Relation Between Smoking and Nasopharyngeal Carcinoma at Assir Region, South of Saudi Arabia

Jibril Hudise; Khalid Alshehri; Ibrahim Sumaily; Nasser Maqbool; Wafa Alshehri; Ashwaq Asiri; Bayan Al jobran; Abdrahman Alshehri

doi:10.4103/1319-8491.273921

ORIGINAL ARTICLE

Year : 2018 | Volume : 20 | Issue : 2 | Page : 51-55

Relation Between Smoking and Nasopharyngeal Carcinoma at Assir Region, South of Saudi Arabia

Jibril Hudise¹, Khalid Alshehri¹, Ibrahim Sumaily¹, Nasser Maqbool¹, Wafa Alshehri², Ashwaq Asiri², Bayan Al jobran², Abdrahman Alshehri²
¹ Deapartment of ORL-HNS Assir Central Hospita, and King Faisal Medical City of the Southerm Region, Abha, Saudi Arabia
² Medical students, Faculty of Medicine, King Khalid University Abha, Saudi Arabia

Date of Web Publication

23-Dec-2019

Correspondence Address:
Jibril Hudise
ORLHNS Department, Aseer central hospital, KFM City of Southern Region, Abha
Saudi Arabia

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-8491.273921

Abstract

Introduction: Nasopharyngeal carcinoma arises from the epithelium that covers the nasopharyngeal mucosa. A variety of risk factors have been correlated with nasopharyngeal carcinoma, including alcohol, tobacco, Cantonese-style salted fish, occupational exposures and herbal drugs.
Objectives : This was a retrospective study made to assess the relation between smoking and nasopharyngeal carcinoma and affect of smoking on nasopharyngeal carcinoma at Assir Region conducted in Assir Central Hospital, Abha, Saudi Arabia.
Methods: During a 5-year period (2011–2016), the medical records of patients with nasopharyngeal masses were collected from the department of pathology at Aseer Central Hospital .The cases were reviewed for data on gender ,age, the pathology, family history and history of smoking.
Results: Over a period of 5 years, a total of 105 patients :68 men and 37 women who had nasopharyngeal masses were studied for pathological assessments. The age of presentation was ranging from 6 to 92 years. The histopathological diagnosis of the nasopharyngeal masses were: reactive lymphoid hyperplasia in 62.7%, nasopharyngeal carcinoma (NPC) 31.4%,tuberculosis (TB) 1%, Warthin tumor 1%, non Hodgken lymphoma 2.9% and rhabdomyosarcomal 1%. In NPC, never smokers were 42.4%, current smokers 36.4% and Ex-smokers 21.2%. while in reactive hyperplasia, never smokers 81.8%, current smokers 12.1% and Ex- smokers 6.1%.
Conclusions : Nasopharyngeal carcinoma has proved to be the most common type of nasopharyngeal cancer arising from the epithelial cells that line the nasopharynx. Smoking is strong risk factor in cases of nasopharyngeal carcinoma.

Keywords: nasopharyngeal carcinoma, smoking and risk factors, lymphoid hyperplasia

How to cite this article:
Hudise J, Alshehri K, Sumaily I, Maqbool N, Alshehri W, Asiri A, Al jobran B, Alshehri A. Relation Between Smoking and Nasopharyngeal Carcinoma at Assir Region, South of Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg 2018;20:51-5

How to cite this URL:
Hudise J, Alshehri K, Sumaily I, Maqbool N, Alshehri W, Asiri A, Al jobran B, Alshehri A. Relation Between Smoking and Nasopharyngeal Carcinoma at Assir Region, South of Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2018 [cited 2023 Jan 31];20:51-5. Available from: https://www.sjohns.org/text.asp?2018/20/2/51/273921

Introduction

Nasopharyngeal carcinoma (NPC) arises from the epithelium that covers the nasopharyngeal mucosa ^[1]. It was first described by Regaud and Schmincke in1921. Squamous cell carcinomas account for 97% of malignant neoplasms of the nasopharynx^[2]. NPC has proved to be the most common type of nasopharyngeal cancer arising from the epithelial cells that line the nasopharynx. NPC is a unique malignant cancer in the head and neck area. Its demographic, clinical and geographic characteristics are distinct from those of other head and neck epithelial malignancies ^[3]. NPC is rarely found in most regions, especially in Europe and North America (as reported, the incidence is below 1/100 000) ^[4],[5]. In contrast, it is of a high incidence in some areas in Southern China, especially in the Cantonese region around Guangzhou, where approximately 25 per 100,000 people suffer from the disease ^[6].

