The relevance of this topic is confirmed by a rather high increase in morbidity and the problem of timely diagnosis of nasopharyngeal carcinoma, because in 85- 90% of cases, the disease is diagnosed in late stages of the process, which significantly impairs five-year survival of these patients.
Taking into account the presence of high titres of immunoglobulins to EpsteinBarr virus in most patients with nasopharyngeal carcinoma and its tropism to tissues of the nasopharynx with high likelihood of prolonged persistence and ability of causing chronic nasopharyngitis, the development of diagnostic criteria for such patients with the goal of formation risk groups, underpins the improvement of early diagnosis of nasopharyngeal carcinoma.
The basis of the study was a group of 108 patients with chronic nasopharyngitis and 30 patients with a diagnosis of nasopharyngeal carcinoma. Comprehensive study included the identification of subjective and objective clinical manifestations of the disease, serological identification of titers of IgG to the capsid (VCA p-18) as well as Ig G to the nuclear (NA-1) Epstein-Barr virus antigens and the pathological study of the biopsy tissues of the nasopharynx. The study showed that a group of patients with chronic nasopharyngitis with high IgG titers to Epstein-Barr virus revealed a number of signs that correlate with signs in the group of patients with nasopharyngeal carcinoma. These characteristics are presented as criteria for the formation of a risk groups for nasopharyngeal carcinoma. Subjective symptoms include: symptom of postnasal drips, symptoms of auditory dysfunction, two or more general symptoms combined with prolonged fever (sub febrile), and a long history of complains for over 3.2 years. In the objective examination, important clinical criteria are: lymphadenopathy alongside the posterior margin of the sternocleidomastoid muscle and signs of hyperplasia of the nasopharyngeal tonsil. An important laboratory criterion for the formation of a risk group for nasopharyngeal carcinoma is the serological test method - the detection of high titers (more than 100 mu / ml, at a laboratory standard up to 20 mu/ml) of IgG to the VCA p-18 and the NA-1 EpsteinBarr virus. Proof of concept was the biopsy study, which found the same pathological findings in the group with chronic nasopharyngitis with high titers of IgG to the VCA p-18 and the NA-1 of Epstein-Barr virus and in the group with nasopharyngeal carcinoma when examining in areas on the border with a healthy tissue. In particular, in patients with chronic nasopharyngitis, in hyperplastic pharyngeal tonsils, focal metaplasia of the superficial respiratory epithelium is observed in a multilayered flat non-threshold in 72%; hyperplasia of lymphoid tissue of follicles and perifollicular tissue; cyst forming with the formation of real cysts and pseudo cysts in 53.1% (due to penetration of the mucous secretion into the lymphoid tissue); Koilocytosis of surface epithelium and epithelium of cyst in 87,3%; diffuse focal sclerosis, which correlates with angiomatosis in 65.6% of cases. These signs indicate the viral nature of the disease, the importance of Epstein-Barr virus as a factor in supporting inflammation, the ability of the virus to the structural rearrangement of affected tissues.
If the patient has the above-mentioned criteria, an endoscopic examination of the nasopharynx and, if indicated, additionally a biopsy should be performed.
Comparing the incidence of nasopharyngeal carcinoma in Ivano-Frankivsk and Transcarpathian regions, after the introduction of risk groups formation in IvanoFrankivsk region since 2010, an increased frequency of early diagnosis of this pathology has been reported. In particular, in Transcarpathia, where this system hasn’t been introduced, during the period from 2000 to 2004, nasopharyngeal carcinoma cases at stages І-ІІ were diagnosed only in 7.5% of cases. Since 2010 diagnosis at early stages slightly increased, but remains unsatisfactory with 13% of cases detected early. On the other hand, in Ivano-Frankivsk region, in the period 2000-2004, nasopharyngeal carcinoma at stages I-II was diagnosed in 8% of patients, but from 2010, due to the introduction of an active detection system, nasopharyngeal carcinoma at stages I-II is being detected in 25% of cases.
Thus, the dissertation paper summarizes and solves the scientific problem - increasing the frequency of early diagnosis of nasopharyngeal carcinoma, because the introduction of criteria for forming risk groups for nasopharyngeal carcinoma showed a significant increase in the diagnosis of this condition at stages I-II.
