The first sign of NPC is often an enlarged metastatic cervical node in the posterior triangle. Common local signs and symptoms include nasal (blood-stained discharge, obstruction), aural (serous otitis media, tinnitis, conductive hearing loss) and neurological symptoms (diplopia due to abducen nerve paralysis). Diagnosis is by flexible fibreoptic nasopharyn-goscopy and biopsy. Elevated blood levels of antibodies to Epstein-Barr virus capsid antigen (IgA-VCA) and early antigen (IgA-EA) are often seen. CT and MRI are useful in staging the disease and in detection of recurrence. Radiation is the firstline treatment for NPC of all stages because of the radiosensi-tivity of undifferentiated carcinoma. For recurrent disease after radiotherapy, surgical resection of the nasopharynx by the transoropalatal approach, mandibular swing or maxilla swing approach are recently established surgical salvage procedures that are preferred over re-irradiation which is associated with complications including radiation myelitis, encephalopathy, cranial nerve palsy, otitis media, hearing loss, trismus, cataract formation and osteoradionecrosis of the maxilla and mandible. For recurrent disease limited to the neck, radical neck dissection provides excellent control of the neck disease.
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