Familial Nasopharyngeal Carcinoma 6

92 C. K. Ong and V. F. H. ChongaNPC commonly arises from the lateral pharyngealrecess and spreads widely into the surroundingsalong well-defined routes. Primary tumor volume is asignificant independent prognostic factor of the disease,but technical complexity often limits its use indaily practice. Cervical lymphadenopathy is very commonin NPC and is usually the initial presenting complaint.NPC has a relatively high incidence of systemicmetastasis, and the risk increases in individuals withparapharyngeal tumor extension and supraclavicularlymphadenopathy.Diagnosis of NPC is often achievable throughendoscopic examination and biopsy, but imaging isessential for accurate staging of the tumor, delineatingthe full scale of submucosal, osseous, or intracranialtumor spread, the detection of which eludesclinical and endoscopic examinations. Multi-planarcontrast-enhanced MRI is the best tool for full evaluationof the disease extent, while high-resolutionbone algorithm CT is of value in assessing corticalbone erosion. A thorough understanding of the complexanatomy of the nasopharynx and the naturalhistory of the disease facilitates accurate tumor mappingand treatment planning, which are crucial forfavorable therapeutic outcome.bFig. 8.14. Extramedullary plasmacytoma of the nasopharynx.(a) Axial contrast-enhanced CT image shows a mild tomoderately enhancing tumor (asterisk) arising from the nasopharyngealmucosal wall, occluding the nasopharyngealairway. (b) Axial contrast-enhanced CT image following radiotherapyshows significant disease resolution8.4SummaryReferencesBentzen SM, Johansen LV, Overgaard J, et al (1991) Clinicalradiobiology of squamous cell carcinoma of the oropharynx.Int J Radiat Oncol Biol Phys 206:1197–1206Cellai E, Olmi P, Chiavacci A, et al (1990) Computed tomographyin nasopharyngeal carcinoma – part II: impact on survival.Int J Radiat Oncol Biol Phys 19:1177–1182Chen MK, Chen TH, Liu JP, et al (2004) Better prediction ofprognosis for patients with nasopharyngeal carcinomausing primary tumor volume. Cancer 100:2160–2166Chong VFH (1997) Masticator space in nasopharyngeal carcinoma.Ann Otol Rhinol Laryngol 106:979–982Chong VFH, Fan YF (1996a) Pictorial essay: maxillarynerve involvement in nasopharyngeal carcinoma. AJR 167:1309–1312Chong VFH, Fan YF (1996b) Radiology of the carotid space.Clin Radiol 51:762–768Chong VFH, Fan YF (1996c) Jugular foramen involvement innasopharyngeal carcinoma. J Laryngol Otol 110:897–900Chong VFH, Fan YF (1997) Pterygopalatine fossa and maxillarynerve infiltration in nasopharyngeal carcinoma. HeadNeck 19:121–125Chong VFH, Fan YF (1998) Nasopharyngeal carcinoma. SeminUltrasound CT MR 19:449–462Chong VFH, Fan YF, Khoo JBK (1995) Retropharyngeal lymphadenopathyin nasopharyngeal carcinoma. Eur J Radiol21:100–105Chong VFH, Fan YF, Khoo JBK (1996) Nasopharyngeal carcinomawith intracranial spread: CT and MRI characteristics.J Comput Assist Tomogr 20:563–639Chong VFH, Ong CK (2008) Nasopharyngeal carcinoma. Eur JRadiol 66:437–447Chong VFH, Zhou JY, Khoo JBK, et al (2004) Tumor volumemeasurement in nasopharyngeal carcinoma. Radiology231:914–921Chong VFH, Zhou JY, Khoo JBK, et al (2006) Correlation betweenMR imaging-derived nasopharyngeal carcinoma tumor-volumeand TNM system. Int J Radiat Oncol Biol Phys 64:72–76Chong VF, Mukherji SK, Ng SH, et al (1999) Nasopharyngealcarcinoma: review of how imaging affects staging. J ComputAssist Tomogr 23:984–993Chua DT, Sham JS, Kwong DL, et al (1997) Volumetric analysisof tumor extent in nasopharyngeal carcinoma and correlationwith treatment outcome. Int J Radiat Oncol Biol Phys39:711–719