Nasofarings carcinoma is a malignant tumor that attacks the epithelium (outer layer of the mucosa) nasofarings area, is a unique tumor in both the symptoms, easily spread and recurrence. Nasofarings is narrow and very hidden area located between the nose with the back of the throat, with an area of approximately 2-4 cm2. Nasofarings the top of the room adjacent to the so-called sinus sfenoidalis, the front is limited choana (the hole on the back of the nose), the side of the estuary there are ears (tuba auditiva), adjacent to the bottom of the soft palate (soft palate), while the back is bordered with the spine.
Blood vessels that provide blood flow to nasofarings are:
• Blood vessels faringea (throat)
• Blood vessels and sfenopalatina maxillary (mouth and surrounding area).
Lymph flow from nasofarings are:
• lymph vessel wall and the rear side of throat
• Blood vessels to the neck area below the lower jaw bone
Figures frequence:
Prevalence figures of nasopharyngeal carcinoma in each country varies greatly. Guangdong Province in southern China was the region with the highest prevalence rates in the world that is about 30-50 patients baru/100.000 inhabitants / year, with comparisons between men and women by 3:1, followed by Hong Kong and Taiwan. (Chan, 2002).
Figures frequence nasofarings carcinoma in Southeast Asia and some countries in Africa including the intermediate level of 50-10 patients sekiar baru/100.000 population / year, whereas in Europe and America are very rarely obtained. In Indonesia it was reported that in 1998 earned 3.9 baru/100.000 patient population / year (Soeripto, 1998) and in 2003 increased to 5.68 baru/100.000 patient population / year (Jia, 2003).
ENT section DR Sardjito Hospital Yogyakarta from January 2002 to April 2005 acquired 303 new patients with carcinoma nasofarings which is 56.4% of all malignancies / tumors malignant head and neck area, suffered by both men and women with a ratio of 2.8:1. and in men is the most frequent tumor found, whereas in women, including the order to 3 after breast tumors and tumor content.
Data Nasofarings carcinoma patients in Yogyakarta obtained in 2002 showed that the distribution of carcinoma Nasofarings in each district is not the same. Mentioned that Sleman showed the highest frequency by 45%, followed by as much as 23% of Bantul Regency).
The cause of carcinoma Nasofarings:
Nasofarings carcinoma is a malignant tumor that causes are very complex due to the accumulation of genetic changes, environmental factors, factors habits and the presence of a virus infection called the Epstein Barr Virus. (EBV).
In China, has conducted several studies on patterns / eating habits and environmental factors as a risk factor for carcinoma Nasofarings can be concluded that the habit of excessive eating salted fish and in a long time, especially starting from the child after the weaning period may increase the risk of Carcinoma Nasofarings sebanyak17 times compared with the never ate salted fish (Chien, 2003).
Smoking habits of more than 30 pack / years may increase the risk of carcinoma Nasofarings by 2 times. Preview geography Nasofarings carcinoma patients in an unequal world suggest that inherited genetic factors play an important role in the occurrence of carcinoma Nasofarings. This is evidenced in the ethnic Chinese who moved to America turned out to have a high tendency to the occurrence of carcinoma Nasofarings, and decreased in the ethnic Chinese who have married non-Chinese ethnic groups (Chan, 2002).
EBV infection occurs in almost 90% of world population, especially in developing countries, and when the immune system is not perfect and there are risk factors which include heredity factors, habits, etc., will not cause Nasofarings carcinoma, and only an infection of the throat and neck lymph nodes, which will recover with antibiotic treatment. The virus will infect humans through the mouth or through saliva, can cause infection, which can be transmitted to others, with a perfect endurance or with treatment will recover, but the presence of risk factors including immune disorders virus will hide in periods of time will cause changes in tissue malignant (cancer) (Khanna et al., 1995).
Carcinoma Symptoms Nasofarings:
As mentioned above, that nasofarings is an area that is hidden and very narrow, resulting in symptoms at an early stage is not typical, such as influenza illness symptoms in common, namely:
• clogged and runny nose sustained.
• Nose bleed repetitive
• Ear feels full, sometimes humming and hearing less sempurna.yang occur continuously and are not cured with medication.
