MRI report of nasopharyngeal carcinoma, how to see the primary focus?

The incidence of nasopharyngeal carcinoma is high in southern China, such as Guangdong, Guangxi, Hunan and other provinces, especially Zhaoqing, Foshan and Guangzhou in central and western Guangdong, with more men than women. According to reports, the incidence rate of men living in the central part of Guangdong Province who speak Cantonese is 30/65438+ 10,000 ~ 50/65438+ 10,000. As far as the whole country is concerned, the incidence of nasopharyngeal carcinoma is gradually decreasing from south to north, for example, the incidence in the northernmost part is not higher than 2/65438+ 10,000 ~ 3/65438+ 10,000.

Most malignant tumors occur in nasopharyngeal mucosa. The onset age is mostly middle-aged, and some teenagers are sick. The etiology is related to racial susceptibility (yellow people have more diseases than white people), genetic factors and EB virus infection. Nasopharyngeal carcinoma has a high degree of malignancy, and cervical lymph node metastasis can occur in the early stage. The clinical features are four major symptoms: ① nasal symptoms. One side of the nose is blocked with nosebleeds. In the early stage, there may only be blood in the nose or blood in the nasal cavity. ② Neck mass. More than half of the patients have lymph node metastasis at the time of diagnosis, and many patients have neck tumor as the first symptom. Tumors are mostly located above the lateral side of the neck, with hard texture and poor fluidity. ③ Craniocerebral symptoms. Tumors can invade the skull along the skull base and many cranial nerves, and headache and diplopia may occur on one side in the early stage of the disease. ④ Ear symptoms. One ear is deaf, deaf or repeatedly blocked. Nasopharyngeal cavity is concealed and early symptoms are vague. When patients have nosebleeds on one side, nosebleeds, deafness, headache on one side, diplopia and neck tumors, they should seek medical attention in time and check repeatedly. Serological examination of EB virus, X-ray photography, CT examination and MRI examination. Can assist in diagnosis. The diagnosis must be confirmed by biopsy of nasopharyngeal tumor, and sometimes repeated biopsy is needed. After the diagnosis of nasopharyngeal carcinoma, radiotherapy should be carried out as soon as possible. Full and uninterrupted radiotherapy combined with traditional Chinese medicine and leukocytosis drugs can make more than half of the patients survive for more than 5 years.

etiology

Epidemiological investigation suggests that the etiology of nasopharyngeal carcinoma may be related to the following factors: ①EB virus infection. ② Environment and diet: Environmental factors are also an inducement of nasopharyngeal carcinoma. It was found in Guangdong that the content of trace element nickel in rice and water in the high incidence area of nasopharyngeal carcinoma was higher than that in the low incidence area. The content of nickel in the hair of patients with nasopharyngeal carcinoma is also very high. Animal experiments show that nickel can promote nitrosamine-induced nasopharyngeal carcinoma. It has also been reported that eating salted fish and pickled food is a high risk factor for nasopharyngeal carcinoma in southern China, which is related to the age, period, quota and cooking method of eating salted fish. ③ Genetic factors: Patients with nasopharyngeal carcinoma have racial and family aggregation. For example, the descendants of southerners living in other countries in China still maintain a high incidence of nasopharyngeal carcinoma, suggesting that nasopharyngeal carcinoma may be a hereditary disease.

pathological change

(1) The most common site and general shape of nasopharyngeal carcinoma often occurs at the top of the posterior wall of nasopharyngeal carcinoma, followed by the lateral wall, and rarely occurs at the anterior wall and the bottom wall. The gross morphology of nasopharyngeal carcinoma can be divided into five types: nodular type, cauliflower type, submucosal type, infiltrating type and ulcer type.

(2) Growth and diffusion law The diffusion of nasopharyngeal carcinoma has its own laws. Early nasopharyngeal carcinoma is confined to the nasopharynx, which can be called localized type. With the growth of the tumor, the tumor can directly spread to the adjacent sinus cavity, space and skull base. Nodular or cauliflower tumors can protrude into the nasopharyngeal cavity, while invasive, submucosal and ulcer types mostly grow under the mucosa. Cancer can grow into nasal cavity, oropharynx, spread to parapharyngeal space, pterygopalatine fossa or invade orbit. Cancer can spread directly upward, destroying the skull base bone and brain nerve. Neck metastasis of nasopharyngeal carcinoma is through lymphatic drainage system, while distant metastasis can enter blood circulation through lymphatic system or cancer cells directly invade peripheral blood vessels, enter blood circulation and transfer to distant organs.

