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Author: admin, 15.05.2014. Category: Severe Tinnitus Symptoms

The nasopharynx is the upper part of the throat behind the nose, so the nostrils lead into the nasopharynx. What is the incidence of this disease among the Malayasians especially the people of Sarawak? Sarawak has one of the highest incidences of this cancer in the world, other places being South East China. The primary reason for this disease is a virus of the herpes family, called Epstein Barr virus. A lot of environmental factors have been attributed to this but none proved conclusively so far.
In conclusion, there may be a variable interplay of genetic and environmental factors that have led to this disease being so common to this area. Is there any way to prevent this cancer especially in people who have a relative with this cancer?
Early testing to detect population who are at high risk of this disease by measuring viral DNA in the blood is both cumbersome, expensive and not shown to be efficacious in our population where over 95% may show a high level of titre. If any of the above mentioned symptoms are seen, especially in people who belong to a high risk population they should immediately consult a doctor, preferably an ENT specialist. Clinical History: Complete history of symptoms, family, occupational history with dietary practices. Yes, WHO has classified 3 types of this cancer of which type 2 and 3 are seen in our patients most commonly. After getting diagnosed what are the procedures that a person must go through before the actual treatment starts? After diagnosis, it is very important that the disease be staged properly so that a correct estimation of the prognosis can be made. A dental evaluation may be requested to prevent later tooth decay due to radiation induced changes. Ideally a nutritional evaluation must also be done and early measures instituted so that adequate dietary requirements are met before beginning the treatment.
The stage of the cancer (whether it affects part of the nasopharynx, involves the whole nasopharynx, or has spread to surrounding structures or to other organs in the body). Stage IIB: Cancer is found in the nasopharynx and has spread to lymph nodes on one side of the neck.
Cancer has spread beyond nearby lymph nodes to other organs of the body like liver, lung or bone. Surgery is not an option in nasopharyngeal cancer since it is surrounded by important structures and it is impossible to remove it without causing major injury. Before treatment, a plastic face cast is made for each patient, which is used to immobilize them during treatment to make sure radiation is delivered to all the right areas.
This is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Concurrent or sensitizer chemotherapy is given along with radiation to improve the tumor kill caused by radiotherapy.
Systemic chemotherapy is usually given 4 weeks after completion of radiotherapy and is given for 3 cycles each 4 weeks apart. Yes, Brachytherapy is a form of radiotherapy where protected radioactive sources are placed close to the tumor so that only the tumor and its immediate neighboring region receives treatment and nearby critical normal structures do not receive any at all. But this is not employed during the initial treatment of NPC and is mainly used for tumor recurrences in the nasopharynx.
Is there any role of complementary or traditional medicine in the treatment of the disease? Until now there is no evidence that any other forms of medicine have any proven efficacy in this cancer. Does radiotherapy have a lot of side effects, or what are the side effects that a person undergoing this form of treatment, have to expect?
Radiotherapy causes reversible damage to rapidly dividing tissue in the skin, mouth and to the glands that produce saliva. Skin- In the first week, this will show as a slight redness with a feeling of warmth and towards the end of the 2nd week there will be dryness of skin and loss of facial hair.
Mouth- Towards the end of the second week, a sore throat develops along with altered taste sensation.
Dryness of mouth- Mouth dryness is seen from the beginning of the 3rd week and progresses thereafter leading to thicker viscous saliva.
Weight loss- All the above mentioned factors along with a decreased appetite causing a weight loss and during a normal course of radiotherapy, a person may lose 10-15% of his baseline weight.
Hoarseness of voice develops towards the 4th week due to a mild swelling of the vocal cords, but the voice usually returns back to normal.
These side effects usually resolve completely but there may be late side effects like dryness and tightening of the skin of the neck, dryness of mouth, mild difficulty in swallowing in most patients. Oral hygiene is to be maintained strictly using a soft toothbrush and fluorinated toothpaste, Regular oral rinses every 2 hrs are to be done with a salt and soda water combination and oral disinfectant gargles 3-4 times daily is to be done.

