Nasopharyngeal carcinoma in Indonesia: epidemiology, incidence,signs, and symptoms at presentation

Abstract

Among all head and neck (H&N) cancers, nasopharyngeal carcinoma (NPC) represents a distinct entity regarding epidemiology, clinical presentation, biological markers, carcinogenic risk factors, and prognostic factors. NPC is endemic in certain regions of the world, especially in Southeast Asia, and has a poor prognosis. In Indonesia, the recorded mean prevalence is 6.2/100 000, with 13 000 yearly new NPC cases, but otherwise little is documented on NPC in Indonesia. Here, we report on a group of 1121 NPC patients diagnosed and treated at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia between 1996 and 2005. We studied NPC incidence among all H&N cancer cases (n=6000) observed in that period, focusing on age and gender distribution, the ethnic background of patients, and the disease etiology. We also analyzed most prevalent signs and symptoms and staging of NPC patients at first presentation. In this study population, NPC was the most frequent H&N cancer (28.4%), with a male-to-female ratio of 2.4, and was endemic in the Javanese population. Interestingly, NPC appeared to affect patients at a relatively young age (20% juvenile cases) without a bimodal age distribution. Mostly, NPC initiated in the fossa of Rosenmuller and spreaded intracranially or locally as a mass in the head. Occasionally, NPC developed at the submucosal level spreading outside the anatomic limits of the nasopharynx. At presentation, NPC associated with hearing problems, serous otitis media, tinnitus, nasal obstruction, anosmia, bleeding, difficulty in swallowing and dysphonia, and even eye symptoms with diplopia and pain. The initial diagnosis is difficult to make because early signs and symptoms of NPC are not specific to the disease. Early-age Epstein-Barr virus (EBV) infection combined with frequent exposure to environmental carcinogenic co-factors is suggested to cause NPC development. Undifferentiated NPC is the most frequent histological type and is closely associated with EBV. Expression of the EBV-encoded latent membrane protein 1(LMP1) Oncogene in biopsy material was compared between NPC patients of < 30 years old and those of ≥ 30 years old, matched for sex and tumor stage. Higher LMP1 expression in patients of <30 years old was observed, which was related to more locoregional progressivity. Increased medical awareness of prevailing early stage signs and symptoms coupled to use of EBV-related diagnostic tumor markers may lead to down-staging and timely treatment to improve survival of patients with this aggressive disease.

Interference of Fisetin with Targets of the Nuclear Factor-κB Signal Transduction Pathway Activated by Epstein-Barr Virus Encoded Latent Membrane Protein 1

“…In human epithelial cells, LMP1 alters many functional properties that are involved in tumor progression and invasions (Kim et al, 2000;Adham et al, 2012;Bambang et al, 2010). Activation of different signal transduction pathways mediates various downstream pathological effects of LMP1 expression, including cell proliferation, anti-apoptosis and metastasis (Eliopoulos et al, 2001;Guo et al, 2012).…”

Ekspresi mRNA LMP2A Epstein-Barr Virus dari Biopsi Jaringan dalam Blok Parafin Berpotensi sebagai Biomarka dalam Diagnosis Karsinoma Nasofaring

“…Ekspresi gen LMP yang terdiri dari LMP-1 dan -2 adalah onkogen EBV yang ekpresinya lebih tinggi pada pasien usia muda (<30 tahun) dan mengindikasikan replikasi virus yang tinggi dalam sel. Ekspresi gen LMP ini juga berkaitan dengan progresifitas lokal dari KNF (Adham et al, 2012). Gen LMP2A memainkan peran penting dalam menjaga kondisi infeksi laten EBV pada sel B dan berpartisipasi dalam induksi Biosfera Vol 33, No 3 September 2016: 121-125 DOI: 10.20884/1.mib.2016 transformasi sel epitel tumor KNF (Dawson et al, 2012).…”

“…Mayoritas penderita KNF pada usia lebih dari 40 tahun, karena pada usia tersebut diperkirakan sudah terjadi akumulasi paparan faktor lingkungan berupa bahan-bahan karsinogen yang sudah melebihi batas ambang terjadinya tumorigenesis. Hasil penelitian ini juga sesuai dengan hasil penelitian Adham et al, (2012) yang memperoleh data distribusi KNF di Rumah sakit Cipto Mangunkusomo yaitu rentang usia 41-50 sebanyak 32,4%, usia 31-40 sebanyak 23,4%, dan usia 51-60 sebanyak 16,4%.…”

The prognostic value of IgA/[EBNA1+VCA-p18] on survival of nasopharyngeal cancer patients

“…In Indonesia, NPC is the fourth commonest cancer in men and sixth among women (Adham, 2012). More than 90% of NPC in Indonesia comprised of histology type World Health Organization (WHO) III or undifferentiated carcinoma which is strongly correlated with Epstein-barr virus (EBV) infection (Soeripto, 1997;Adham et al, 2012).…”

“…In Indonesia, NPC is the fourth commonest cancer in men and sixth among women (Adham, 2012). More than 90% of NPC in Indonesia comprised of histology type World Health Organization (WHO) III or undifferentiated carcinoma which is strongly correlated with Epstein-barr virus (EBV) infection (Soeripto, 1997;Adham et al, 2012). Consistent expression of EBV gene products in nasopharyngeal cancer cells, specific immune response to EBV antigen in NPC patients, as well as detection of EBV in premalignant lesion support the pathogenic role of EBV in NPC (Henle et al,1970;Wolf et al, 1973;Henle, 1976;Ho et al, 1976;Zeng et al 1982Zeng et al , 1983Yeung et al, 1993;Sam et al, 1994;Pathmanathan et al, 1995;Gulley, 2001;Chien et al, 2001;Middeldorp et al, 2003).…”