Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
New diagnosis of nasopharyngeal cancer (NPC) OR follow-up for established NPC
(Specify) Symptoms of NPC can vary depending on the stage and location of the tumor.
Common presenting complaints include:
Nasal congestion or blockage (one-sided or persistent)
Epistaxis (nosebleeds)
Otalgia (ear pain) – often radiating from the affected side
Tinnitus (ringing in the ear)
Cranial nerve palsies (facial weakness, difficulty swallowing) – in later stages
Neck masses (lymph node enlargement)
Hearing loss (conductive or sensorineural)
Visual disturbances (rare)
History of Present Illness:
Onset, duration, and severity of symptoms.
For established NPC:
Date of diagnosis and initial treatment received (surgery, radiation, chemotherapy).
Response to treatment (tumor shrinkage, symptom improvement).
Any new or worsening symptoms.
History of treatment side effects.
Past Medical History:
Underlying medical conditions (e.g., Epstein-Barr virus (EBV) infection).
Family history of NPC (increased risk in some ethnicities, particularly Southeast Asian).
Social History:
Tobacco use (smoking is a risk factor for NPC).
Dietary habits (preserved salted fish consumption may be a risk factor).
Occupational exposures to dust or wood particles (potential risk factors).
Physical Exam:
Head and neck examination: Assess for nasal masses, asymmetry, or discharge.
Evaluate for facial weakness, palatal movement, and lymph node enlargement in the neck. Examine the ears for signs of otitis media with effusion (fluid behind the eardrum).
Visual acuity testing (if vision problems are reported).
Imaging Studies:
Nasopharyngoscopy: Direct visualization of the nasopharynx using a flexible fiberoptic scope.
Biopsy of suspicious lesions can be performed during this procedure.
MRI scan with contrast: Essential for evaluating the extent of the tumor, involvement of lymph nodes, and potential bone invasion.
CT scan of the chest, abdomen, and pelvis: May be done to assess for distant metastasis (spread of cancer to other organs).
Laboratory Tests:
Epstein-Barr virus (EBV) serology: EBV infection is a risk factor for NPC. Tests can detect past or present EBV infection.
Complete blood count (CBC): May show abnormalities if cancer has spread to bone marrow.
Basic metabolic panel (BMP): Assesses overall health and may identify potential complications from treatment.
Staging:
The stage of NPC is determined based on the TNM classification system, which considers tumor size (T), lymph node involvement (N), and distant metastasis (M). Higher stages indicate more advanced disease.
Assessment:
Nasopharyngeal carcinoma (stage [insert stage]): Confirmed by biopsy and staged based on imaging studies.
EBV status: Positive or negative for EBV infection.
Differential Diagnoses:
Consider other conditions that can cause similar symptoms:
Chronic rhinosinusitis
Nasal polyps
Adenoid hypertrophy (enlarged adenoids)
Lymphoma involving the nasopharynx
Plan:
The treatment plan for NPC is typically multimodality, involving a combination of:
Surgery: Nasopharyngectomy (removal of the tumor and surrounding tissues) is the mainstay of treatment for early-stage NPC.
Radiation therapy: External beam radiation therapy with or without concurrent chemotherapy is often used after surgery or for inoperable tumors.
Chemotherapy: May be used in combination with radiation therapy or alone for advanced-stage disease.
Discuss the specific treatment plan based on the stage of the cancer, overall health, and patient preferences.
Outline potential side effects of treatment and plan for supportive care.
Schedule follow-up appointments for monitoring and surveillance