These symptoms cause the sufferer less aware of impending nasofarings carcinoma at an early stage, so people come to the Hospital is already at an advanced stage with symptoms as follows:
• Incurred a lump in the neck, especially under the lower jaw arch., Either on the left, right or both. (Figure 3).
• If the situation continues to spread to the nerves of sight, in the form of crossed eyes, double vision, blurred and so on.
• severe headaches may occur if the tumor has spread to the brain
• Pain in the bone in case of deployment on the bone.
In the research section Sardjito DR ENT Hospital in Yogyakarta in 2004 obtained the sequence data that drives the main symptoms of the patient checked into the Hospital as follows:
• Enlarged neck lymph nodes (51.67%) ..
• Nose clogged (18:33%).
• Nose bleed (10.00%).
While the symptoms are felt very scary is as follows
• severe headaches that occur continuously.
• Difficulty swallowing.
• Vision squint / double. (Dahlia, 2003).
Diagnosis
Carcinoma diagnosis Nasofarings apart from the symptoms mentioned above, supplemented with clinical examination, and laboratory rontgenologis. Clinical examination includes examining nasofarings area through the back of the nose, especially the nose. Because of the location and volume of tumor is very small, needed a tool called with nasofaringoskop, namely in the form of an optical tube that is inserted through the nose, and can be viewed either by the examining physician or by the patient.
To know the size of the tumor, its spread and enforce the required examination staged photographs, CT scans both photos nasofarings area, photos of the lung, ultrasound (ultra-sonography) area of the upper abdomen, liver function tests and if necessary, the bone picture. (Figure 4)
To know the type of tumor, whether the tumor is malignant or benign, easy to spread or not, sensitive to radiation treatment / radiotherapy or not do a biopsy, which takes a fraction of the tumor and sent to the Anatomical Pathology laboratory
As already explained at the outset that the Epstein-Barr virus infection is one cause of carcinoma Nasofarings, TSB virus infection will cause increased levels of immunoglobulin body against viruses TSB, which can be detected by examination of blood seologi, so serology, blood is needed to determine the level of virus in the body, and. is necessary also to monitor therapeutic efficacy by seeing a decrease in virus levels after treatment or be used as a tool for early detection of carcinoma Nasofaings (Fachiroh et al., 2004).
Nasofarings carcinoma treatment:
Already explained above that nasofarings is an area that is hidden, and difficult to reach so far treatment with surgery is not recommended.
Radiation / radiotherapy / light therapy is the mainstay of therapy in both early Nasofarings carcinoma, which has not happened enlarged neck lymph nodes or less than 6 cm in size, and still one side / unilateral. Or at an advanced stage.
In some hospitals included in Hospital DR Sardjito Yogyakarta, Nasofarings advanced stage carcinoma treatment starts with chemotherapy for several cycles, followed by radiation therapy / radiotherapy / light therapy by about 35 times, carried out 5 times / week. With the advances in therapeutic areas Nasofarings carcinoma, after conventional therapy (radiation and chemotherapy) can proceed with brachytherapy (light in) as much as 2-3 times.
Several studies aimed at improving treatment outcomes Nasofarings kaesinoma performed, one with treatment uses a laser beam is called Photo Dynamic Therapy (PDT), which until now aimed at Nasofarings carcinoma patients who failed on standard treatments or who have a relapse. Only the problem is still very high medical expenses.
Treatment Results:
Several studies both within and outside the country can be concluded that the optimal treatment of carcinoma Naofarings Nasofarings carcinoma obtained at the initial stage. Stated that recovery Nasofarings early stage carcinoma can reach 80-90%, with success rates for 5-year life can reach more than 65%. At an advanced stage of therapeutic efficacy dropped to 50% -80%, while the success rate of living for 5 years only sekitar10% -40% and if it has obtained the spread to the lungs, liver, bones or the brain, as much as 85% of patients will die in first year (Lee, 2000, Al-Sarraf, 1990)
Schedule control after treatment:
From observation and research experts concluded that Nasofarings carcinoma treatment nasofarings main problem is the high recurrence rate, ranging between 18% -45% (Cenc, 2002; Chan et al., 2002), so the required schedule and kept tight control by the patient Nasofarings carcinoma.
Hospital DR Sardjito standardized schedule of post-treatment control Nasofarings carcinoma clinical examination is performed on 8-12 post-treatment. Include CT scan examination, biopsy, serology, liver function, if necessary, photograph the lung and bone images. If the result is good (no tumor), then do 8-12 in control then, and continued in the first year every 6 months. In the next year controls are performed each year.
