鼻咽癌可疑症狀

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據資料顯示,鼻咽癌屬本港五十歲以下男性組群的頭號常見癌症,臨床上不少患者都正值盛年,甚至是肩負家庭經濟重擔的一家之主。事實上,鼻咽位置隱蔽,癌變早期病徵不明顯,到出現耳鳴丶唾液帶血絲,甚至視力不受影響時,癌細胞往往已擴散。

據醫生臨床觀察所得,在確診患鼻咽癌的個案中,僅有10%是在早期階段被發現患病; 其餘在較後期被確診的人士,分別是因出現可疑病徵如頸部淋巴結腫大(50%) 丶鼻雙關症狀如鼻塞丶流鼻血或唾液帶血絲等(30%) ,以及耳雙關症狀如中耳積水丶耳鳴等(20%) ,經醫生進行檢查後才證實患上鼻咽癌。當病人出現頸部淋巴結腫大的症狀時,代表癌細胞已開始轉移; 亦有一些較嚴重的擴散性鼻咽個案,癌細胞「蝕穿」顱底骨,影響面部神經線導致面部神經痛,或是侵襲眼球神經,導致患者視力受影響,例如出現重影等。當癌細胞出現遠端轉移,有機會侵蝕骨骼丶肺部以至肝臟等,治療難度將進一步提升。事實上,第一期鼻咽癌的治癒成功率可逹九; 隨著病情演進,第二期及第三期患者的治癒成功率分別下降至八成及六成; 如第四期的鼻咽癌出現轉移,患者的平均存活期更只有約六個月。

對耳鼻喉科專科醫生而言,若發現鼻咽癌雙關的可疑症狀,會安排患者接受「內窺鏡檢查加組織抽檢」的常規測試組合。醫生可能會建議高風險患鼻咽癌的人士,例如有強烈家族病史 (如直系親屬曾患有鼻咽癌)丶曾出現鼻咽癌症狀者等等,安排接受抽血測試,檢驗EBV-IgA (EB病毒抗體) EBV DNA 指數。然而整體來說,這兩類測試仍有機會出現「假陽性」或「假陰性」的錯誤結果,因此有機會混淆患者的治療決定。

今年本港率先引入「無痛鼻咽癌細胞基因測試技術」,由醫生以特製刷子經測試者口腔進入鼻咽掃拭,採集所需要的鼻咽表層細胞樣本後,再以定量聚合酶鏈鎖反應 (Q-PCR) 技術檢驗樣本的EBV DNA指數,準確度達99%

耳鼻喉科專科

鄧樹安醫生

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