symptoms of nasopharyngeal carcinoma, nasopharyngeal carcinoma treatment
early diagnosis and early treatment of NPC Technical ProposalThe project intends
the four cities in Guangdong Province and Guangxi Zhuang Autonomous Region to carry out Cangwu screening and early detection of nasopharyngeal carcinoma governance. screening targeted at 30-59 year-old local resident. with head and neck examination and EB virus antibody (VCA / IgA) detection as a screening tool, further positive serology and nasopharyngeal endoscopy to the diagnosis based on pathological examination. the discovery of early cancer and cancer patients to carry out appropriate treatment.
specific number of screening: Screening of each project site not less than 10,000, the number of diagnostic tests at least 700 people.
performance indicators requirements: screening task completion rate ? 100%; Compliance ? 70%; early diagnosis rate of ? 50%; cure rate ? 80%; time compliance rate of diagnosis and treatment of ? 95%.
actual task completion rate = Number Screening / Screening number of tasks;
compliance = number of screening the target population of actual / current number of the target population;
early diagnosis rate = (carcinoma in situ I of Cancer II cancers) / (carcinoma in situ cancer);
treatment rate = actual number of patients treated / number of cases should be treated;
diagnostic standard time compliance rate = actual number of (? 1 biopsy pathology report to months) / number should be standard.
aging treatment standards compliance rate = actual number of (? 1 pathology report to months after treatment) / number should be standard.
(a) the establishment of the queue.
population of the project is based on the work of early diagnosis and early treatment, require that the project will carry out before specific screening groups and control subjects in order to evaluate the program. proposed household sector from the local public security organs to obtain screening population, the total population of the control group and the establishment of a database, along with carrying out the project covered the counties (districts and townships) all groups The death surveillance. in the whole cause of death based on monitoring, focusing on cancer incidence and death registration. cancer incidence and death registration in accordance with the guide the work of Cancer Registration in China, the standards.
( b) the choice of screening people.
cluster sampling method to determine the higher incidence of NPC town or village as a screening population, complete the entire population registered. to carry out the health of nasopharyngeal carcinoma knowledge, advocacy, awareness and health knowledge of nasopharyngeal carcinoma high-risk groups the participation rate. screening criteria matches the crowd to participate in screening compliance target of not less than 70% rate of early treatment should be treated no less than the number of 80%.
key target for the screening of high incidence of local residents 30-59 years of age (no other serious illness, volunteered to participate and who can accept checks). Based on previous field studies ,30-59-year-olds about of the total population of 1 / 3, in accordance with the participation rate was 70%, such as the number of people per year to less than 5,000 people screened, 3-year screening group for a total of no less than 65,000 people.
(c) the choice of control subjects.
control subjects and screening populations to have a certain geographical buffer to avoid some of the control group participated in the early diagnosis and early treatment result of the project bias. control regions corresponding to the tumor incidence and death to carry out the registration-based monitoring of all causes of death, so that the final evaluation of the performance of early diagnosis and early treatment. In addition a small sample of selected risk factors in the control group were monitored for quality control screening population comparability with the control group.
control subjects a variety of situations (eating habits, socioeconomic status, etc.) should be as consistent with the target population. the control group should carry out baseline survey of screening people at the same time. control baseline survey of the village population stratified random sampling can be carried out. sample size of the actual situation according to the decision of the scene, but no less than 600 people, each age group (5-year-old age group) not less than 100 people.
Second, the screening flow chart
three screening procedures
(a) informed consent.
screening of all participants people must participate in informed consent procedure. The program consists of two parts: the first call to participate in the mass screening, focused screening propaganda purpose, significance and participation in screening for benefits and possible risks, read the informed consent form, answered the masses problem. and then by hand to participate in the mass screening of the relevant description of screening, further to answer the question do not understand. Finally, under the principle of voluntary informed consent.
(b) of the questionnaire.
signed the informed consent of the people receiving baseline information survey. baseline survey covered health knowledge survey information and Hospital survey of two parts, unified by the prior completion of professional training for investigators. all before a formal investigation, should be based on local conditions, pre-survey to become familiar with research project to understand the investigation process may occur other problems, cancer, early detection and timely treatment to the model base reflect the Expert Group. Baseline information survey was to evaluate the project performance baseline is important .
health knowledge survey includes a comprehensive knowledge of cancer prevention and treatment of nasopharyngeal carcinoma in two parts. baseline survey of knowledge of cancer prevention and control in the early diagnosis and early treatment should be formally launched before the completion of work in order to carry out an accurate picture of early diagnosis Early treatment before the knowledge of the local people’s health situation.
clinical investigation include basic personal information, family history and simple physical examination.