When the results are less satisfactory treatment performed additional calibration [I can be either radiotherapy or chemotherapy or a combination of both.
Blood vessels that provide blood flow to nasofarings are:
• Blood vessels faringea (throat)
• Blood vessels and sfenopalatina maxillary (mouth and surrounding area).
Lymph flow from nasofarings are:
• lymph vessel wall and the rear side of throat
• Blood vessels to the neck area below the lower jaw bone
Figures frequence:
Prevalence figures of nasopharyngeal carcinoma in each country varies greatly. Guangdong Province in southern China was the region with the highest prevalence rates in the world that is about 30-50 patients baru/100.000 inhabitants / year, with comparisons between men and women by 3:1, followed by Hong Kong and Taiwan. (Chan, 2002).
Figures frequence nasofarings carcinoma in Southeast Asia and some countries in Africa including the intermediate level of 50-10 patients sekiar baru/100.000 population / year, whereas in Europe and America are very rarely obtained. In Indonesia it was reported that in 1998 earned 3.9 baru/100.000 patient population / year (Soeripto, 1998) and in 2003 increased to 5.68 baru/100.000 patient population / year (Jia, 2003).
ENT section DR Sardjito Hospital Yogyakarta from January 2002 to April 2005 acquired 303 new patients with carcinoma nasofarings which is 56.4% of all malignancies / tumors malignant head and neck area, suffered by both men and women with a ratio of 2.8:1. and in men is the most frequent tumor found, whereas in women, including the order to 3 after breast tumors and tumor content.
Data Nasofarings carcinoma patients in Yogyakarta obtained in 2002 showed that the distribution of carcinoma Nasofarings in each district is not the same. Mentioned that Sleman showed the highest frequency by 45%, followed by as much as 23% of Bantul Regency).
The cause of carcinoma Nasofarings:
Nasofarings carcinoma is a malignant tumor that causes are very complex due to the accumulation of genetic changes, environmental factors, factors habits and the presence of a virus infection called the Epstein Barr Virus. (EBV).
In China, has conducted several studies on patterns / eating habits and environmental factors as a risk factor for carcinoma Nasofarings can be concluded that the habit of excessive eating salted fish and in a long time, especially starting from the child after the weaning period may increase the risk of Carcinoma Nasofarings sebanyak17 times compared with the never ate salted fish (Chien, 2003).
Smoking habits of more than 30 pack / years may increase the risk of carcinoma Nasofarings by 2 times. Preview geography Nasofarings carcinoma patients in an unequal world suggest that inherited genetic factors play an important role in the occurrence of carcinoma Nasofarings. This is evidenced in the ethnic Chinese who moved to America turned out to have a high tendency to the occurrence of carcinoma Nasofarings, and decreased in the ethnic Chinese who have married non-Chinese ethnic groups (Chan, 2002).
EBV infection occurs in almost 90% of world population, especially in developing countries, and when the immune system is not perfect and there are risk factors which include heredity factors, habits, etc., will not cause Nasofarings carcinoma, and only an infection of the throat and neck lymph nodes, which will recover with antibiotic treatment. The virus will infect humans through the mouth or through saliva, can cause infection, which can be transmitted to others, with a perfect endurance or with treatment will recover, but the presence of risk factors including immune disorders virus will hide in periods of time will cause changes in tissue malignant (cancer) (Khanna et al., 1995).
Carcinoma Symptoms Nasofarings:
As mentioned above, that nasofarings is an area that is hidden and very narrow, resulting in symptoms at an early stage is not typical, such as influenza illness symptoms in common, namely:
• clogged and runny nose sustained.
• Nose bleed repetitive
• Ear feels full, sometimes humming and hearing less sempurna.yang occur continuously and are not cured with medication.
These symptoms cause the sufferer less aware of impending nasofarings carcinoma at an early stage, so people come to the Hospital is already at an advanced stage with symptoms as follows:
• Incurred a lump in the neck, especially under the lower jaw arch., Either on the left, right or both. (Figure 3).
• If the situation continues to spread to the nerves of sight, in the form of crossed eyes, double vision, blurred and so on.
