WordNet

any malignant tumor derived from epithelial tissue; one of the four major types of cancer
of or relating to or located near the nasopharynx

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/03/26 15:20:29」(JST)

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Nasopharynx cancer or nasopharyngeal carcinoma (NPC) is the most common cancer originating in the nasopharynx, the uppermost region of the pharynx ("throat"), behind the nose where the nasal passages and auditory tubes join the remainder of the upper respiratory tract. NPC occurs in children and adults. NPC differs significantly from other cancers of the head and neck in its occurrence, causes, clinical behavior, and treatment. It is vastly more common in certain regions of East Asia and Africa than elsewhere, with viral, dietary and genetic factors implicated in its causation. It is most common in males. It is a squamous cell carcinoma or an undifferentiated type. Squamous cells are a flat type of cell found in the skin and the membranes that line some body cavities. Differentiation means how different the cancer cells are from normal cells. Undifferentiated is a word used to describe cells that do not have their mature features or functions.

Symptoms and signs[edit]

Cervical lymphadenopathy (disease or swelling of the lymph nodes in the neck) is the initial presentation in many patients, and the diagnosis of NPC is often made by lymph node biopsy. Symptoms related to the primary tumor include trismus, pain, otitis media, nasal regurgitation due to paresis (loss of or impaired movement) of the soft palate, hearing loss and cranial nerve palsies (paralysis). Larger growths may produce nasal obstruction or bleeding and a "nasal twang". Metastatic spread may result in bone pain or organ dysfunction. Rarely, a paraneoplastic syndrome of osteoarthropathy (diseases of joints and bones) may occur with widespread disease.

Causes[edit]

Nasopharyngeal carcinoma (NPC) is caused by a combination of factors: viral, environmental influences, and heredity.^[1] The viral influence is associated with infection with Epstein-Barr virus (EBV).^[2]^[3] The Epstein-Barr virus is one of the most common viruses. 95 percent of all people in the U.S. are exposed to this virus by the time they are 30–40 years old. The World Health Organization does not have set preventative measures for this virus because it is so easily spread and is worldwide. Very rarely does Epstein-Barr virus lead to cancer, which suggests a variety of influencing factors. Other likely etiological factors include genetic susceptibility, consumption of food (in particular salted fish)^[4] containing carcinogenic volatile nitrosamines.^[5]

The association between Epstein-Barr virus and nasopharyngeal carcinoma is unequivocal in World Health Organization (WHO) types II and III tumors but less well-established for WHO type I (WHO-I) NPC, where preliminary evaluation has suggested that human papillomavirus HPV may be associated.^[6] EBV DNA was detectable in the blood plasma samples of 96% of patients with non-keratinizing NPC, compared with only 7% in controls.^[3] The detection of nuclear antigen associated with Epstein-Barr virus (EBNA) and viral DNA in NPC type 2 and 3, has revealed that EBV can infect epithelial cells and is associated with their transformation. The etiology of NPC (particularly the endemic form) seems to follow a multi-step process, in which EBV, ethnic background, and environmental carcinogens all seem to play an important role. More importantly, EBV DNA levels appear to correlate with treatment response and may predict disease recurrence, suggesting that they may be an independent indicator of prognosis. The mechanism by which EBV alters nasopharyngeal cells is being elucidated^[7] to provide a rational therapeutic target.^[7]

Diagnosis[edit]

Classification[edit]

Nasopharyngeal carcinoma, commonly known as nasopharyngeal cancer, is classified as a malignant neoplasm, or cancer, arising from the mucosal epithelium of the nasopharynx, most often within the lateral nasopharyngeal recess or fossa of Rosenmüller (a recess behind the entrance of the eustachian tube opening). The World Health Organization classifies nasopharyngeal carcinoma in three types. Type 1 (I) is squamous cell carcinoma. Type 2a (II) is keratinizing undifferentiated carcinoma. Type 2b (III) is nonkeratinizing undifferentiated carcinoma.^[8] Type 2b (III) nonkeratinizing undifferentiated form also known as lymphoepithelioma is most common, and is most strongly associated with Epstein-Barr virus infection of the cancerous cells.^[9]