A variety of risk factors have been correlated with NPC, including alcohol, tobacco, Cantonese-style salted fish, occupational exposures and herbal drugs ^[7]. Tobacco is a well-known causal factor for head and neck cancers, except NPC ^[8]. Tobacco contains more than 7000 chemicals (at least 250 of these chemicals are known to be harmful) and more than 70 carcinogens ^[9],[10]. Cigarette smoke can damage the cell’s DNA and activate the cancer cells, weaken the body’s immune system and make it harder to kill cancer cells ^[11].

Objectives:

This study aimed at assessing the relation between smoking and nasopharyngeal masses and its effect on nasopharyngeal carcinoma in Assir region of Saudi Arabia.This study was conducted at Assir Central Hospital, Abha,, Saudi arabia.

Methods:

During a 5-year period (2011–2016), the medical records of patients with nasopharyngeal masses were collected from the Department of Pathology at Assir Central Hospital, Abha, Saudi Arabia. The cases were reviewed for data on gender, age, the pathology, family history and history of smoking . We divided the age to 4 categories : less than 21 year , from 21 to 40 year , from 41 to 60 year , and more than 60 years. We also divided history of smoking into 3 categories : Never smokers, current smokers, and ex-smokers .All statistical tests were performed with SPSS software. IRB approval was obtained.

Results

Over a period of 5 years , a total of 105 patients 68 men and 37 women who had nasopharyngeal masses for pathological assessments were studied. The age of presentation was ranging from 6 to 92 years .The histopathological diagnosis of the nasopharyngeal masses were: reactive lymphoid hyperplasia was most common followed by nasopharyngeal carcinoma (NPC) [Table 1].

Table 1: Distribution Of Nasopharyngeal Masses

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In cases of nasopharyngeal carcinoma (NPC) :

i-Age distribution : The age at diagnosis was ranging from 16 to 75 years. The most common age was from 41 to 60 years [Table 2].

Table 2: Age in Reactive Lymphoid Hyperplasia and Nasopharyngeal Carcinoma

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ii-Sex: Of 33 cases of nasopharyngeal carcinoma there were 23 males( 69.7% ) and 10 cases females (30.3%) .

iii-Family History: Of 33 cases of nasopharyngeal carcinoma there was only one case with a family history of nasopharyngeal carcinoma (3%) , 5 cases with a family history of other malignancy (15.2%) ,and 27 cases with no history of nasopharyngeal nor other malignancy (81.8%).

iv-Smoking: Nineteen cases of the nasopharyngeal carcinoma cases gave a history of current smoking and ex- smoking and 14 patients never smoked . [Table 3].

Table 3: Comparison Between NPC and Reactive Lymphoid Hyperplasia In Relation to Smoking in our Study

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Table 4: Comparison Between our Study and Other Study Regarding NPC and Smoking

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Cases of reactive lymphoid hyperplasia :

i-Age distribution: The age at diagnosis was ranging from 14 to 65 years. The most common age presentation was from 21 to 40 years [Table 2].

ii-Sex: In the total of 66 cases of reactive lymphoid hyperplasia : male were 41 (62.1% ) and females were 25 (37.9% ).

iii-Family History: Of the total cases of reactive lymphoid hyperplasia three cases had a family history of nasopharyngeal carcinoma (4.5% ,) nine cases with family history of other malignancy (13.6% ), and 54 cases with no history of nasopharyngeal or other malignancy (81.9%).

iv-Smoking: Of the 66 cases of reactive lymphoid hyperplasia 54 cases never smoked and the rest between were current smokers and ex-smokers [Table 3].

