Immunoglobulin A against viral capsid antigen of Epstein-Barr virus and indirect mirror examination in the detection of asymptomatic nasopharyngeal carcinoma

Article Abstract:

Nasopharyngeal carcinoma (NPC) is a cancer of the nasal cavity and pharynx which is rare among many ethnic groups but which is common in southern China and Southeast Asia, North Africa, and Greenland. As is the case with many cancers, early detection may be beneficial, but ways must be found to screen large numbers of people quickly and inexpensively. One method which might prove useful is to reserve direct examination of the nasopharynx for patients who are positive for IgA antibodies against Epstein-Barr virus nucleocapsid protein. Epstein-Barr virus has been implicated in the development of nasopharyngeal carcinoma. While most adult humans may have antibodies against this ubiquitous virus, IgA antibodies, which are secreted in mucus, are preferentially found in patients with NPC. A trial screening project has been conducted involving 42,048 subjects from an area of high incidence of NPC and 10,402 subjects from an area of low incidence. In the high-incidence region, 2,823 people were found by screening to have IgA antibodies which specifically recognize the viral capsid protein. These people, presumed to be at higher risk of NPC, were then given yearly mirror examinations of the nasal and pharyngeal cavities. A total of 136 people had abnormalities which appeared to be cancerous. Of these, 41 subjects were confirmed to have cancer when the lesion was examined under the microscope. Sixty-eight percent of these patients had Stage I nasopharyngeal carcinoma; among patients who are found to have NPC after seeking help for symptoms, only 0.8 percent are likely to have Stage I disease. During the course of the study, three patients who did not have IgA antibodies developed symptoms and were found to have NPC. The incidence of IgA antibodies recognizing the Epstein-Barr virus capsid protein was less in the low-incidence region. However, among the people who were positive for these antibodies, the rate of NPC was about the same, indicating that the antibodies may be among the more important risk factors for the development of nasopharyngeal carcinoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Physiological aspects, Epstein-Barr virus, Immunoglobulin A

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Efficacy of radical neck dissection for the control of cervical metastasis after radiotherapy for nasopharyngeal carcinoma

Article Abstract:

Radiation therapy is considered the best treatment for patients with cancer of the nasal pharynx, the area of the throat above the level of the roof of the mouth, which communicates with the nose and ear canals. The five-year survival rate following radiotherapy, with or without radical neck dissection surgery, ranges from 32 to 56 percent. The incidence of continued or recurrent cancer in the glands of the neck is about 18 percent. Treatment when there is cervical metastasis (spread) is controversial. In order to document the effectiveness of radical neck dissection in treatment of recurrent or residual neck metastasis, a review of 51 patients was undertaken. All patients had previously undergone radiotherapy for the initial disease and had since developed metastasis. The average patient age was 50 years, and the follow-up ranged from 0.5 to 9 years (median 2 years). Radical neck dissection removes all the lymph nodes in the neck, from the jaw to the collar bone. All patients survived the surgery. Twenty-six patients (51 percent) had metastasis to more than one lymph node. Study of the tissue removed at surgery revealed malignant cells in 45 specimens (88 percent). The only factor that correlated significantly with successful control of neck cancer was mobility of the lymph nodes. This is understandable, since the tumors spread outside the capsule of the node, and 18 (35 percent) of the patients were found at surgery to have lymph nodes that were adhering to surrounding structures. Five-year survival was 38 percent, and probability of disease control was 66 percent. It is concluded that radical neck dissection is effective in controlling postirradiation metastasis in the neck from a primary nasopharyngeal cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Therapeutics, Surgery, Cancer, Cancer treatment, Radiotherapy, Lymphatic metastasis, Nose cancer, Radical neck dissection

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