(3) Histological classification

1. cancer in situ: the concept of cancer in situ means that cancer cells have not broken through the basement membrane, and nasopharyngeal carcinoma in situ is no exception. There must be a complete basement membrane under the cancer focus. When cancer cells proliferate in situ, they show bud-like or spike-like processes, and there is still a clear basement membrane to separate cancer cells from the underlying lamina propria of mucosa. The diagnosis of nasopharyngeal carcinoma in situ is mainly based on cytological criteria, followed by histological arrangement and structure. Therefore, we must strictly grasp the cytological standard of in-situ diagnosis of nasopharyngeal carcinoma, that is, the transitional images must reach the recognized level. Compared with normal epithelial cells, the proportion of nuclear plasma in in situ cancer cells increased, that is, the nuclear area increased significantly.

2. Invasive cancer

(1) Micro-invasive carcinoma: refers to a field of vision in which the basement membrane is destroyed by cancer cells, but the infiltration area is less than 400 times under the light microscope. Compared with carcinoma in situ, the cell morphology is more obvious, and it grows by infiltrating the basement membrane.

(2) Squamous cell carcinoma: Although most NPC originated from columnar epithelium, most NPC is squamous cell carcinoma. In order to diagnose squamous cell carcinoma, it is necessary to have the characteristics of squamous differentiation in the section. Squamous differentiation refers to: ① keratinized beads; ② Intracellular and extracellular keratinization; ③ Intercellular bridge; ④ Cells in cancer nests are arranged like squamous epithelium, but the cells are not syncytia. According to the squamous differentiation degree of cancer cells, nasopharyngeal squamous cell carcinoma can be divided into three grades: high, medium and low differentiation.

① Well-differentiated squamous cell carcinoma: Most cancer tissues with intercellular bridges or keratinization are called well-differentiated squamous cell carcinoma or keratinized squamous cell carcinoma. There is generally no lymphocyte infiltration in the cancer nest, and sometimes individual scattered lymphocytes can be seen. The boundary of cancer nest is generally clear, sometimes surrounded by complete membrane. This type of cancer is mostly fibrous tissue type. With neutrophils, lymphocytes and plasma cells infiltration, but generally there are not many plasma cells.

② Moderately differentiated squamous cell carcinoma: clear intercellular bridges and/or keratinization can be seen in the cancer tissue, but there are a certain number of nasopharyngeal carcinoma. The amount of keratinization, whether intracellular or extracellular, is much less than that of well-differentiated squamous cell carcinoma. There are different numbers of lymphocytes infiltrating in the cancer nest and plasma cells around the cancer nest. Interstitial changes are similar to poorly differentiated squamous cell carcinoma, but different from well differentiated squamous cell carcinoma.

③ poorly differentiated squamous cell carcinoma: under the light microscope, there are also a certain number of cancer cells with intercellular bridges or intracellular keratinization, but the number is small. The cancer cell nucleus is deeply stained. Hypertrophic nucleoli, often basophilic eosin staining. The boundary between cancer nest and stroma is clear, but stroma can also be mixed. There are different numbers of lymphocytes infiltrating in each cancer nest, and there are many types of stroma, namely, lymphocyte-rich infiltration type, granulation tissue type, fibrosis type and inherent tissue type. No matter what type of stroma, there are different numbers of plasma cells infiltrating in each stroma.

(3) Adenocarcinoma: Compared with nasopharyngeal squamous cell carcinoma, nasopharyngeal adenocarcinoma is extremely rare, especially in areas with high incidence of nasopharyngeal carcinoma. According to histogenesis, adenocarcinoma must originate from glands.

