Epipharyngeal tumors

The most common epipharyngeal tumors include angiofibroma, carcinoma, malignant lymphoma. Other types of tumors are rare in the nasopharynx.

Benign tumors

 * Juvenile angiofibroma

It is a polypoid tumor. It occurs mainly in men between the ages of 15 and 25. Most regress during puberty. lIt grows either exophytically or inverted - locally aggressive
 * Papilloma
 * Angioma

Nasopharyngeal cancer
Nasopharyngeal cancer is common in Southeast Asia. It is rare in Europe. It is probably related to EBV exposure, not related to alcohol and cigarette consumption (unlike other head and neck ca).

Histology
There are 3 types of nasopharyngeal cancer: Type ll and lll have similar biological properties:
 * type I – squamous cell ca with horn:
 * tendency to local spread (cranial base)
 * less often the formation of metastases (regional and remote)
 * lower chemo- and radiosensitivity
 * type II – little differentiated squamous cell ca without horns.
 * type III – undifferentiated ca.
 * characteristic lymphocyte infiltration ,
 * early regional metastases (cervical nodes - packets),
 * formation of distant metastases more often than in other head and neck tumors,
 * association with EBV infection (increased anti-EBV antibody titers),
 * highly chemo- and radiosensitive.

Clinical picture
The first symptom is usually painless enlargement of the cervical nodes (metastases).

Early symptoms

 * From Eustachian tube obstruction (earring, tinnitus - consequence of chronic secretion in the middle ear - otitis media chronica secretorica).
 * Nasal obstruction (often unilateral ), epistaxis.

Late symptoms

 * Neurological disorders - involvement of the cranial nerves.
 * First paresis n. VI and n. V - diplopia and impaired sensitivity in the face.
 * In large tumors - paresis of other oculomotor muscles and lateral mixed system.

Diagnostics

 * Rhinoepifaryngoscopy,
 * neck palpation,
 * biopsy ,
 * CT, MR - spread to the base of the skull,
 * USG - nodal finding,
 * Chest X- ray - lung metastases.

Angiofibroma

 * Surgery - lateral rhinotomy,
 * Bleeding - AG supply vessels and their selective embolization.

Carcinoma
The main treatment modality is radiotherapy - primary tumor and cervical nodes bilaterally (even in patients with unproven cervical metastases electively).
 * Nasopharyngeal cancer is associated with a high incidence of occult meta in the cervical nodes!
 * Chemotherapy - neoadjuvant × concomitant - patients with advanced tumor ( T3 and T4 ) and patients with cervical metastases.

related articles

 * Lymphomas
 * Oropharyngeal tumors