenance facial skin clean ﹑ maintain oral health, pharyngeal dry counterparts ﹑ serious medicine for patients with appropriate conditioning.