① Well-differentiated adenocarcinoma: the boundary between cancer parenchyma and stroma is clear, and the cancer nest is obvious. Some cancer cells are arranged in acinar shape; Some are arranged in high columnar duct-like structures; Some are adenoid cystic carcinoma or cribriform carcinoma; Some are simple adenocarcinoma.

② Moderately differentiated adenocarcinoma: refers to adenocarcinoma that forms a certain number of clear glandular cavities in cancer tissues, but is accompanied by some undifferentiated cancer structures, which is often the result of further metaplasia of the above-mentioned well-differentiated adenocarcinoma, so there are still some traces of well-differentiated adenocarcinoma.

③ poorly differentiated adenocarcinoma: clear glandular cavity structure can be seen in the cancer tissue, and the number is very small. Most cancer tissues are undifferentiated. The tumor cells were foamy vacuoles, and Asin blue staining was weakly negative.

(4) Vesicular nuclear cell carcinoma: Nasopharyngeal carcinoma with vacuolar degeneration of most cancer cells can be called vesicular nuclear cell carcinoma. Because of its special morphology, it has a good prognosis after radiotherapy and is an independent type. The so-called nuclear vacuolation means that the nucleus is large, round or oval or fat spindle-shaped. The area of nucleus is more than three times that of lymphocyte. The chromatin in the nucleus is scarce, which makes the nucleus vacuolated; Chromatin is unevenly attached to the inner surface of the nuclear membrane, making it uneven in thickness, even similar to nuclear membrane defect in thin places. In order to diagnose nasopharyngeal vesicular cell carcinoma, it must be found that more than 75% of cancer cells have vacuolar degeneration in sections. Less than 25% of the remaining cancer cells can be poorly differentiated squamous cell carcinoma or undifferentiated carcinoma. The standard of diagnosis of vesicular nuclear cell carcinoma is that more than 75% of cancer cells have vacuolar degeneration, because it can show its unique biological characteristics, that is, the prognosis is better after radiotherapy.

(5) Undifferentiated cancer: Cancer cells are widely distributed and often mixed with stroma. Cells are medium or small, short spindle-shaped, oval or irregular, with little brain volume and mild basophilia. Nuclear chromatin is increased, granular or massive, and sometimes nucleoli can be seen.

clinical picture

(1) Early rebreathing of nasal mucus may lead to bleeding, which is manifested by blood in sputum after nasal aspiration or blood in nasal mucus when you blow your nose. There is only a small amount of bloodshot in the early sputum or snot, sometimes not. There is more bleeding in the later stage, and nosebleeds may occur.

(2) Tinnitus, hearing loss, and a sense of occlusion in the ear. When nasopharyngeal carcinoma occurs in the lateral wall, lateral fossa or the upper lip of the eustachian tube opening, unilateral tinnitus or hearing loss may occur when the tumor compresses the eustachian tube, and catarrhal otitis media may also occur. Unilateral tinnitus or hearing loss and ear occlusion are one of the symptoms of early nasopharyngeal carcinoma.

(3) Headache is a common symptom, accounting for 68.6%. It can be the first symptom or the only symptom. Early headache is not fixed, but intermittent. The later stage is persistent migraine with fixed position. The reason may be neurovascular reflex or stimulation of the first peripheral nerve of trigeminal nerve. Advanced patients are often caused by tumors destroying the skull base and spreading in the skull involving cranial nerves.

(4) diplopia is often caused by the tumor invading abducent nerve. Invasion of trochlear nerve often causes esotropia and diplopia, accounting for 6.2% ~ 19%. Often damaged at the same time as trigeminal nerve.

(5) Facial numbness refers to facial skin numbness, and clinical examination shows that pain and touch are alleviated or disappeared. Tumors invading cavernous sinus often cause damage to trigeminal nerve 1 branch or the second branch; Tumors invade the foramen ovale, the anterior part of styloid process and the third branch of trigeminal nerve, and often cause numbness or abnormal sensation in the skin of the anterior part of auricle, temporal part, cheek, lower lip and chin. Facial skin numbness accounts for 10% ~ 27.9%.

(6) Nasal congestion may occur in nostrils after tumor blockage. When the tumor is small, the nasal congestion is light. With the growth of tumor, nasal congestion is aggravated, mostly unilateral nasal congestion. If the tumor blocks the bilateral posterior nostrils, bilateral nasal congestion may occur.

