Why surgical resection is not the first choice for nasopharyngeal carcinoma

Generally speaking, surgical resection is a radical cure for malignant tumors, but nasopharyngeal carcinoma is an exception. Its preferred treatment is radiotherapy for the following three reasons.

1. Special anatomical position.

The location of nasopharyngeal cancer is relatively hidden, with a vertical diameter of only 5.5cm~6.0cm, and a rectangular cavity shaped like a small matchbox. Its back wall is the cervical vertebrae, and the top wall is the skull base. The rupture foramen has the sublingual, glossopharyngeal, vagus, accessory nerves and important arteries and veins entering and exiting the cranial cavity. Nasopharyngeal cancer can also invade the skull from here. There are large arteries, veins and lymphatic tissues on both sides of the wall. It is very difficult to perform radical tumor surgery without damaging these important structures in such a small area surrounded by large blood vessels and cranial nerves.

2. The rapid development of the lesion brings difficulties and limitations to the surgery.

The tumor of nasopharyngeal carcinoma expands upward into the middle cranial fossa, which can damage many cranial nerves and metastasize to the deep cervical lymph nodes. The metastasis rate can be as high as 60% to 80%. It can also metastasize to the brain and neck at the same time, and can also metastasize to the distant liver. Most nasopharyngeal carcinomas are highly malignant undifferentiated or poorly differentiated cancers. Only 4% to 7% of them are diagnosed in the early stage. Most patients are in the middle and late stages of nasopharyngeal carcinoma when they seek medical treatment.

3. Radiotherapy has good effect.

Nasopharyngeal carcinoma is sensitive to radiotherapy. If radiotherapy is chosen, the patient's 5-year survival rate can reach 49.5%. In addition, radiotherapy can maintain the original structure of the nasal cavity and has the advantages of less trauma.

Of course, there are some cases where surgical resection is needed, such as when the tumor is localized with no signs of metastasis, or when there is residual cancer after radiotherapy.