Nasopharyngeal carcinoma: diagnosis, staging, and management

Nasopharyngeal carcinoma is a common tumor in several parts of the world, accounting for approximately 18% of cancers in Chinese populations, but is an uncommon tumor in whites. Genetic, environmental, and viral factors all seem to have a part in the genesis. Its various forms have been classified by the World Health Organization (WHO) into three histologic categories, all of which can be identified as squamous cell carcinomas by electron microscopy. The WHO types 2 and 3 tumors are associated with Epstein-Barr virus. Nasopharyngeal carcinoma most often arises in the fossa of Rosenmueller and the most common presenting signs are a lump in the neck and serous otitis media. External beam-supervoltage irradiation is the standard therapy, with surgery having a limited role. A new staging system has been proposed that predicts risk of death better than the TNM system. Evidence indicates two distinct types of nasopharyngeal carcinoma--WHO type 1 and the combined WHO types 2 and 3.