Medical history and head-neck examination

Suspect nasopharyngeal tumor Normal-looking nasopharynx

EBV Serology (-) EBV Serology (+)

CT Scan (-) Clinically suspected Clinically unsuspected
CT Scan (-)

CT Scan 1. Suspected neck glands EBV Serology

(-) CT Scan (-)
Observation Nasopharyngeal biopsy
(local anesthesia) FNAB (Cytology)
2. Suspected radiology Observation

3. Unknown serous Squamous cell

Other diagnosis Uncertain diagnosis Other diagnosis
otitis media carcinoma/Ca
(2x local biopsy)
Treatment based on
undifferentiated Treatment based on
diagnosis Repeat biopsy 4. ↑IgA persistent
(general anesthesia) diagnosis
repeat biopsy
+ panendoscopy (general anesthesia)
Nasopharyngeal biopsy + panendoscopy
NPC (-) NPC (+)
NPC (-) NPC (+) NPC (+) NPC (-)

Observation Thorax X-ray, liver function, Treatment based on

blood chemistry diagnosis
Consult to neurology
and
ophtalmology
Serology test (if not already)

Treatment as Nasopharyngeal Rehabilitation & follow up

cancer (see Treatment
Algorithm)
 Nasopharyngeal Carcinoma (NPC)

T1, N0, M0 T2, N1, M0; T1-2, N2-3, M0; All T,

T1-2, N1, M0 T3-4, N0-3, M0 All N, M1
Definitive radiotherapy ≥ 70 gy
Externa radiotherapy 50 Gy + brachytherapy 4x3 Gy Without complication With complication Platinum-based
and chemotherapy
Elective radiotherapy on neck
Chemoradiation + adjuvant chemotherapy, or
Chemotherapy only, or
Induction chemotherapy + Chemoradiation, or Multimodality clinical trial
Radiotherapy to
primary and neck tumors

Response Neck: Residual tumor

Observation Neck dissection

Follow up