What tests should be done when nasopharyngeal carcinoma is highly suspected

Optical fiber scopy and Epstein-Barr virus serological examination can greatly improve the early diagnosis rate of people at high risk of nasopharyngeal carcinoma, but for those who are highly suspected of nasopharyngeal carcinoma, what kind of examinations are needed?

Indirect nasopharyngoscopy and/or fiberoptic endoscopy

This examination helps to detect nasopharyngeal masses, as well as abnormal lesions such as ulcers, necrosis and hemorrhage. Fiberoptic endoscopy is suitable for patients with large pharyngeal reflexes or difficulty opening the mouth, and may detect small lesions in the nasopharynx and posterior nasal cavity that cannot be found by indirect endoscopy.

Biopsy

This examination can be used as the basis for the diagnosis of nasopharyngeal carcinoma. Biopsy tissue can be collected through the nasal cavity or oral cavity, or under direct vision of a nasopharyngeal fiberscope. For early patients who are highly suspected of nasopharyngeal carcinoma, if the biopsy is negative, do not easily deny the diagnosis, and perform another biopsy if necessary. Cervical lymph node biopsy is limited to patients with cervical lymph node enlargement whose clinical symptoms and signs and EB virus serology highly suggest nasopharyngeal carcinoma, but the primary lesion of the nasopharynx is not obvious on CT scan and multiple biopsies of the nasopharynx are negative. The nasopharyngeal smear exfoliative cytology examination can only be used as an auxiliary diagnosis.

Epstein-Barr virus serology

EB virus serological examination includes VCA-IgA, EA-IgA, and DnaseAb testing. Patients with nasopharyngeal carcinoma may have increased EB virus titers, and this phenomenon may sometimes occur before clinical symptoms and signs appear. It is very helpful for general investigation, early diagnosis, and observation of disease changes and development, but it cannot be used alone as a basis for the diagnosis of nasopharyngeal carcinoma.

Imaging tests

CT or MRI examinations are helpful in assisting the diagnosis of NPC, as well as accurate staging, accurate design of radiation fields, and estimation of prognosis. CT is better for showing skull base bone destruction, while MRI is more helpful in distinguishing tumors, inflammation, or fibrosis. Abdominal B-ultrasound and whole-body bone ECT examinations are conducive to early detection of possible distant metastases.