(VII) Symptoms of cervical lymph node metastasis Nasopharyngeal cancer is prone to cervical lymph node metastasis, which is about 60.3% ~ 86. 1%, and half of them are bilateral metastasis. Cervical lymph node metastasis is often the first symptom of nasopharyngeal carcinoma (23.9% ~ 75%). A few patients can't find the primary lesion by nasopharyngeal examination, and cervical lymph node metastasis is the only clinical manifestation. This may be related to the small primary focus of nasopharyngeal carcinoma and its spread to submucosa.

(8) Lingual muscular atrophy, direct invasion of nasopharyngeal carcinoma with tongue extension or lymph node metastasis to the posterior styloid region or hypoglossal neural tube. The invasion of hypoglossal nerve leads to the deviation of tongue extension to the affected side, accompanied by muscle atrophy of the affected tongue.

(9) Eyelid droop and eyeball fixation are related to oculomotor nerve injury. The decrease or disappearance of vision is related to optic nerve injury or orbital cone invasion.

(10) The distant metastasis rate of nasopharyngeal carcinoma is about 4.8% ~ 27%. Distant metastasis is one of the main reasons for the failure of nasopharyngeal carcinoma treatment. The common metastatic sites are bone, lung and liver. Simultaneous metastasis of multiple organs is more common.

(1 1) Dermatomyositis with dermatomyositis can also be accompanied by nasopharyngeal carcinoma. Therefore, patients with dermatomyositis should carefully check the nasopharynx whether they have symptoms of nasopharyngeal carcinoma or not.

(12) Nasopharyngeal carcinoma with climacteric as the first symptom is very rare, which is related to the invasion of sphenoid sinus and pituitary gland by nasopharyngeal carcinoma.

diagnose

In addition to paying attention to the above clinical manifestations, the following examinations should also be done:

(1) After the nasal mucosa is converged by the anterior nostril mirror, the posterior nostril and nasopharynx can be seen through the anterior nostril mirror, and cancer invading the nostril or adjacent nostril can be found.

(2) Indirect nasopharyngoscopy is simple and practical. It is necessary to check the nasopharyngeal wall in turn, pay attention to the posterior nasopharyngeal wall and bilateral pharyngeal recess, and observe the corresponding parts on both sides, especially the asymmetrical submucosal protuberance or solitary nodule on both sides.

(3) Fiberoptic nasopharyngoscopy Fiberoptic nasopharyngoscopy can use 1% ephedrine solution to converge nasal mucosa and expand nasal passages. Then anesthetize the nasal passage with 1% tetracaine solution, and then insert the fiberscope through the nasal cavity, and push it forward while observing until it reaches the nasopharyngeal cavity. This method is simple and the mirror is fixed well, but the observation of the posterior nostril and anterior wall is not ideal.

(4) Neck biopsy: For cases with undiagnosed nasopharyngeal biopsy, neck mass biopsy can be performed. Generally, it can be performed under local anesthesia, and the earliest hard lymph nodes should be selected during the operation in order to take out the whole capsule. If it is really difficult to take out the biopsy, a wedge biopsy can be done at the mass, and the tissue must be cut to a certain depth to avoid extrusion. The suture should not be too tight or too dense after operation.

(5) Fine needle aspiration, a simple, safe and efficient method for tumor diagnosis, has gained popularity in recent years. For those who suspect cervical lymph node metastasis, fine needle aspiration can be used to obtain cells first. The specific method is as follows:

1. Nasopharyngeal tumor puncture: Connect the No.7 long needle to the syringe. After oropharyngeal anesthesia, the needle was inserted into the tumor parenchyma under indirect nasopharyngoscope, the syringe was pulled out to make it negative pressure, and it could move back and forth twice in the tumor, and the extract was smeared on the glass slide for cytological examination.

2. Fine needle puncture for neck mass: Connect No.7 or No.9 needle to 10 1 syringe. After local skin disinfection, the puncture point is selected, the needle is inserted along the long axis of the tumor, and the needle is aspirated with a syringe and moved back and forth in the tumor for 2 ~ 3 times, and then the aspirate is taken out for cytological or pathological examination.