Undifferentiated nasopharyngeal carcinoma—low power
Undifferentiated nasopharyngeal carcinoma—med. power
Undifferentiated nasopharyngeal carcinoma—high power

Staging[edit]

FDG-PET/CT scan of a patient with nasopharyngeal cancer. Transverse slice demonstrating FDG-positive primary site

Staging of nasophayngeal carcinoma is based on clinical and radiologic examination. Most patients present with Stage III or IV disease.

Stage I is a small tumor confined to nasopharynx.

Stage II is a tumor extending in the local area, or that with any evidence of limited neck (nodal) disease.

Stage III is a large tumor with or without neck disease, or a tumor with bilateral neck disease.

Stage IV is a large tumor involving intracranial or infratemporal regions, an extensive neck disease, and/or any distant metastasis. ^[10]

Treatment[edit]

Nasopharyngeal carcinoma can be treated by surgery, by chemotherapy, or by radiotherapy.^[11] The expression of EBV latent proteins within undifferentiated nasopharyngeal carcinoma can be potentially exploited for immune-based therapies.^[12]

Epidemiology[edit]

Nasopharynx cancer as of 2010 resulted in 65,000 deaths globally up from 45,000 in 1990.^[13]

NPC is uncommon in the United States and most other nations, representing less than 1 case per 100,000 in most populations.^[2] but is extremely common in southern regions of China,^[14] particularly in Guangdong, accounting for 18% of all cancers in China.^[5] It is sometimes referred to as Cantonese cancer because it occurs in about 25 cases per 100,000 people in this region, 25 times higher than the rest of the world.^[5] It is also quite common in Taiwan.^[5] This could be due to the South East Asian diet which typically includes consumption of salted vegetables, fish and meat.^[5] While NPC is seen primarily in middle-aged persons in Asia, a high proportion of African cases appear in children. The cause of increased risk for NPC in these endemic regions is not clear.^[9] In low-risk populations, such as in the United States, a bimodal peak is observed. The first peak occurs in late adolescence/early adulthood (ages 15–24 years), followed by a second peak later in life (ages 65–79 years).

References[edit]

^ Zhang F, Zhang J. (1999). "Clinical hereditary characteristics in nasopharyngeal carcinoma through Ye-Liang's family cluster". Chinese Medical Journal 112: 185–7.
^ ^a ^b "Initiative for Vaccine Research (IVR): Viral cancers". World Health Organization. Retrieved 2 October 2012.
^ ^a ^b Lo KW, Chung GT, To KF. Deciphering the molecular genetic basis of NPC through molecular, cytogenetic, and epigenetic approaches. Semin Cancer Biol. 2012 Apr;22(2):79–86. doi: 10.1016/j.semcancer.2011.12.011. PMID 22245473
^ Yu, M. C.; Ho, J. H.; Lai, S. H.; Henderson, B. E. (1986). "Cantonese-style salted fish as a cause of nasopharyngeal carcinoma: Report of a case-control study in Hong Kong". Cancer Research 46 (2): 956–961. PMID 3940655.
^ ^a ^b ^c ^d ^e Chang E T, Adami H (2006). "The Enigmatic Epidemiology of Nasopharyngeal Carcinoma". Cancer Epidemiol Biomarkers Prev 15 (10): 1765–1777. doi:10.1158/1055-9965.EPI-06-0353. PMID 17035381.
^ Lo EJ, Bell D, Woo JS, et al. Human papillomavirus and WHO type I nasopharyngeal carcinoma. Laryngoscope. 2010 Oct;120(10):1990–7. doi: 10.1002/lary.21089. PMID 20824783
^ ^a ^b Lo AK, Lo KW, Ko CW et al. Inhibition of the LKB1-AMPK Pathway by the Epstein-Barr Virus-encoded LMP1 Promotes Proliferation and Transformation of Human Nasopharyngeal Epithelial Cells. J Pathol. 2013 Apr 17. doi: 10.1002/path.4201. PMID 23592276
^ Cummings Otolaryngology. 5th ed. (2010). Chapter 99. pg 1344
^ ^a ^b Richard Cote, Saul Suster, Lawrence Weiss, Noel Weidner (Editor) (2002). Modern Surgical Pathology (2 Volume Set). London: W B Saunders. ISBN 0-7216-7253-1.
^ AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 41–56.
^ Brennan, Bernadette (June 26, 2006). "Nasopharyngeal carcinoma". Orphanet Journal of Rare Diseases 1:23: 1–5. doi:10.1186/1750-1172-1-23.
^ Khanna, Rajiv; Denis Moss and Maher Gandhi (1 March 2005). "Technology Insight: applications of emerging immunotherapeutic strategies for Epstein-Barr virus-associated malignancies". Nature Reviews Clinical Oncology 2: 138–149. Cite uses deprecated parameters (help)
^ Lozano, R (Dec 15, 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. PMID 23245604.
^ Fang W, Li X, Jiang Q, (2008). "Transcriptional patterns, biomarkers and pathways characterizing nasopharyngeal carcinoma of Southern China". J Transl Med 6: 32. doi:10.1186/1479-5876-6-32. PMC 2443113. PMID 18570662.

