MANAGEMENT OF NASOPHARYNGEAL CARCINOMA

Ashri Yudhistira, Rizalina A Asnir, Farhat

Haji Adam Malik Medan General Hospital
Medical Faculty of Universitas Sumatera Utara
HEAD AND NECK TUMORS

• Tumors of head and neck is common

• Nasopharyngeal Carcinoma ranks no.1 in head and neck

tumors, and no.5 in human body

• Nearly 60% of head and neck tumors are Nasopharyngeal

Carcinoma

Punagi, 2007
SUMATERA UTARA

Area: 72.981,23 km2

Population: 13.937.797 (Sensus 2015)
capital: Kota Madya Medan
Ethnics: Batak 41.95%, Jawa 32.62%, Nias 6.36%, Melayu 4.92%,
Tionghoa 3.07%, Minangkabau 2.66%, Banjar 0.97%, Others 7.45%
HAJI ADAM MALIK MEDAN GENERAL HOSPITAL

Founded in 1990 as type A hospital

In1991 became to referral center for Develpoment Area A
In1993 became teaching hospital for Medical Faculty of Universitas Sumatera Utara
PATIENT PROFILE FROM THE ONCOLOGY – HNS DIVISION
OF ENT DEPARTMENT

Diagnosa Jumlah Persentase

Nasopharyngeal Carcinoma 492 61.19
Laryngeal Carcinoma 143 17.78
Sinonasal Carcinoma 112 13.93
Nasopharyngeal Angiofibroma 24 2.98
Oropharyngeal Carcinoma (Tonsil / Tongue) 19 2.36
Ear Carcinoma 7 0.87
Thyroid Tumors 5 0.62
Parotid Tumors 2 0.24
Total 804 100
Patient Percentage
Nasopharyngeal
Carcinoma
Laryngeal Carcinoma

Sinonasal Carcinoma

Nasopharyngeal
Angiofibroma
Oropharyngeal Carcinoma
(Tonsil / Tongue)
Ear Carcinoma

Thyroid Tumors

Parotid Tumors
NASOPHARYNGEAL CARCINOMA
• NPC is a squamous cell carcinoma originating from
nasopharyngeal epithelial cells

• Has high potential for regional metastases to cervical lymph

nodes and distant metastases

• About 90% of NPC patients show malignancy of the cervical

lymph nodes

Brennan, 2016
EPIDEMIOLOGY
• Highest incidence in China (Guangdong Province): 20-30 / 100.000 (male)
and 15-20 / 100.000 (female)

• Also high incidence reports from regions throughout South East Asia
(Thailand, Vietnam, Malaysia, Indonesia)

• Some reports from Middle East, Alaska (Eskimo population)

• Rarely found in caucasian population

NPC IN INDONESIA

• Most patients came at advanced stages

• Poor prognosis

• Poor early detection: diagnosis difficulties, patient’s

awareness
NPC IN INDONESIA

• Indonesia’s Ministry of Health reported (2007): NPC is among 10 most

cancer found in Indonesia

• Tan (2010): NPC incidence in Indonesia is 6 / 100.000, with average of

12.000 new cases a year

• Bimodal age incident: 15-25 years old AND 40-60 years old

• Male : Female is 3 : 1
ETIOLOGY
• Specific causes are still unkown

• Factors:
• Genetics
• Associated with HLA A2 and Bw46 (China)
• Susceptibility in Batak tribe: HLA-DRB1 *08 gene allele
• Epstein-Barr virus
• Environment: diet habit (salted fish), smoking, alcohol, workplace
SYMPTOMS

EAR NEUROLOGY CERVICAL

LYMPHADENOPATHY

NPC DISTANT
NOSE SYMPTOMS METASTASIS

Wei, Wi and Kwong DL, 2010

MANAGEMENT
• Radiotherapy has been the primaery therapeutic modality for
NPC

• Radiotherapy managed to control 75-90% of T1 and T2 cases,

and 50-75% of T3 and T4 cases

• Chemotherapy functions as radiosensitizer and help controlling

distant metastases
FACILITES AT HAJI ADAM MALIK GENERAL HOSPITAL

• Surgery

• Chemotherapy

• Radiotherapy

• Paliative Care
Radiotherapy: Linear Accelerator
(1 unit)

Serving 50 – 70 patients / day

at 5 workdays / week

Patient’s Waiting time: 30-60

days
ROOM FOR IMPROVEMENTS

• Patients Services:
• Human resources improvements
• Additional faclities

• Research and Education:

• Developing relations with other institution regarding NPC

• Promotive and Preventive Services

SCIENCE CENTER OF EXCELLENCE FOR
NASOPHARYNGEAL CARCINOMA UNDER MEDICAL FACULTY
UNIVERSITAS SUMATERA UTARA

• Founded in 2018 in Universitas Sumatera Utara, Medan with dr. Farhat,

Mked (ORL-HNS), SpTHTKL(K), FICS as chairman

• Actively promoting studies, publishing reports and journals and HR

improvements in the field of Nasoparhyngeal Carcinoma

• Very open for working together and developing relations with other scientific
body for better understanding and better patient services of Nasopharyngeal
Carcinoma cases globally
 1st National Conference of NPC

1st International Conference of NPC

Inauguration of Oncology HNS Consultants