Hospital Survey of the major local hospitals to collect nasopharyngeal cancer patients admitted to the basic situation, including the proportion of patients and treatment methods.
basic information over the baseline questionnaire for each project, in strict accordance with the investigation and complete coding instructions. every day the completed questionnaire, requiring 10% of randomly selected for review, after review of the purpose of compliance rate of not less than 90%. Data entry requirements twice, and then to the original questionnaire as the standard proofreading twice the data entry, sorting into the final database . database reporting requirements of both time and code documentation submitted to the field.
(c) clinical examination.
1. medical history inquiry
nasopharyngeal cancer screening check when the first object to ask medical history and family history screening, this method is most convenient, is also very effective. screening some of the symptoms complained of an object can provide clinicians with important information, allow clinicians to strengthen vigilance.
2. palpation of cervical lymph node
should be the object of each screening examination. check should pay attention to in order to avoid omissions. generally the order can be as follows: ? the group of deep cervical lymph nodes, the chain in front of the internal jugular vein (deep to the posterior belly of digastric muscle) or rear (below the mastoid tip, and before the deep surface of sternocleidomastoid muscle) of the lymph nodes, and deep in the neck, the next group of lymph nodes; ? back of the neck Triangle Area nerve lymph node chain; ? the supraclavicular lymph node chain transverse cervical artery; ? submandibular, submental, preauricular, occipital and other superficial lymph nodes after. nasopharyngeal carcinoma lymph node metastasis, most often on the deep cervical the first group of lymph nodes (deep to the posterior belly of digastric muscle) or posterior (in the mastoid tip and the bottom of the deep surface of sternocleidomastoid), part of the first appeared in the posterior triangle lymph node nerve area. Check these parts of lymph nodes, especially on the deep cervical lymph nodes should be highly suspected nasopharyngeal carcinoma.
3. a variety of serum EB virus antibodies
EB virus associated with different antibodies EB virus reflects the acute, chronic, persistent infection, convalescence or past infection status. testing the corresponding antibodies, contribute to the diagnosis and treatment. The variety of the significance of detection of antigen-antibody reaction in natural populations, nasopharyngeal carcinoma high-risk groups, precancerous lesions and early cancer detection has been verified.
serum EB virus VCA / IgA test, serum EB virus EA / IgA test, serum EB virus EA / IgG were detected by immunoenzyme method.
criterion test results are as follows. negative cells: cells are not colored, or pale brown background color; positive cells: the brown cells in the membrane around the color depth.
(1) indirect nasopharyngeal mirror
indirect nasopharyngoscopy tools and operation is relatively simple, can peep nasopharyngeal cavity, the diagnosis Early mucosal lesions of nasopharyngeal carcinoma and found significant.
Methods: subjects riding, head slightly forward, mouth, nose breathing, the examiner left hand holding a spatula, pressing Sheqian 2 / 3, expanding base of the tongue from the pharyngeal arch, right hand holding the nasopharynx heating without hot mirror, mirror up, into the soft palate and pharyngeal wall between the back and try to avoid touching the tongue base, pharyngeal arch, pharyngeal wall, so as to avoid gag reflex of inspection. rotating mirror can be observed in the wall of the structure of the nasopharynx, nasopharyngeal should check the top of the order (especially the front top area), both sides of the wall (with particular attention to check the pharyngeal recess), and the bilateral compared to observe whether bilateral symmetry nasopharynx, nasal cavity is narrow. check should pay special attention to whether the nasopharyngeal mucosa thickening, rough, congestion, bleeding, ulcers, infiltration, the new biology. where the mucous membrane of isolated nodules or asymmetry under the uplift, especially in the wall or place on the basis of the adenoids, and even more should pay attention to. In general, most of the subjects in the nasopharynx to the nasopharynx indirect microscope peep the normal structure of the wall or abnormal change If the gag reflex sensitivity, can be 1% -2% of the lidocaine spray 1-3 times to do the pharyngeal mucosa after topical anesthesia examination.
(2) nasopharynx fiber mirror
As nasopharyngeal fiber Mirror is soft, easy to operate, there are enlarged vision, and could direct bite taken under direct vision biopsy suspicious tissue. Therefore, this examination method has been applied to the screening of nasopharyngeal carcinoma.
ways: first with 2% of bilateral nasal ephedrine nasal spray to shrink and shrink small blood vessels, and then with 1% -2% of the lidocaine and inhalation of bilateral nasal spray for the surface of the nasopharynx anesthesia, the 2-3, the patient lying on the examining table, the surgeon who left the Department of nasopharyngeal fiber mirror control, right hand holding the top of the Ministry of fiber mirror inserts, from the side of the nasal cavity through the nasal passages into the fiber under the microscope to the nasopharynx by adjusting the angle of bending the Department to observe the entire nasopharynx cavity condition, structure, symmetry, mucous membrane color, with or without the new biology and new bio-location, size and shape. into the mirror and back mirror in the process, carefully whether bilateral nasal lesions observed suspicious.