Diet is changed to semi solid during latter phases of treatment and should be monitored to ensure adequate dietary allowances of all nutrients.
Patients are assessed weekly during treatment and the side effects are graded according to severity and when toxicities reach grade 3, treatment is interrupted till adequate recovery. IMRT is a type of 3-dimensional radiation therapy that uses computer-generated images to clearly mark the areas involved by the tumor and gives the ability to modify the shape and direction of radiation beams in such a way that the tumor and involved areas can be treated to a high dose and normal organs and structures are given a very low dose. But this kind of planning is labor intensive and planning will require a week more than that required for conventional planning. Patients older than 65 yrs with NPC are assessed at baseline using a questionnaire called Geriatric Functionality Index which has been modified to ascertain the fitness levels of this group of patients to tolerate this kind of treatment.
We are also currently evaluating IMRT in this subgroup of patients and results are expected to be announced during the SIOG conference in Jan 2011 being held at Kuching. 6-8 weeks after completion of radiotherapy and chemotherapy, a CT scan of the head and neck region and Nasal Endoscopy is recommended for all patients, following which they are followed by the ENT and the Oncology department on a 3-4 monthly basis for 2 yrs. What are the future directions in the treatment, prevention and early detection of this cancer?
There is a lot of research currently underway exploring the molecular and epidemiological etiology of this disease. Also lot of research is being done in tumor markers that may be able to predict the possibility of recurrence and metastasis but none are available commercially yet.
This website is best viewed using Mozilla Firefox 3 or Microsoft Internet Explorer 7 or better with a screen resolution of 1024 X 768. Receive a Platinum Favor Visa Rewards Credit Card for as low as 4.99% APR for the first 6 months. Are you a small business looking for a ringing in the ear dizziness vomitingblurred vision ears ringing lower back neckear rednessshakinessheadacheear ringing sore throatheadache ringing ears night sweats tired dark urinesimple yet reliable checking account? We want you to feel comfortable with our employees, feel at ease knowing your money is safe and secure and feel confident that you have been given the best product for your needs. At The Vinton County National Bank, we want you to know we are here for you and that we think our customers deserve the very best in banking. This then multiplies, increasing in size and invades surrounding tissues involving the Eustachian tube and the cranial nerves, even eroding through the tough bone of the skull into the brain.
This virus affects most people in childhood, but in some, especially those of Chinese ancestry, this virus causes cancerous change in the normal cells. Among the various theories been evaluated so far, one has been the consumption of salted fish especially in early childhood when it is traditionally given with rice as a weaning food. Active community based research is underway at our department in collaboration with WHO that may help solve this riddle. But clinical trials are underway in vaccines based on proteins from the virus and the results are eagerly awaited. This requires a high level of awareness especially among the population at risk and coordinated efforts between peripheral health care services for early detection and referral of these cases. These are also the more aggressive type and the type seen most commonly in areas where this disease is endemic. Of these the initial procedure that must be done is a biopsy from the tumor tissue to confirm the pathology and to ascertain the grade, followed by a CT scan of the head and neck area. Usually teeth need not be removed and only a plaque removal, examination of the gums, teeth and proper dental hygiene advice would suffice. We use specific questionnaires to assess the fitness level of older people and treatments can be tailored to adapt to these conditions. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Then a process called Simulation is done where plain Xrays are taken from different angles and processed into films.
This can be taken on an out-patient basis, but for patients coming from distant places like Sibu, Miri, inpatient beds are arranged for the duration of treatment.
In the initial phase the radiotherapy is delivered to all clinically diseased areas and also surrounding areas suspected of harboring microscopic diseases. On the other hand taking these kinds of medicines during treatment may lead to their interaction with the radiation and actually increase the side effects of the treatment. This dryness increases towards the later weeks and towards the end of the 4th week the dried skin turns darker and begins to flake off revealing newer lighter colored skin beneath.