(VI) Serological detection of EB virus At present, immune enzyme method is widely used to detect IgA/VCA and IgA/EA antibody titers of EB virus. The former has higher sensitivity and lower accuracy; The latter is just the opposite. Therefore, it is advisable to detect both antibodies in patients with suspected nasopharyngeal carcinoma at the same time, which is helpful for early diagnosis. In the case of IgA/VCA titer ≥ 1: 40 and/or IgA/EA titer ≥ 1: 5, exfoliated cells or living tissues should be taken from the common site of nasopharyngeal carcinoma even if there is no abnormality in the nasopharyngeal part. If the diagnosis can't be made for the time being, we should follow up regularly and do multiple biopsies if necessary.

(VII) Lateral film of nasopharynx, cranial film and CT examination Every patient should routinely take lateral film of nasopharynx and cranial film. If sinus, middle ear or other parts are suspected to be involved, corresponding radiological examination should be carried out. Conditional units should do CT scanning to understand the local expansion, especially the infiltration range of parapharyngeal space. This is very important for determining clinical stages and making treatment plans.

(VIII) B-ultrasound examination B-ultrasound examination has been widely used in the diagnosis and treatment of nasopharyngeal carcinoma. This method is simple, non-invasive and acceptable to patients. In the case of nasopharyngeal carcinoma, it is mainly used to check the lymph nodes in the liver, neck, retroperitoneum and pelvic cavity to find out whether there is liver metastasis, lymph node density and cyst.

(9) magnetic resonance imaging examination because magnetic resonance imaging (MRl) can clearly show the skull, sulcus, gyrus, gray matter, white matter, ventricle, cerebrospinal fluid tube, blood vessels and other aspects. Using SE method to display T 1 and T2 extended high-intensity images can diagnose nasopharyngeal carcinoma, maxillary sinus carcinoma and so on. And show the relationship between tumor and surrounding tissues.

Treatment measures

(1) radiotherapy

Radiotherapy has always been the first choice for the treatment of nasopharyngeal carcinoma. The reason is that most nasopharyngeal carcinoma is poorly differentiated and highly sensitive to radiation, and the primary focus and cervical lymphatic drainage area are easily included in the irradiation field. Since the 1940s, deep X-ray radiotherapy for nasopharyngeal carcinoma has been carried out in China. In 1950s and 1960s, 60Co external irradiation was performed, and the combined field irradiation of nasopharynx and neck was changed to lobular irradiation, which reduced the radiotherapy reaction and improved the survival rate. At present, the most effective and reliable method is to use 60Co remote therapy machine.

1. Indications and contraindications of radiotherapy for nasopharyngeal carcinoma

(1) Indications of radical radiotherapy: ① The general condition is above average; ② There was no obvious bone destruction in skull base; ③CT or MRI showed no or only mild or moderate infiltration near nasopharynx; ④ The largest diameter of cervical lymph nodes is less than 8cm, which is active and does not reach the supraclavicular fossa; ⑤ No distant organ metastasis.

(2) Indications of palliative radiotherapy: ①KS score above 60; (2) Severe headache with moderate or above nasopharyngeal bleeding; ③ Patients with single distant metastasis or cervical lymph node metastasis greater than 10cm. After palliative radiotherapy, if the general condition improves and the symptoms disappear, the distant metastasis can be controlled and radical radiotherapy can be changed. (3) Contraindications to radiotherapy: ①KS score below 60; ② Extensive distant metastasis; ③ Patients with acute infection; ④ Radiation encephalomyelitis. (4) The principle of re-radiotherapy for recurrence after radiotherapy. Re-radiotherapy is not suitable for those who have the following conditions. ① The recurrence time of the same target area (including nasopharyngeal and cervical target areas) after radiotherapy is less than one year; ② Radiation encephalopathy or radiation myelopathy occurred after radiotherapy; ③ The total course of treatment of nasopharyngeal target area should not exceed three courses, and that of cervical target area should not exceed two courses.