5. nasopharyngeal biopsy
nasopharynx or nasopharyngeal fiber indirect mirror examination revealed suspicious lesions or nasopharyngeal cancer, are required for nasopharyngeal biopsy in order to identify pathological diagnosis.
four histological types of NPC
(a) of nasopharyngeal precancerous lesions.
nasopharyngeal epithelial precancerous lesion is moderate or severe atypia change, mild atypia change can not be considered precancerous lesions.
(b) of the keratinizing squamous cell carcinoma or squamous cell carcinoma.
keratinizing squamous cell carcinoma of the nasopharynx can be divided into well-differentiated, moderately differentiated and poorly differentiated levels.
(c) non- keratinizing carcinoma.
non-keratinizing nasopharyngeal carcinoma can be divided into differentiated, undifferentiated and mixed type of Sanya. whether differentiated non-keratinizing nasopharyngeal carcinoma or undifferentiated nasopharyngeal cancer, can lead to varying amounts of lymphoid cell infiltration in class. cell nucleus can be detected EBERs. This type of tumor, called the lymphatic epithelial cancer.
1. differentiated non-keratinizing carcinoma
some differentiated non-keratinizing nasopharyngeal carcinoma cells almost fusiform, then can be called spindle-cell non-keratinizing carcinoma.
2 . non-keratinizing undifferentiated carcinoma or undifferentiated carcinoma of nasopharyngeal type
classic undifferentiated nasopharyngeal carcinoma, in our country has been called the large round cell carcinoma.
3. Mixed non-keratinizing carcinoma
(d) of nasopharyngeal carcinoma.
1. ordinary adenocarcinoma
cancer can be divided is differentiated, moderately differentiated and poorly differentiated levels. sometimes visible focal squamous metaplasia lesions may be referred to as focal squamous metaplasia associated with adenocarcinoma. differentiation phase if the cancer is clear, glandular coexist with squamous metaplasia should be referred to as adenosquamous carcinoma. papillary carcinoma is a nasopharyngeal cancer is more common subtypes, some of mucinous adenocarcinoma of the nasopharynx, and its morphology and Results similar rectal adenocarcinoma can be called intestinal cancer.
2. salivary adenocarcinoma
one of the most common are adenoid cystic carcinoma, followed by mucus epidermoid tumor.
(e) carcinoma in situ.
five principles of treatment
Radiation therapy is the preferred cure for NPC, in accordance with the hierarchical General principles of treatment, the majority of early cases can be treated with radiotherapy alone, a small number of the radiosensitivity of tumors and in advanced cases with poor adjuvant chemotherapy or may be sensitizing agent, in order to improve the outcome. for some early stage patients, such as tumor confined to the cavity, after nostril in patients with mild involvement, but also external beam brachytherapy, external beam radiotherapy to reduce the damage.
(a) outside the normal nasopharyngeal irradiation.
line with 60Co? or linear accelerator 6-8MV high-energy X ray; cervical lymph node irradiation using 60Co? line or linear accelerator 6-8MV high-energy X ray, and 6-12Mev the electronic line or 180-210KV deep X line. linear accelerator 6-8MV high-energy X ray , total dose 66-70Gy ,33-35 ,6-7 weeks time. segmentation conventional radiation 5 days a week, 1 time / day, tissue dose (DT) 1.8-2Gy / second, continuous irradiation.
(b) of the endovascular brachytherapy.
intraluminal high dose rate brachytherapy with iridium 192 (192Ir), the effective dose distribution within the tumor is limited to 1cm, with a range of treatment some limitations, which can only treat small and superficial tumors, as a supplement external radiation therapy. clinically often associated with external radiation and for the early cases, residual nasopharyngeal carcinoma after radiotherapy and the treatment of nasopharyngeal recurrence . dose and segmentation: nasopharyngeal lesions after external beam 60Gy, plus brachytherapy 10-25Gy. each 3-5Gy, 2-3 times per week.
(c) Intensity Modulated Radiation therapy and stereotactic radiation therapy.
conditional NPC patients can choose intensity modulated radiation therapy. nasopharyngeal residual lesions after conventional radiotherapy large, not suitable for brachytherapy patients may choose to be fractionated stereotactic radiotherapy.
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