External links[edit]

Nasopharyngeal Cancer Or Sinus Infection
Cancer Management Handbook: Head and Neck Tumors
Clinically reviewed nasopharyngeal cancer information for patients from Cancer Research UK

UpToDate Contents

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1. 早期の局所進行性鼻咽頭癌の治療 treatment of early and locoregionally advanced nasopharyngeal carcinoma
2. 鼻咽頭癌の疫学、病因、および診断 epidemiology etiology and diagnosis of nasopharyngeal carcinoma
3. 再発性および転移性鼻咽頭癌の治療 treatment of recurrent and metastatic nasopharyngeal carcinoma
4. 頭頸部癌に対する治療の概要 overview of treatment for head and neck cancer
5. 頭頸部腫瘍の病理 pathology of head and neck neoplasms

English Journal

FOXC2 promotes chemoresistance in nasopharyngeal carcinomas via induction of epithelial mesenchymal transition.

Zhou Z1, Zhang L2, Xie B2, Wang X2, Yang X2, Ding N2, Zhang J3, Liu Q4, Tan G5, Feng D6, Sun LQ7.
Cancer letters.Cancer Lett.2015 Jul 28;363(2):137-45. doi: 10.1016/j.canlet.2015.04.008. Epub 2015 Apr 17.
Paclitaxel (Taxol) is currently used as the front-line chemotherapeutic drug for many types of human cancers. However, the emergence of drug resistance has been a major obstacle to the effective treatment of cancers in clinical settings. The transcription factor Forkhead box protein C2 (FOXC2) was r
PMID 25896630

MicroRNA-93 promotes cell growth and invasion in nasopharyngeal carcinoma by targeting disabled homolog-2.

Xu YF1, Mao YP1, Li YQ1, Ren XY1, He QM1, Tang XR1, Sun Y1, Liu N2, Ma J3.
Cancer letters.Cancer Lett.2015 Jul 28;363(2):146-55. doi: 10.1016/j.canlet.2015.04.006. Epub 2015 Apr 16.
Dysregulation of microRNAs (miRNAs) has been demonstrated to contribute to malignant progression in nasopharyngeal carcinoma (NPC). We previously reported that miR-93 was significantly upregulated in NPC based on a microarray analysis. However, the potential role and mechanism of action of miR-93 in
PMID 25892549

Polymorphism in mature microRNA-608 sequence is associated with an increased risk of nasopharyngeal carcinoma.