2. Selection of radiation and irradiation range

(1) Design of irradiation field: The design principle of irradiation field is "small without leakage". All the parts involved in the tumor should be included in the irradiation field, but the normal tissues in the irradiation field, especially those sensitive to radiotherapy, should be protected. The primary nasopharyngeal lesions mainly use the binaural frontfields. If the nasal cavity and parapharyngeal space are involved, the anterior nasal region can be irradiated, and if the orbit is involved, the upper or lower orbital region can be irradiated. Attention should be paid to protecting eyes with lead plate to prevent radiation cataract. The irradiation range of neck depends on the pathological changes of lymph nodes. For those who have not been exposed to cervical lymph nodes, preventive radiation is often given to the upper neck areas on both sides. If there is cervical lymph node metastasis, preventive irradiation is often given to the drainage area below the metastatic focus.

3. Radiation dose and time

(1) continuous radiotherapy: 200cGY five times a week, with a total amount of TD 6000 ~ 7000 cgy/6 ~ 7 weeks.

(2) Segmented radiotherapy: Generally, radiotherapy is divided into two segments, five times a week, each with 200cGY, and each segment lasts about 3.5 weeks. The two groups were rested for four weeks, with a total dose of TD 6500 ~ 7000 cgy.

4. After-loading intracavitary radiotherapy

(1) indications:

① Localized small nasopharyngeal lesions (tumor thickness less than 0.5 cm) located on the top wall, front wall or side wall;

② The residual lesions of nasopharyngeal carcinoma after external irradiation or surgical resection meet the item 1.

(2) Treatment method: external irradiation and intracavitary irradiation are often combined, with the external irradiation amount of 4500 ~ 6000 cgy, and after external irradiation 1 ~ 2 weeks, intracavitary irradiation 1 ~ 2 times with an interval of 7 ~ 10 days, and each dose is 0.25cm below the mucosa, and 65433 is given.

5. Radiation reaction and degradation and its treatment

Complications of radiotherapy (1)

① Systemic reactions: including fatigue, dizziness, anorexia, nausea, vomiting, tasteless or bad taste in the mouth, insomnia or drowsiness. Individual patients may have hemogram changes, especially leukopenia. Although the degree is different, after symptomatic treatment, they can generally overcome and complete radiotherapy. Take vitamins B 1, B6, C and metoclopramide when necessary. If the white blood cell count drops below 3× 109, radiotherapy should be suspended.

② Local reactions: including skin, mucous membrane and salivary gland reactions. The skin reaction is dry dermatitis or even wet dermatitis, and 0. 1% borneol talcum powder or lanolin can be used locally as anti-inflammatory ointment. Mucosal reactions are congestion, edema, exudation and secretion accumulation of nasopharyngeal and oropharyngeal mucosa, and mouthwash and lubricating anti-inflammatory agents can be used locally. A few patients can have parotid gland swelling after 2Gy irradiation, and the swelling will gradually decrease after 2 ~ 3 days. When irradiated with 40Gy, the secretion of saliva decreased obviously, while the secretion of oral mucosa increased, and the mucosa was congested and swollen. The patient's mouth is dry and it's hard to eat dry food. Therefore, excessive irradiation of parotid gland should be avoided.

(2) Radiation-induced degeneration: there are mainly temporomandibular joint dysfunction, soft tissue atrophy and fibrosis, radiation dental caries, radiation osteomyelitis and radiation encephalomyelitis. At present, there is no suitable method to reverse it, and symptomatic treatment and support methods are helpful. It is necessary to strictly avoid overexposure of important tissues and organs.

(2) Surgical treatment

1, resection of primary nasopharyngeal carcinoma

(1) indications:

① Early cases of well-differentiated nasopharyngeal carcinoma, such as adenocarcinoma, squamous cell carcinoma I and II, malignant mixed tumor, etc.

② After radiotherapy, the nasopharynx recurred locally, and the focus was confined to the posterior or anterior wall, or only involved the edge of pharyngeal recess. There was no infiltration in other parts, and there was no difficulty in opening the mouth. The patient was healthy.

③ Patients who have been given radical dose radiotherapy, but the primary nasopharyngeal focus has not disappeared, or have anti-radiation phenomenon, can be surgically removed after a month's rest.

