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Asians are shown to be at greater risk for nasopharyngeal cancer

04/01/2009

Tufts Medical Center, in the heart of Boston’s Chinatown, is uniquely poised to detect, treat and research an uncommon cancer of the head and neck known as nasopharyngeal carcinoma. It disproportionately affects individuals of Southeast Asian descent, in particular the Cantonese-speaking Chinese from Guangdong province of China.

“Up to thirty percent of my patients per clinic are Asian,” said Dr. Richard O. Wein, MD, FACS, Director of the Division of Head and Neck Surgery at Tufts Medical Center. “The focus of my practice is the diagnosis and management of head and neck cancer and a greater percentage of my practice is dedicated to the care of patients with nasopharyngeal cancer (NPC) than is typically seen by other head and neck surgeons. Our goal is to become a center for excellence for NPC.”

Head and neck cancer comprises approximately 3 percent of all cancers in North America. NPC represents only about 2-4 percent of all head and neck cancers. While the North American caucasian has a 1 in 100,000 chance of being diagnosed with NPC, the incidence can be up to 50 times greater for individuals from certain portions Southeast Asia.

Wein and the staff of the Otolaryngology Department at Tufts Medical Center have become experts in early detection of the cancer that forms in the trapezoidal space between the nasal choanae and the soft palate. Early detection is crucial; unfortunately, about half of all nasopharyngeal cancers are only detected once the cancer has metastasized to lymph nodes, and presents as neck mass.

“Early detection allows us to treat the patient with radiation only and earlier staged lesions are associated with a much better prognosis,” said Wein. Five-year survival rates for patients treated with early stage (I/II) NPC can be as high as 85 percent while rates for patients with advanced stage disease (III/IV) can fall below 50 percent.

Early signs of NPC can be as subtle as serous otitis media, ear pain similar to an ear infection, epistaxis or blood in the sputum and nasal secretions. Early changes in the nasopharynx cannot be detected with a tongue blade and endoscopic examination is typically required.

“It takes 20 seconds,” said Wein. “When I hear a Southeast Asian patient has come in with an ear problem without having a history of ear problems, I want to see them.” Wein has lead NPC screenings at Tufts Medical Center for Asian-Americans from Boston, Quincy and elsewhere in the region and hopes to hold additional screenings in the future. “We need to say: If you have a family history of NPC or come from the most impacted regions, give us 20 seconds for a screening.”

Nasopharyngeal cancer is usually treated via chemotherapy and radiation therapy. Surgery is utilized in the initial diagnosis and staging of the cancer and for salvage of post-chemoradiation persistent disease. Wein said the team approach at Tufts Medical Center allows the hospital to undertake each step of the treatment process in a coordinated response.

“It is what I like best here,” said Wein. “It is a multidisciplinary approach, the team approach that has Otolaryngology-Head & Neck Surgery, Medical Oncology, Radiation Oncology, Radiology, Pathology, Nutrition, Dentistry, Speech Language Pathology – all in one place is the best scenario for the patient. In addition, we try to work closely with the referring physician, making them part of the team as well.”

Wein and the Tufts Medical Center Department of Otolaryngology are a strong resource for doctors seeking guidance on head & neck reconstructive techniques following the surgical management of head and neck cancers. Free flap reconstruction of the tongue, mandible and face allows for a capacity to tailor reconstruction to a surgical defect with the patient’s living tissue and can allow patients to return to a life of normal speaking, eating and appearance. The reconstructive surgery team is increasingly seeing patients from all across the region.

Pointing to a picture of an elderly man whose jaw has been reconstructed using bone grafted from his fibula, Wein says, “Now he feels comfortable enough to go back to church. That’s what makes this so rewarding.”