What are the early symptoms of nasopharyngeal carcinoma? Can nasopharyngeal carcinoma be cured?

Nasopharyngeal carcinoma is one of the common tumor diseases. If found in time, it can be cured, and the probability of recurrence is relatively small. Nasopharyngeal carcinoma is a kind of respiratory cancer. So, what are the early symptoms of nasopharyngeal carcinoma? Can nasopharyngeal carcinoma be cured? If you want to find the symptoms of nasopharyngeal carcinoma in time, you must understand the early symptoms of nasopharyngeal carcinoma.

1, early symptoms

1, nasal congestion

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.

2, bleeding

There may be bleeding symptoms in the early stage, which is manifested as blood in the sputum after nasal suction or nosebleeds when blowing 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.

Step 3 have a headache

This is a common symptom, which may be the first symptom. Early headache is not fixed, but intermittent. The later stage is persistent migraine with fixed position.

4. Tinnitus and deafness

When nasopharyngeal carcinoma occurs in the lateral wall of nasopharynx, lateral fossa or upper lip of eustachian tube opening, unilateral tinnitus or hearing loss may occur when the tumor compresses eustachian tube, and catarrhal otitis media may also occur. One of the symptoms of early nasopharyngeal carcinoma is unilateral tinnitus or hearing loss, and there is a sense of occlusion in the ear.

5, drooping eyes

Eyeball fixation is related to oculomotor nerve injury, and vision loss or disappearance is related to optic nerve injury or orbital cone invasion.

The above are the five common symptoms of nasopharyngeal carcinoma, which are still very harmful to us, so when these symptoms appear, we should pay attention to them, so as to reduce the harm of nasopharyngeal carcinoma.

2. Treatment of nasopharyngeal carcinoma

(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 and lovely diseases; 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 no cervical lymph nodes, preventive radiation is often given to the upper neck area on both sides. If there is cervical lymph node metastasis, preventive irradiation is often given to the drainage area below the metastasis.

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, and submucosal incision was made to the junction of oropharynx and posterior nasopharyngeal wall, and all 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 removed, and all the metastatic focus and 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)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, * * * for 4 courses of treatment. The effective rate is 60.8%.

(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.

(3)PF regimen: cisplatin 20mg/m2, 5- fluorouracil 500mg/m2, intravenous drip, rest for 2 weeks after 5 days, which can be used for 2 ~ 3 courses of treatment. This scheme can be used to shrink tumors before radiotherapy, or for cases with simple chemotherapy, with an effective rate of 93.7%.

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.