鼻咽癌專題知識講座培訓課件

1、鼻咽癌專題知識講座鼻咽癌專題知識講座一、概述(outline)1、發(fā)病有一定的地區(qū)性(more common in south-east Asia in the world, more common in southern China) 我國頭頸惡性腫瘤之冠(the top of the malignant tumor in head and neck)。某些高發(fā)區(qū)可能為全身惡性腫瘤之首，廣東、廣西、湖南和福建高發(fā)。鼻咽癌專題知識講座2一、概述(outline)1、發(fā)病有一定的地區(qū)性(more 2、高發(fā)年齡（maximum age incidence)：4060歲（86.62%）3、性別(se

2、x)：男多于女(male to female is 2:1)鼻咽癌專題知識講座32、高發(fā)年齡（maximum age incidence)：二、病因（etiology)(three possible causal factors)1、遺傳因素(genetic factors)種族易感性家族聚集性(racial predilection, family tendency and HLA typing) 鼻咽癌專題知識講座4二、病因（etiology)(three possible2、病毒因素-Epstein-Barr virus EB病毒NPC患者血清中檢測到EB病毒相關(guān)抗體(patients

3、with NPC have high level of antibody against EBV(over 90% of patients) ，NPC活組織的癌細胞中存在EBV DNA特異性mRNA或基因表達產(chǎn)物(expression of gene products， (but whether the relationship between the two is causal or incidental is still unknown)鼻咽癌專題知識講座52、病毒因素-Epstein-Barr virus E3、環(huán)境因素(environment factors) 微量元素(microel

4、ement)：鎳(nickel) 維生素缺乏(vitamin lack) 性激素失調(diào)(hormonal factors) 亞硝胺A combination of genetic, virus and environmental influences would best explain the occurrence of nasopharyngeal carcinoma)鼻咽癌專題知識講座63、環(huán)境因素(environment factors)鼻咽癌病理學(pathology)主要為低分化鱗癌。 少見腺癌、肉瘤等 Over 95% Squamous cell carcinoma( poorly

5、 differentiation)Adenocarcinoma, sarcoma, 鼻咽癌專題知識講座7病理學(pathology)主要為低分化鱗癌。 少見腺癌、好發(fā)部位most tumors arise on the posterosuperior wall or fossa of Rosenmuller 圖 咽隱窩 鼻咽頂后壁鼻咽癌專題知識講座8好發(fā)部位most tumors arise on the 臨床表現(xiàn)(clinical manifestations)1、鼻部癥狀: 涕血或后吸涕帶血，鼻塞。nasal symptoms such as epistaxis, bloodypostna

6、sal discharge, nasal obstruction2、耳部癥狀：分泌性中耳炎Secretory otitis media: conductivedeafness, fluid in the middle ear, tympanic membrane indrawn 鼻咽癌專題知識講座9臨床表現(xiàn)(clinical manifestations)鼻咽癌專題知識講座10鼻咽癌專題知識講座10鼻咽癌專題知識講座培訓課件頸淋巴轉(zhuǎn)移圖鼻咽癌專題知識講座12頸淋巴轉(zhuǎn)移圖鼻咽癌專題知識講座12鼻咽癌專題知識講座13鼻咽癌專題知識講座134、顱神經(jīng)癥狀:（圖）involved cranial ne

7、rves: fifth and sixth nerve are the most frequently involved, Headache, internal strabismus. 4th , 3rd and 2nd cranial nerves are next most commonly affected. 9th, 10th 11th and 12th may also be involved 鼻咽癌專題知識講座144、顱神經(jīng)癥狀:（圖）involved cranial ne 舌下神經(jīng)麻痹 外展神經(jīng)麻痹 Hypoglossal paralysis abducens paralysis

8、 鼻咽癌專題知識講座15 舌下神經(jīng)麻痹 外展神經(jīng)麻痹 鼻咽癌專5、遠處轉(zhuǎn)移：Distant metastases occur to bone, lung, liver and other sites 鼻咽癌專題知識講座165、遠處轉(zhuǎn)移：Distant metastases occu診斷(Diagnosis)1、病史、癥狀和體征History, symptoms and signsEarly symptoms: bloody postnasal discharge fluid in the middle ear (unilateral)鼻咽癌專題知識講座17診斷(Diagnosis)1、病史、癥

9、狀和體征鼻咽癌專題知識2、鼻咽鏡檢查The posterior rhinoscopyFibreoptic nasopharyngoscopy3、血清學檢查EBVCA-IgA, EBVEA-IgG鼻咽癌專題知識講座182、鼻咽鏡檢查鼻咽癌專題知識講座184、影象學檢查Imaging CT, MRI鼻咽癌專題知識講座194、影象學檢查鼻咽癌專題知識講座195、鼻咽活檢確診的方法Definitive diagnosis is made by biopsy鼻咽癌專題知識講座205、鼻咽活檢確診的方法鼻咽癌專題知識講座20鑒別診斷圖鼻咽癌專題知識講座21鑒別診斷圖鼻咽癌專題知識講座21治療(Treatment)放射治療: Radiotherapy is the method of choice. Prognosis: the overall 5-year survival rate is about 50% ranging from 75% for early tumors to 15% for late