This gradually progresses and may be slightly painful towards the end of the 5th week, leading to decrease in food intake. This affects proper swallowing of solid food and added to the sore throat may require food to become more semisolid through the course of treatment thus leading to weight loss. Also hearing loss may persist in some patients and if the brain area was treated there may be some neurocognitive loss too.
They are advised not to rub or scratch the irradiated area, not apply creams or lotions and keep it dry.
Local anesthetics are used to control the pain during swallowing towards the end of treatment.

Diet supplements, vitamins and minerals are prescribed early in the course of treatment to combat weight loss. Also weekly nutritional assessment is done to institute timely changes in the diet and monitor weight loss.
Dryness of mouth can be managed by conservative measures and in some cases saliva substitutes need to be used. This reduces the side effects due to radiotherapy during and after completion of treatment.
This service was started in Feb 2009 and currently is offered free in Sarawak General Hospital but this form of treatment could cost anywhere between 25,000 to 30,000 RM in private hospitals. Decisions are made based on the clinical assessment and the GFI scores and treatment is customized based on this data. Annually a Chest X ray and Ultrasound scan of the liver is done to assess for any spread of the disease. The survival is better for earlier stages, hence cure rates of around 90% are achieved for stage I and II. High levels of viral DNA in the blood after completion of treatment has been found to corroborate with an increased incidence of recurrence of the disease after treatment, but these are expensive and are not currently available in government hospitals.
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Directly above this space is the base of the skull with its many openings transmitting the nerves that pass from the brain down to the head.
This is due to a genetic predisposition in the HLA of this subgroup of population that enables the virus to enter the DNA and cause these changes. Other factors that have been implicated are occupational exposure to formaldehyde, soot, consumption of smoked and preserved food. It is a thin, tube-like instrument with a light and a lens for viewing and may also have a tool to remove tissue samples. This helps to assess the spread of the disease in the head and is of utmost importance in staging the person’s disease properly. Extraction may be needed when the tooth is shaky and cannot be salvaged by any conservative management.
Also the position of the lymph node in the neck matters, with LN lower down in the neck towards the collar bone signaling a more advanced disease than those higher up.
The area to be treated is then marked out on these films by the oncologist and calculations made for radiation delivery by the physicist. The treatment is given every day from Monday to Friday with no radiotherapy on Saturday and Sunday.
Towards the final phase, treatment is directed only towards the area with disease only, so that normal tissue side effects can be kept low while giving a curative dose to tumor.
The drug used in this case is called Cisplatin and is injected through the veins, commonly those of the arm. Two drugs called Cisplatin and 5 Flourouracil are used and are given as an infusion through the vein over 5 days. In some cases where proper skin care is not done, the new skin appears red and moist in some areas especially at the junction of the neck and shoulder. With increasing tumor and nodal size this figure comes down as the chance of distant metastases increases. Also there are clinical trials looking at the feasibility of adding newer less toxic chemotherapy and biological targeted therapy to radiation to improve results and decrease the rate of recurrence and metastasis. Its surface is rich in lymphoid tissue and is connected to a rich plexus of lymphatics which connects them to many lymph nodes that are seen in the neck region. At an early stage itself, this tumor can spread through lymphatics to the lymph nodes in the neck and thenceforth from there to the rest of the body especially to the bones, lung and liver. This may be the reason why we have seen many cases of this disease coming in members belonging to the same family. An appointment time is given to the patient and the actual treatment time per day takes between 10 to 15 minutes only. The dose to be given is usually calculated based on the body surface area and the kidney function of the patient, so the doses may vary from person to person. This may be preceded by a glucose and saline drip for a day to improve the kidney clearance so that the drugs can be eliminated from the body. They are symptoms dizziness blackout cold sweat ringing in earspolitical and, indeed, correct.
The incidence is also quite high among the Ibans and the Chinese, where as it is lesser among the Malays and relatively rare in Indians. In some instances when the patient presents with very advanced disease, this chemotherapy may be given before the radiotherapy to reduce the size of the nodal masses in the neck.

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