Nasopharynx Flashcards
What is the nasopharynx?
- The posterior region of the nasal cavity
- function is respiratory
- euchachian tube = covered by mucous membrane which will open to allow swallowing
- tonsils sit on wall
What is waldeyers ring?
- The lymphoid tissue in the pharyngeal, forms the tonsils
- one nasopharyngeal tonsil
- two palatine tonsils
- two lingual tonsily
Where is arterial supply from in the nasopharynx?
- Branches of external carotid artery
- primary vessels include the ascending pharyngeal artery, ascending palatine artery and greater palatine artery
What is the venous drainage from the nasopharynx?
- Veins form a plexus beneath the constrictor muscles
- some blood empties directly to internal jugular vein
Where is lymphatic drainage in the nasopharynx?
- postinf to retropharyngeal nodes (rouvierre) the into deep cervical nodes
- Directly to superior deep cervical nodes
- Laterally to mastoid and spinal accessory nodes
How are nerves supplied in nasopharynx?
- predominantly through the pharyngeal plexus of nerves
- small anterior medial roof of the nasopharynx is supplied by somatic branches of the maxillary nerve
- motor supply to the muscles of the nasopharynx is via the vagus nerve
What are the signs and symptoms of nasopharyngeal cancer?
- lump or growth, longer than three weeks
- one sided hearing loss
- tinnitus
- fluid in ear
- blocked nose
- bloody discharge in nose
- numbness in face
- hoarseness
- headache
- double vision
- dysphagia
What investigations are typical?
- Palpation of lymph nodes
- history
- examination of neck nodes and cranial nerve function (endoscope)
- Nasopharangoscopy
- EUA biopsy of mass
- chest x-ray (?)
- CT/MRI
- anti epstein-barr virus antibodies
- bone assessment for spread
How is Nasopharynx TNM staged?
- T1 = contained to nasopharynx
- T2 = spread to oroopharybx
- T3 = directly to the sinuses (likely bone infitration)
- T4 = intracranial extention, cranial nerve involvement, infratemporal fossa, masticator space or the orbit
What is stage I nasopharyngeal cancer?
- T1N0M0
What is stage IIa nasopharyngeal cancer?
-T1N1M0 or T2N0-1M0
What is stage III nasopharyngeal cancer?
T3N0-2M0
or
T1-2N2M0
What is stage IV nasopharyngeal cancer?
A = T4,N0-2,M0
B =T(any),N3M0
C = T(any),N(any)M1
What is the gold standard treatment for nasopharyngeal cancer?
- ChemoRT (5FU/Cisplatin)
- Surgery is impractical but could be used for lymph nodes
- Currenty complex planning, but VMAT is used
- Dental and oral evaluation is required first
What is the dose and fractionation for RT for nasopharynx?
- ChemoRT = 56-70Gy/35#/7 weeks
- RT only = 54-66/30#/6 weeks
