Case Report Session“Nasopharyngeal Carcinoma”

By :Metha Arsilita HulmaRizqa Fiorendita HadiThinagarayan Brabu

Introduction

The Literatural Study

The definition• Nasopharyngeal carcinoma is a malignant tumor grown at the

nasopharyngeal area with the predilections on fossa Rossenmuller and the roof of nasopharynx.

Epidemiology

Etiology and Risk Factors

Pathogenesis of Nasopharyngeal Carcinoma

AJCC/UICC Classifications (2010)

Stadium• Stadium I : T1N0M0• Stadium II : T1N1M0 atau T2N0-1M0• Stadium III : T1-2N2M0 atau T3N0-2M0• Stadium IVA : T4N0-2M0• Stadium IVB : anyTN3M0• Stadium IVC : anyT anyN M1

Signs and Symptomps

Diagnose

Therapy

a. Stadium I : Radioterapi.b. Stadium II&III : Kemoradiasi.c. Stadium IV dengan N<6cm : Kemoradiasi.d. Stadium IV dengan N>6cm : Kemoterapi dosis penuh

dilanjutkan kemoradiasi

Complications• Local and general metastasis• Toxicity of radiotherapy : sensorineural hearing loss, xerosmia

hypothyroidism, retardation of growth, renal toxicity

Prognosis

5 years survival rate• After radiation therapy :1.Stadium I 85-95%2.Stadium II 70-80% 3.Stadium III dan stadium IV : 24-80%4.1/3 died because of general metastasis in the bone, lungs, and

hepar

CASE REPORT

Patient’s Identity• Name : Mr. RA• Sex : Male• Age : 18 y.o• Occupation : Working at the industry• Race : Minang• MR : 38.98.15

ANAMNESIS

Physical Examination

ENT local status (Ears)Examination disorder Dextra Sinistra

Earlobes Congenital disorderTraumaInflamationMetabolic disorderPulling painTragus pressing pain

------

------

Ear canals and ear walls

Moderately large (N)HiperemisEdemaMass

+---

+---

Secretes/cerumen

SmellColorAmountType

-

Yellowish

Little

Serumen

-yellowish

littleSerumen

Examination Disorder Dextra Sinistra

Tymphani membrane

Intact ColorCone lightBulgingRetractionAtrophy

dull(+) 5 o’ clock

-+-

Dull (+) 7 oclock

-+-

Perforation Amount of perforationTypeQuadranThe side

----

----

Mastoid Inflamation signFistelSikatrikPressing painNyeri ketok

-----

-----

examination Disorder Dextra Sinistra

RinneSchwabachWeber

Kesimpulan

+Same as examinerLateralisasi to the

left

Conductive deafness

-lenght

Audiometry Didn’t done Didn’t done

Timpanometry Didn’t done Didn’t done

ENT local status (Nose)examination disorder Dextra Sinistra

Outer nose DeformityCongenital disordersTraumaInflamationMass

-----

-----

Paranasal Sinuses

Pressing pain - -

Anterior Rhinoscope

Vestibulum VibriseInflamation

Closed with tampon

Closed with tampon

Closed with tamponClosed with tampon

Cavum nasi Moderately large Closed with tampon

Closed with tampon

Secretes Location TypeAmountSmell

Closed with tampon

Closed with tampon

Examination disorder Dextra Sinistra

Inferior concas SizeColorSurfaceEdema

Closed with tamponClosed with tamponClosed with tamponClosed with tampon

Closed with tamponClosed with tamponClosed with tamponClosed with tampon

Medialis concas SizeColorSurfaceEdema

Closed with tamponClosed with tamponClosed with tamponClosed with tampon

Closed with tamponClosed with tamponClosed with tamponClosed with tampon

Septum Straight/deviationSurfaceColorSpinaKristaAbsesPerforation

Closed with tamponClosed with tamponClosed with tamponClosed with tamponClosed with tamponClosed with tamponClosed with tampon

Closed with tamponClosed with tamponClosed with tamponClosed with tamponClosed with tamponClosed with tamponClosed with tampon

Mass Closed with tampon Closed with tampon

Examination Disorder Dextra Sinistra

Rinoskopi Posterior

Koana Broad Hard to identify Hard to identify

Mukosa colourEdemaGranulasion

Hard to identifyHard to identifyHard to identify

Hard to identifyHard to identifyHard to identify

Konka inferior sizecoloursurfaceEdema

Hard to identifyHard to identifyHard to identifyHard to identify

Hard to identifyHard to identifyHard to identifyHard to identify

Adenoid Got /not Hard to indentify

Muara Tuba Eustachius

Filled with sekretEdema mukosa

Hard to indentifyHard to indentify

Hard to indentifyHard to indentify

Massa Lokation SizeshapeSurface

Hard to identifyHard to identifyHard to identifyHard to identify

Hard to identifyHard to identifyHard to identifyHard to identify

Post Nasal Drip Yes/noType

Hard to identify Hard to identify

ENT local status (Mouth and Oropharynx)

Pemeriksaan Kelainan Dekstra Sinistra

Trimus + +

Uvula EdemaBifida

--

Palatum Mole + Pharyngeal Arch

Simetris/notcolourEdemaBercak/eksudat

SimetrisLigth red

--

Pharyngeal wall colourSurface

Ligth redsmooth

Tonsil sizecoloursurfaceMuara kriptiDetritusEksudat

T1Ligth redsmooth

---

T1Ligth redSmooth

---

Pemeriksaan Kelainan Dekstra Sinistra

Peritonsil colourEdemaAbses

Ligth red--

Ligth red--

Tumor Yes/no Hard to identify Hard to identify

Teeth Karies/radiksKesan

Good oral hygiene Good oral hiegine

Tongue colourshapeDeviationMassa

Ligth redNot simetrisTo the left

-

Pemeriksaan Kelainan Dekstra Sinistra

Laringoskopi Indirek

Epiglotis Hard to indentify Hard to indentify

Aritenoid Hard to indentify Hard to indentify

Ventrikular band Hard to indentify Hard to indentify

Plika vokalis Hard to indentify Hard to indentify

Sinus Piriformis Hard to indentify Hard to indentify

Valekulae Hard to indentify Hard to indentify

PEMERIKSAAN KGB• Inspections : no enlarged lymph node• Palpation : no enlarged lymph node

RESUME

Discussion• Nasopharyngeal carcinoma is a type of carcinoma originated

from the epithelial or mucosa and cripty that covering the nasopharyngeal surface. In Indonesia, nasopharyngeal carcinoma insidence is about 5,78% from all of the cancer in the latest decade.

• From anamnesis, we got the main complaint is difficulty in speech since 6 months ago and it followed by other symptomps such as blocked left nose since 6 months ago, dizziness since 3 months ago, tinnitus in left ear since 2 months ago, Ringing at left ear and fullness since 2 month ago, no pain in the ear.Petient had double vision sine 2 month ago.

• Numbness in the cheek since 2 month ago.• Patient had history of smoking since 3 month ago,

approximately 5 stick per day.