Qiu F1, Yang L1, Zhang L1, Yang X1, Yang R1, Fang W1, Wu D1, Chen J1, Xie C1, Huang D1, Zhou Y2, Lu J3.
Gene.Gene.2015 Jul 10;565(2):180-6. doi: 10.1016/j.gene.2015.04.008. Epub 2015 Apr 8.
Accumulative evidences indicated that microRNAs (miRNAs) can function as tumor suppressors and oncogenes, in which genetic variations are implicated in various cancer susceptibilities. However, it remains unclear whether single nucleotide polymorphisms (SNPs) in mature miRNA sequence alter nasophary
PMID 25861865

Japanese Journal

上咽頭癌放射線治療後に側頭骨壊死をきたした3例

大和谷崇,水田邦博,中西啓,瀧澤義徳,細川久美子,細川誠二,峯田周幸
耳鼻咽喉科臨床 105(9), 821-825, 2012-09-01
NAID 10031012223

上咽頭癌の治療成績および予後因子の統計学的検討

藤井良一,今西順久,冨田俊樹,坂本耕二,重冨征爾,羽生昇,大塚邦憲,佐藤陽一郎,小澤宏之,山下拓,藤井正人,茂松直之,小川郁
日本耳鼻咽喉科學會會報 115(8), 773-782, 2012-08-20
NAID 10031047055

Induction of lymphangiogenesis through vascular endothelial growth factor-C/vascular endothelial growth factor receptor 3 axis and its correlation with lymph node metastasis in nasopharyngeal carcinoma

Wakisaka Naohiro,Hirota Kyoko,Kondo Satoru,Sawada-Kitamura Seiko,Endo Kazuhira,Murono Shigeyuki,Yoshizaki Tomokazu
Oral Oncology 48(8), 703-708, 2012-08
… As the biological behavior of nasopharyngeal carcinoma (NPC) depends on its nodal status, patients with advanced nodal status show a higher tendency toward a poor outcome. …
NAID 120004754693

Related Pictures

★リンクテーブル★

リンク元	「上咽頭癌」「鼻咽頭癌」「上咽頭がん」「鼻咽頭がん」「NPC」
関連記事	「nasopharyngeal」

「上咽頭癌」

Nasopharynx cancer
	Classification and external resources
	; Metastatic nasopharyngeal carcinoma in a lymph node
ICD-10	C11
ICD-9	147
OMIM	161550
DiseasesDB	8814
eMedicine	ped/1553
MeSH	D009303

　　[★]

英: epipharyngeal cancer, cancer of epipharynx, epipharynx carcinoma
同: 鼻咽頭癌 nasopharyngeal carcinoma NPC, nasopharyngeal cancer, cancer of the nasopharynx
関: 上咽頭悪性腫瘍、咽頭癌、上咽頭

症候

初期には乏しく、早期にに頚部転移を生じる
鼻閉、鼻出血、難聴、外転神経麻痺、三叉神経麻痺などを呈する。

頚部リンパ節腫脹：外側頚三角上部。両側転移例が半数。

進展方向による症状

SOTO.483

側方進展：耳管の閉塞により滲出性中耳炎を来す()。咽頭側索に浸潤して中陰等に進展。腹咽頭間隙に進展したり、外側咽頭後リンパ節が腫脹するとIX, X, XI, XII脳神経を圧迫し、種々の症状を呈する。
前方進展：後鼻孔を閉塞。鼻腔に進展し、鼻閉、鼻出血、軟口蓋の膨隆を来す。
上方進展：咽頭陥凹の直上部に破裂孔があり、中頭蓋窩に進展。外転神経を、動眼神経、滑車神経・三叉神経(V1,V2)の順に障害し、ついには[[Garcin症候群を生じる。脳神経症状の出現率は30%。

転移

骨、肺、肝
遠隔転移の出現率は20%。(SOTO.483)

治療

放射線療法、化学療法の組み合わせ。
手術療法は解剖学的に困難であるために通常施行されることはない。

参考

1. がん情報サービス

http://ganjoho.jp/public/cancer/data/nasopharynx.html

国試

104A054、102A047

「鼻咽頭癌」

　　[★]

