|Year : 2018 | Volume
| 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|
ORLHNS Department, Aseer central hospital, KFM City of Southern Region, Abha
Source of Support: None, Conflict of Interest: None
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 2022 Nov 28];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 . It was first described by Regaud and Schmincke in1921. Squamous cell carcinomas account for 97% of malignant neoplasms of the nasopharynx. 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 . NPC is rarely found in most regions, especially in Europe and North America (as reported, the incidence is below 1/100 000) ,. 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 .
A variety of risk factors have been correlated with NPC, including alcohol, tobacco, Cantonese-style salted fish, occupational exposures and herbal drugs . Tobacco is a well-known causal factor for head and neck cancers, except NPC . Tobacco contains more than 7000 chemicals (at least 250 of these chemicals are known to be harmful) and more than 70 carcinogens ,. 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 .
| 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].
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 . Major risk factors for NPC include Epstein- Barr virus (EBV) infection, diet ,and genetic susceptibility . 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 . where keratinizing squamous cell carcinomas are the predominant histological type of NPC . 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%) . 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%) . 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. Krishna et al studied primary nasopharyngeal cancer of Indian origin and report (70%) males and (30%) females . 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%) . 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%) . 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%). 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% . 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% . 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 . Turkoz et al studied risk Factors of nasopharyngeal carcinoma in Turkey and found never smokers to be 37.16% and 62.84% smokers . 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.
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 .
We would like to thank all doctors and nurses working in the Histopathology Department in Assir Central Hospital , Abha, Saudi Arabia.
| References|| |
Vasef MA, Ferlito A, Weiss LM. Nasopharyngeal carcinoma, with emphasis on its relationship to Epstein-Barr virus. Ann Otol Rhinol Laryngol.
Yeh S. The relative frequency of cancer of the nasopharynx and accessory sinuses in Chinese in Taiwan. Cancer Nasopharynx.
UICC Monograph Series 1.1967; 54-57.
Liu FF, Frappier L, Kim J O, Sullivan B, Hui A, Bastianutto C. East-West Symposium on nasopharyngeal cancer. Symposium on nasopharyngeal cancer. Int. J. Radiation Oncology Bio Phys.
2007;67. 3: 703-708.
Trends in the Incidence Rates of Nasopharyngeal Carcinoma among Chinese Americans Living in Los Angeles County and the San Francisco Metropolitan Area, 1992-2002. Am J Epidemiol,
Risk factors of nasopharyngeal carcinoma in Turkey-an epidemiological survey of the Anatolian Society of Medical Oncology. Asian Pac J Cancer Prev.
2011; 12.11: 3017-3021.
Mak HW, Lee SH, Chee J, Tham I, Goh BC, Chao SS, Lim CM. Clinical outcome among nasopharyngeal cancer patients in a multi-ethnic society in Singapore. PloS one.
Mimi CY, Yuan JM, Epidemiology of Nasopharyngeal Carcinoma. Semin Cancer Bio.
2002; 12: 421-429.
Lin J. Smoking and Nasopharyngeal Carcinoma: Perspective Evidence from the Guangzhou Occupational Cohort Study and a Meta-Analysis. 2015; HKU Theses Online HKUTO
Centers for Disease Control and Prevention. How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease: A Report of the Surgeon General.
Eastwood B, Dockrell MJ, Arnott D, Britton J, Cheeseman H, Jarvis MJ, McNeill A. Electronic cigarette use in young people in Great Britain 2013-2014. Public Health.
Warren GW, Alberg AJ, Kraft AS, Cummings KM. The 2014 Surgeon General’s report:The Health Consequences of Smoking-50 Years of Progress : a paradigm shift in cancer care. Cancer.
2014; 120.13: 19141916.
Devi BC, Pisani P, Tang TS, Parkin DM. High incidence of nasopharyngeal carcinoma in native people of Sarawak, Borneo Island. Cancer Epidemiol and Prev Biomarkers.
Hildesheim A, Dosemeci M, Chan CC, Chen CJ, Cheng YJ, Hsu MM, Chen JY. Occupational exposure to wood, formaldehyde, and solvents and risk of nasopharyngeal carcinoma. Cancer Epidemiol and Prev Biomarkers.
Chow WH, McLaughlin JK, HrubecZ, NamJM, Blot WJ. Tobacco use and nasopharyngeal carcinoma in a cohort of US veterans. Internat J Cancer.
Ou SH, Zell JA, Ziogas A, Anton-Culver H. Epidemiology of nasopharyngeal carcinoma in the United States: improved survival of Chinese patients within the keratinizing squamous cell carcinoma histology. Ann J Oncol.
2006; 18.1: 29-35.
Safavi-Naini A, Raad N, Ghorbani J, Chaibakhsh S, Ramezani-Daryasar R. Incidence trends and geographical distribution of nasopharyngeal carcinoma in Iran. Iran J Cancer Prev.
Lee AW, Foo W, Mang O, Sze WM, Chappel R, Lau WH, Ko WM. Changing epidemiology of nasopharyngeal carcinoma in Hong Kong over a 20-year period (1980-99): An encouraging reduction in both incidence and mortality. Internat J Cancer
Krishna S, James S, Sreelekha T, Kattoor J, Balaram P. Primary Nasopharyngeal Cancer of Indian Origin and the Viral Link-A Preliminary Study. Austral-Asian J Cancer.
2006; 5: 241-252.
Hsu WL, Chen JY, Chien YC, Liu MY, You SL, Hsu MM, Chen C. Independent Effect of EBV and Cigarette Smoking on Nasopharyngeal Carcinoma: A 20-Year Follow-Up Study on 9,622 Males without Family History in Taiwan. Cancer. Epidemiol Biomarkers Prev.
Friborg JT, Yuan JM, Wang R, Koh WP, Lee HP, Yu MC. A prospective study of tobacco and alcohol use as risk factors for pharyngeal carcinomas in Singapore Chinese. Cancer.
2007; 109: 1183-1191
Yuan JM, Wang XL, Xiang YB, Gao YT, Ross RK, Yu MC, Preserved foods in relation to risk of nasopharyngeal carcinoma in Shanghai, China. China Internat J Cancer.
2000; 85: 358-363.
Yong SK, Ha TC, Yeo MCR, Gaborieau V, McKay JD, Wee J. Associations of lifestyle and diet with the risk of nasopharyngeal carcinoma in Singapore: a case-control stud. Chinese J Cancer.
Guo X, Johnson RC, Deng H, Liao J, Guan L, Nelson GW, Winkler CA. Evaluation of non-viral risk factors for nasopharyngeal carcinoma in a high-risk population of Southern China. Internat J Cancer.
2009; 124: 2942-2947.
[Table 1], [Table 2], [Table 3], [Table 4]