(2) Contraindications:

① Bone destruction of skull base or nasopharyngeal infiltration, cranial nerve damage or distant metastasis.

② Patients with hepatic and renal insufficiency and poor general condition.

(3) Operation method: First, tracheotomy and intubation, then operation under general anesthesia. A horseshoe-shaped incision was made along the inner side of the maxillary root, 0.5cm away from the alveolar bone, and the hard hip mucosa was cut and peeled off to the submucosal soft palate, and some hard hip plates and vomeroids were removed. The nasal mucosa was transected at the junction of soft palate and hard palate, exposing the top wall of nasopharyngeal cavity, the front of both sides and the tumor. Nasopharyngeal mucosa was cut at the posterior edge of nasal septum and the upper edge of posterior nostril, reaching the bone surface, with blunt or sharp separation, along the junction of nasopharyngeal apex, submucosal incision to the junction of oropharynx and posterior nasopharyngeal wall, and the whole mucosa at the posterior part of nasopharyngeal apex was removed together with cancer.

2. Cervical lymph node dissection

(1) Indications: After radiotherapy or chemotherapy, the primary nasopharyngeal carcinoma has been controlled, and the whole body is in good condition, with only residual or recurrent neck lesions with limited scope and activity. Cervical lymph node dissection can be considered.

(2) Contraindications:

(1) The residual or recurrent lesions of the neck are adhered and fixed with the deep tissues of the neck;

② Patients with distant metastasis or extensive skin infiltration;

(3) Old and frail, with heart, lung, liver and renal insufficiency, which cannot be corrected.

(3) Excision range: The lymph nodes and fatty connective tissues from the top of mastoid, the lower edge of upper skull to the upper edge of clavicle, from the anterior cervical midline to the anterior border of trapezius muscle, together with platysma, sternocleidomastoid muscle, internal and external jugular vein, shoulder swelling hyoid muscle, submandibular gland, lower parotid pole and accessory nerve, were removed in large pieces.

3. Simple neck lymph node resection

Simple resection is feasible for single cervical lymph nodes that are insensitive to radiotherapy or isolated cervical lymph nodes that recur after radiotherapy. After local infiltration anesthesia, the skin and subcutaneous tissue on the surface of the metastatic focus were cut, and all the metastatic focus and some surrounding normal tissues were removed. The wound can be slightly compressed and bandaged after operation.

(3) Chemotherapy

1. Indications of chemotherapy for nasopharyngeal carcinoma

(1) patients with stage ⅳ and patients with obvious lymphatic metastasis in stage ⅳ;

(2) Any patient suspected of distant metastasis;

(3) Cervical lymph node metastasis, and induction chemotherapy before radiotherapy;

(4) Chemosensitization before radiotherapy;

(5) As adjuvant chemotherapy after radiotherapy or surgical treatment.

2. Commonly used combination chemotherapy schemes

(1)PF regimen: cisplatin 20 mg/m2, 5- fluorouracil 750 mg/m2, intravenous drip, rest for 2 weeks after 5 days, and can be used for 2 ~ 3 courses. This scheme can be used to shrink tumors before radiotherapy, or for cases with simple chemotherapy, and the effective rate is between 40% and 90%. This is the most commonly used chemotherapy regimen.

(2)PFA regimen: cisplatin 20mg, 5- fluorouracil 500mg, intravenous drip for 5 days; Adriamycin 40mg, intravenous injection on the first day of treatment. Repetition after 3 ~ 4 weeks can significantly reduce the tumor. It is used less now.

(3)CBF regimen: cyclophosphamide 600 ~ 1000mg/ time, intravenous injection, applied to 1 and 4 days. Photomycin 1.5 mg/time, intramuscular injection, applied on 1 and 5 days. 5- fluorouracil 500mg, intravenous injection, applied on the 2nd and 5th days, rest after the course of treatment, 1 week, a total of 4 courses. The effective rate is 60.8%. It is used less now.