英: nasopharyngeal cancer、nasopharyngeal carcinoma、cancer of the nasopharynx
関: 上咽頭がん、上咽頭癌、鼻咽頭がん

「上咽頭がん」

　　[★]

英: nasopharyngeal carcinoma、nasopharyngeal cancer、cancer of the nasopharynx
関: 上咽頭癌、鼻咽頭癌、鼻咽頭がん

「鼻咽頭がん」

　　[★]

英: nasopharyngeal cancer、nasopharyngeal carcinoma、cancer of the nasopharynx
関: 上咽頭がん、上咽頭癌、鼻咽頭癌

「NPC」

　　[★]

「nasopharyngeal」

　　[★]

adj.

鼻咽頭の、上咽頭の、鼻咽腔の

関: nasopharynges、nasopharynx

[1] Zhang F, Zhang J. (1999). "Clinical hereditary characteristics in nasopharyngeal carcinoma through Ye-Liang's family cluster". Chinese Medical Journal 112: 185–7.

[WHO-2] "Initiative for Vaccine Research (IVR): Viral cancers". World Health Organization. Retrieved 2 October 2012.

[Lo-3] Lo KW, Chung GT, To KF. Deciphering the molecular genetic basis of NPC through molecular, cytogenetic, and epigenetic approaches. Semin Cancer Biol. 2012 Apr;22(2):79–86. doi: 10.1016/j.semcancer.2011.12.011. PMID 22245473

[4] Yu, M. C.; Ho, J. H.; Lai, S. H.; Henderson, B. E. (1986). "Cantonese-style salted fish as a cause of nasopharyngeal carcinoma: Report of a case-control study in Hong Kong". Cancer Research 46 (2): 956–961. PMID 3940655.

[chang2006-5] Chang E T, Adami H (2006). "The Enigmatic Epidemiology of Nasopharyngeal Carcinoma". Cancer Epidemiol Biomarkers Prev 15 (10): 1765–1777. doi:10.1158/1055-9965.EPI-06-0353. PMID 17035381.

[6] Lo EJ, Bell D, Woo JS, et al. Human papillomavirus and WHO type I nasopharyngeal carcinoma. Laryngoscope. 2010 Oct;120(10):1990–7. doi: 10.1002/lary.21089. PMID 20824783

[Lo2013-7] Lo AK, Lo KW, Ko CW et al. Inhibition of the LKB1-AMPK Pathway by the Epstein-Barr Virus-encoded LMP1 Promotes Proliferation and Transformation of Human Nasopharyngeal Epithelial Cells. J Pathol. 2013 Apr 17. doi: 10.1002/path.4201. PMID 23592276

[8] Cummings Otolaryngology. 5th ed. (2010). Chapter 99. pg 1344

[Weidner.27s-9] Richard Cote, Saul Suster, Lawrence Weiss, Noel Weidner (Editor) (2002). Modern Surgical Pathology (2 Volume Set). London: W B Saunders. ISBN 0-7216-7253-1.

[10] AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 41–56.

[11] Brennan, Bernadette (June 26, 2006). "Nasopharyngeal carcinoma". Orphanet Journal of Rare Diseases 1:23: 1–5. doi:10.1186/1750-1172-1-23.

[12] Khanna, Rajiv; Denis Moss and Maher Gandhi (1 March 2005). "Technology Insight: applications of emerging immunotherapeutic strategies for Epstein-Barr virus-associated malignancies". Nature Reviews Clinical Oncology 2: 138–149. Cite uses deprecated parameters (help)

[Loz2012-13] Lozano, R (Dec 15, 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. PMID 23245604.

[pmid18570662-14] Fang W, Li X, Jiang Q, (2008). "Transcriptional patterns, biomarkers and pathways characterizing nasopharyngeal carcinoma of Southern China". J Transl Med 6: 32. doi:10.1186/1479-5876-6-32. PMC 2443113. PMID 18570662.

匿名

検索

案内

案内

nasopharyngeal carcinoma