• severe headaches may occur if the tumor has spread to the brain
• Pain in the bone in case of deployment on the bone.
In the research section Sardjito DR ENT Hospital in Yogyakarta in 2004 obtained the sequence data that drives the main symptoms of the patient checked into the Hospital as follows:
• Enlarged neck lymph nodes (51.67%) ..
• Nose clogged (18:33%).
• Nose bleed (10.00%).
While the symptoms are felt very scary is as follows
• severe headaches that occur continuously.
• Difficulty swallowing.
• Vision squint / double. (Dahlia, 2003).
Diagnosis
Carcinoma diagnosis Nasofarings apart from the symptoms mentioned above, supplemented with clinical examination, and laboratory rontgenologis. Clinical examination includes examining nasofarings area through the back of the nose, especially the nose. Because of the location and volume of tumor is very small, needed a tool called with nasofaringoskop, namely in the form of an optical tube that is inserted through the nose, and can be viewed either by the examining physician or by the patient.
To know the size of the tumor, its spread and enforce the required examination staged photographs, CT scans both photos nasofarings area, photos of the lung, ultrasound (ultra-sonography) area of the upper abdomen, liver function tests and if necessary, the bone picture. (Figure 4)
To know the type of tumor, whether the tumor is malignant or benign, easy to spread or not, sensitive to radiation treatment / radiotherapy or not do a biopsy, which takes a fraction of the tumor and sent to the Anatomical Pathology laboratory
As already explained at the outset that the Epstein-Barr virus infection is one cause of carcinoma Nasofarings, TSB virus infection will cause increased levels of immunoglobulin body against viruses TSB, which can be detected by examination of blood seologi, so serology, blood is needed to determine the level of virus in the body, and. is necessary also to monitor therapeutic efficacy by seeing a decrease in virus levels after treatment or be used as a tool for early detection of carcinoma Nasofaings (Fachiroh et al., 2004).
Nasofarings carcinoma treatment:
Already explained above that nasofarings is an area that is hidden, and difficult to reach so far treatment with surgery is not recommended.
Radiation / radiotherapy / light therapy is the mainstay of therapy in both early Nasofarings carcinoma, which has not happened enlarged neck lymph nodes or less than 6 cm in size, and still one side / unilateral. Or at an advanced stage.
In some hospitals included in Hospital DR Sardjito Yogyakarta, Nasofarings advanced stage carcinoma treatment starts with chemotherapy for several cycles, followed by radiation therapy / radiotherapy / light therapy by about 35 times, carried out 5 times / week. With the advances in therapeutic areas Nasofarings carcinoma, after conventional therapy (radiation and chemotherapy) can proceed with brachytherapy (light in) as much as 2-3 times.
Several studies aimed at improving treatment outcomes Nasofarings kaesinoma performed, one with treatment uses a laser beam is called Photo Dynamic Therapy (PDT), which until now aimed at Nasofarings carcinoma patients who failed on standard treatments or who have a relapse. Only the problem is still very high medical expenses.
Treatment Results:
Several studies both within and outside the country can be concluded that the optimal treatment of carcinoma Naofarings Nasofarings carcinoma obtained at the initial stage. Stated that recovery Nasofarings early stage carcinoma can reach 80-90%, with success rates for 5-year life can reach more than 65%. At an advanced stage of therapeutic efficacy dropped to 50% -80%, while the success rate of living for 5 years only sekitar10% -40% and if it has obtained the spread to the lungs, liver, bones or the brain, as much as 85% of patients will die in first year (Lee, 2000, Al-Sarraf, 1990)
Schedule control after treatment:
From observation and research experts concluded that Nasofarings carcinoma treatment nasofarings main problem is the high recurrence rate, ranging between 18% -45% (Cenc, 2002; Chan et al., 2002), so the required schedule and kept tight control by the patient Nasofarings carcinoma.
Hospital DR Sardjito standardized schedule of post-treatment control Nasofarings carcinoma clinical examination is performed on 8-12 post-treatment. Include CT scan examination, biopsy, serology, liver function, if necessary, photograph the lung and bone images. If the result is good (no tumor), then do 8-12 in control then, and continued in the first year every 6 months. In the next year controls are performed each year.
When the results are less satisfactory treatment performed additional calibration [I can be either radiotherapy or chemotherapy or a combination of both.