3. Regional arterial infusion chemotherapy

Arterial intubation chemotherapy can be used for local recurrence of nasopharyngeal carcinoma after ascending and radiotherapy. Retrograde intubation of superficial temporal artery or facial artery can be selected. Several chemotherapy drugs with strong action and short action time are often selected for combined or sequential treatment. Before administration, 2% procaine 2m 1 was injected to prevent arterial spasm, then anticancer drugs were injected, and then the lumen was filled with 2.5% sodium citrate solution to seal the tube end. If continuous medication is needed, heparin solution 100m 1 and 5% glucose saline 1500mg anticancer drugs can be continuously dripped for 24 hours.

Treatment of nasopharyngeal carcinoma with traditional Chinese medicine

Taxus chinensis has long been recorded in Chinese medicine: Compendium of Materia Medica records the efficacy of Taxus chinensis in treating cholera, typhoid fever and detoxification; There are further records in Dictionary of Modern Chinese Medicine, Annals of Northeast Materia Medica, Jilin Chinese Herbal Medicine and Materia Medica. Taxus herbs can generally take effect after a course of treatment (28 days). For cancer surgery patients, the best effect is to start taking it 10 ~ 15 days after surgery. Patients with radiotherapy and chemotherapy can take it while receiving treatment, which has the effect of enhancing efficiency and reducing toxicity. After 4 ~ 6 courses of treatment, all the test indexes are normal, which can be maintained by taking a small dose under the guidance of a doctor to prevent diffusion and metastasis; Severe patients, according to the condition, increase the course of treatment under the guidance of the attending doctor; Patients with rectal cancer have diarrhea symptoms after taking it, so they should take it in small doses first, and then continue taking it after the symptoms disappear.

Usage and dosage:

Take 5 ~ 10g of branches and leaves of Taxus chinensis and put them in a casserole. Add a liter of water (about 2 kg) to boil and simmer for 10 to 15 minutes. Take it after meals and take it orally within one day.

Precautions:

Avoid fasting, eating spicy food and drinking alcohol; Keep calm and avoid getting angry. Some patients have increased defecation frequency after taking it, which is a normal symptom and usually recovers within one week; Some cancer patients have leg soreness and fatigue after taking it, which is a sign of the effect of the disease; Some patients feel stomach discomfort after taking it, and can reduce the amount appropriately. This product is not recommended for people who are dying or dying.

Tamarix chinensis in the treatment of nasopharyngeal carcinoma.

Tamarix chinensis and Lycium barbarum peel are decocted with 1 water, daily 1 dose. After 68 days and 3 months, the symptoms of 2 cases were relieved and the original nasopharyngeal vegetation disappeared. After half a year, the vegetation did not recur. Excerpted from the Dictionary of Traditional Chinese Medicine

prognosis

The natural course of nasopharyngeal carcinoma varies from patient to patient. The natural process from initial symptoms to death ranges from 3 months to 1 13 months. Radiotherapy is the main treatment for nasopharyngeal carcinoma. According to domestic and foreign reports, the 5-year survival rate after radiotherapy is 8% ~ 62%. With the update of radiotherapy equipment and the improvement of radiotherapy technology, the 5-year survival rate of nasopharyngeal carcinoma after radiotherapy has been continuously improved. The Cancer Hospital of Shanghai Medical University reported that the 5-year survival rate was 8% before 1955 and 54% after 1983. Local recurrence and distant metastasis of nasopharyngeal carcinoma after radiotherapy are the main causes of death. Therefore, in addition to improving radiotherapy technology and improving radiotherapy effect, we should also study the biological characteristics of nasopharyngeal carcinoma, the factors of nasopharyngeal carcinoma patients and the interaction between tumor and patients. According to the biological characteristics of patients with nasopharyngeal carcinoma, radiotherapy, chemotherapy, surgical treatment, immunotherapy, traditional Chinese medicine and other treatment methods are comprehensively considered, and appropriate treatment schemes are selected and formulated to further improve the curative effect.

Prevention of nasopharyngeal carcinoma

1. Reduce exposure to risk factors, such as eating less or not eating pickled or moldy foods, such as salted fish, pickles and bacon, and not smoking.

2. Eliminate potential risk factors and actively treat severe glandular inflammation and nasopharyngeal ulcer.