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1、鼻咽癌NasopharyngealCarcinoma(NPC)一、概述(outline)1、发病有一定的地区性(morecommoninsouth-eastAsiaintheworld,morecommoninsouthernChina)我国头颈恶性肿瘤之冠(thetopofthemalignanttumorinheadandneck)。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（maximumageincidence)：40~60岁（86.62%）3、性别(sex)：男多于女(maletofemaleis2:1)二、病因（etiology) (threep
2、ossiblecausalfactors)1、遗传因素(geneticfactors)种族易感性家族聚集性(racialpredilection,familytendencyandHLAtyping)2、病毒因素----Epstein-BarrvirusEB病毒NPC患者血清中检测到EB病毒相关抗体(patientswithNPChavehighlevelofantibodyagainstEBV(over90%ofpatients)，NPC活组织的癌细胞中存在EBVDNA特异性mRNA或基因表达产物(expressionofgeneproducts，(butwhethertherelati
3、onshipbetweenthetwoiscausalorincidentalisstillunknown)3、环境因素(environmentfactors)微量元素(microelement)：镍(nickel)维生素缺乏(vitaminlack)性激素失调(hormonalfactors)亚硝胺Acombinationofgenetic,virusandenvironmentalinfluenceswouldbestexplaintheoccurrenceofnasopharyngealcarcinoma)病理学(pathology)主要为低分化鳞癌。少见腺癌、肉瘤等Over95%S
4、quamouscellcarcinoma(poorlydifferentiation)Adenocarcinoma,sarcoma,好发部位mosttumorsariseontheposterosuperiorwallorfossaofRosenmuller图咽隐窝鼻咽顶后壁临床表现(clinicalmanifestations)1、鼻部症状:涕血或后吸涕带血，鼻塞。nasalsymptomssuchasepistaxis,bloodypostnasaldischarge,nasalobstruction2、耳部症状：分泌性中耳炎Secretoryotitismedia:conductiv
5、edeafness,fluidinthemiddleear,tympanicmembraneindrawn3、颈淋巴结肿大（图）Metastasesinthelymphnodesoftheneck,regionalnodalmetastasesarepresentin60to80percentofpatients,withbilateralspreadbeingevidentinalmosthalf.Superiordeepjugularnodesaremostoftennoted颈淋巴转移图4、颅神经症状:（图）involvedcranialnerves:fifthandsixthner
6、vearethemostfrequentlyinvolved,Headache,internalstrabismus.4th,3rdand2ndcranialnervesarenextmostcommonlyaffected.9th,10th11thand12thmayalsobeinvolved舌下神经麻痹外展神经麻痹Hypoglossalparalysisabducensparalysis5、远处转移：Distantmetastasesoccurtobone,lung,liverandothersites诊断(Diagnosis)1、病史、症状和体征History,symptomsan
7、dsignsEarlysymptoms:bloodypostnasaldischargefluidinthemiddleear(unilateral)2、鼻咽镜检查TheposteriorrhinoscopyFibreopticnasopharyngoscopy3、血清学检查EBVCA-IgA,EBVEA-IgG4、影象学检查ImagingCT,MRI5、鼻咽活检——确诊的方法Definitivediagnosisism
