The nasopharynx has a cuboidal shape. The lateral walls are formed by the eustachian tube and the fossa of Rosenmuller. The roof, sloping downward from anterior to posterior, is bordered by the pharyngeal hypophysis, pharyngeal tonsil, and pharyngeal bursa with the base of the skull above. Anteriorly, the nasopharynx abuts the posterior choanae and nasal cavity, and the posterior boundary is formed by the muscles of the posterior pharyngeal wall. Inferiorly, the nasopharynx ends at an imaginary horizontal line formed by the upper surface of the soft palate and the posterior pharyngeal wall.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the risks of continued smoking in cancer patients and about quitting patterns and cessation intervention in these patients. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
Unlike other squamous cell cancers of the head and neck, nasopharyngeal cancer does not appear to be linked to excess use of tobacco or moderate alcohol intake (up to 15 drinks a week). Factors thought to predispose to this tumor include the following:
Symptoms and signs at presentation include the following:
Painless, enlarged lymph nodes in the neck (present in approximately 75% of patients and often bilateral and posterior).
Recurrent otitis media.
Cranial nerve dysfunction (usually II–VI or IX–XII).
In the patient who presents with only cervical adenopathy, the finding of EBV genomic material in the tissue after amplification of DNA with the polymerase chain reaction lends strong evidence for a nasopharyngeal primary tumor, and a concerted search should be conducted in that area.
Diagnosis is made by biopsy of the nasopharyngeal mass. Workup includes the following:
Careful visual examination (by fiberoptic endoscopic examination or examination under anesthesia [EUA]).
Documentation of the size and location of the tumor and neck nodes.
Evaluation of cranial nerve function including neuro-ophthalmological evaluation and audiological evaluation.
Computed tomographic (CT) scan or positron emission tomography (PET)-CT scan.
Magnetic resonance imaging (MRI) to evaluate skull base invasion.
Epstein-Barr virus titers.
Any clinical or laboratory suggestion of distant metastasis may prompt further evaluation of other sites. Careful dental and oral hygiene evaluation and therapy is particularly important prior to initiation of radiation treatment. MRI is often more helpful than CT scans in assessing skull base involvement and in defining the extent of abnormalities detected.[5,6,7]