Nasopharyngeal Carcinoma in South of Iraq: A Retrospective Study View PDF

Nasopharyngeal carcinoma (NPC) is the most common head and neck tumor in people from southern China and Southeast Asia, especially Malaysia [1,2]. In Singapore it is the second most common tumor [3]. Its incidence is 87% in China, 10% in Malaysia, 3% in European [2,3]. In Hong Kong NPC forms the third commonest malignant tumor in men and sixth commonest tumor in women [4]. This finding suggests that genetic and environmental factors contribute to the cause of the disease [5]. Patients with NPC commonly present at an advanced stage lead to poor prognosis due to delay in seeking medical advice, and confusing nature of the presenting symptoms [6,7-11]. A study in Gungxi medical university (south of china) in 2008 reported that smoking may play a role by activating the Epstein-Barr virus replication which is the strongest etiological risk factor in NPC [12].

This is a retrospective study, was conducted in Al-Shifaa oncology center and al-Sadder teaching hospital for a period of 8 months from by performed using the pathology files of patients, with legal permission.  In which 20 patients documented with NPC from different southern cities. History and investigation results documented are focusing on the following: age, address, gender, stage of the disease, histopathology, and tobacco smoking.

Twenty patients were included in this study. The mean±SD of age was 40±13.98 years. Misan and Nasiriya high percent of NPC. Males were 3 folds affected than females (Table 1).

Table 1: Distribution according to Age, Address and gender.

Eleven patients presented with stage II disease, followed by stage III in six cases. The undifferentiated NPC was frequently recorded in 50% of patients. Of 20 patients, 13 (65%) patients were tobacco smoking (Table 2).

Table 2: Distribution of cases according to stage, histopathology and smoking.

NPC continues to be of concern to clinical oncologist due to non-specificity of symptoms often delays the diagnosis and therapy decrease the opportunities for curative treatment [12]. In our study we found that disease is observed mal-frequently among patients more than 40 years which is the commonest mode of presentation in south of Asia, it is by model presentation of age start to rise in the second decade and peaks at the fourth decade then reach to plateau level and declines [5,7,10].

We have found that Misan and Nasiriyah have the greatest percentages with a male to female ratio 3:1 which is confirmed to the most of worldwide studies [3,4,7, 11].

In southern of china where NPC nearly all cases are of undifferentiated type, in USA where NPC is rare about one of five keratinizing type [5], in our study we found that most cases are undifferentiated. The stages II were considered the commonest one, about 55% of patients. The 5-year survival rate in this stage is about 64% [12].

Smoking considered as strong etiological factor for head and neck tumor especially laryngeal and nasopharynx tumor in many studies as showed that risk is reached it is peak level with increased duration and exposure to tobacco, in addition our study strongly reported that 65% of cases effected were smokers.

NPC was more often in 20-60 years age group than other groups. Misan and Nasiriyah provinces have high incidence than Basrah and Wasit provinces of NPC cases. Male to female ratio of NPC is 3:1. In Iraq, the stage II represented the commonest stage of sample. Undifferentiated histopathology is the dominant one. Tobacco smoking is major risk factor in our country.

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