Discussion

Nasopharyngeal carcinoma is a rare cancer type in most regions of the world, but is more common in South-East Asia, North Africa and the Inuit populations of Greenland, Canada, and Alaska ^[12]. Major risk factors for NPC include Epstein- Barr virus (EBV) infection, diet ,and genetic susceptibility ^[13]. In our study we studied the affect of smoking on NPC . Association between cigarette smoking and increased risk of NPC has been consistently reported in some low incidence populations, such as North American ^[14]. where keratinizing squamous cell carcinomas are the predominant histological type of NPC ^[15]. Safavi-Naini et al. studied the Incidence Trends and Geographical Distribution of NPC in Iran from2004 to 2009Theyidentified 1431 patients with histologically proven NPC ,Male patients have accounted for 981 cases (68.5%) and females for 450(31.5%) ^[16]. Turkoz et al studied risk factors of nasopharyngeal carcinoma in Turkey in an epidemiological survey of the Anatolian Society of Medical Oncology reported a total of 183 NPC patients (males 66.7%; females 33.3%) ^[5]. Lee et al studied the epidemiology of nasopharyngeal carcinoma in Hongkong during a 20-year period (1980 –99) and report a total of 21,768 new cases of NPC had been registered; 15,801 (72.5%) males and 5,967 (27.5%) females^[17]. Krishna et al studied primary nasopharyngeal cancer of Indian origin and report (70%) males and (30%) females ^[18]. In our study males (69.7%) and females(30.3%). Regarding age distribution in nasopharyngeal carcinoma, Turkoz et al studied risk factors of nasopharyngeal carcinoma in Turkey in an epidemiological survey of the Anatolian Society of Medical Oncology in a total of 183 NPC patients , and report the peak age incidence for NPC as 40-50 years (36.3%) ^[5]. Hsu et al report in their study about NPC in Taiwan , the age to be less than 40 years (19.5%), from 40 to 49 years (24.4% ),from 50 to 59 years (28% ) and more than 60 years (28.1%) ^[19]. Krishna et al studied primary nasopharyngeal cancer of Indian Origin and report that NPC occurs in age less than 20 years in (24.3%) and more than 20 years in (75.7%), while in benign epithelium age of less than 20 years (65.4%) and more than 20 years (34.6%)^[18]. In our study ,the peak age incidence for NPC was from 41 to 60 years. while in reactive hyperplasia the peak age incidence was from 21 to 40 years 57.6% .

Friborget et al. studied tobacco and alcohol use as a risk factors for pharyngeal carcinomas in Singapore Chinese and found the following in NPC and smoking status in total of 173 patients diagnosed with NPC, to be; never smokers 57.8% , current smokers 31.2% and ex-smokers 11% ^[20]. Yuan et al. studied non-dietary risk factors for NPC in Shanghai , China in 935 patient with NPC and the smoking status was , never smokers 45.9%, current smokers 47.3% , and ex-smokers 6.8% ^[21]. Yong et al. in their study of associations of lifestyle and diet with the risk of nasopharyngeal carcinoma in Singapore: in total of 300 cases with NPC they found never smokers to be 50.3%, current smokers 27.2%, and ex-smokers 22.4% [ 22]. Guo et al. in their evaluation of non-viral risk factors for nasopharyngeal carcinoma in a high-risk population of Southern China reported the association between NPC and smoking in a total of 1049 cases with NPC to be as follows: never smokers 48.3% and 51.7% in smokers ^[23]. Turkoz et al studied risk Factors of nasopharyngeal carcinoma in Turkey and found never smokers to be 37.16% and 62.84% smokers ^[5]. In our study we found smoking to be a strong risk factor in cases of NPC in comparison with benign nasopharyngeal masses. In NPC, never smokers were 42.4%, current smokers 36.4% and ex-smokers 21.2%. while in Reactive hyperplasia never smokers were 81.8%, current smokers 12.1% and ex-smokers 6.1%.

Conclusions

Nasopharyngeal carcinoma (NPC) arises from the epithelium that covers the nasopharyngeal mucosa. Nasopharyngeal carcinoma has proved to be the most common type of nasopharyngeal cancer which arising from the epithelial cells that line the nasopharynx. Smoking is a strong risk factor in cases of nasopharyngeal carcinoma. Aging another important risk factors . Any patient older than 20 years with nasopharyngeal mass should undergo biopsy from the nasopharynx.

Limitation

1- This is a retrospective cohort study based on quality of records keeping in the hospital.

2- Our study was based only in one center . 3-Small numbers of cases .

Acknowledgement

We would like to thank all doctors and nurses working in the Histopathology Department in Assir Central Hospital , Abha, Saudi Arabia.

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