CASE REPORT: MISDIAGNOSIS CASE OF NASOPHARYNGEAL CARCINOMA IN PATIENT WITH CHRONIC RHINOSINUSITIS: FAMILY DOCTORS AWARENESS IS ESSENTIAL
Nasopharyngeal carcinoma (NPC) is the most common head and neck malignancy in Indonesia. It’s commonly misdiagnosed in the early stages, because of nonspecific signs and symptoms as well as a difficult anatomic site to examine. Inflamation and infection in the upper respiratory airway such as chronic rhinosinusitis will obscure the cancer. NPC misdiagnosed will results in a high morbidity and mortality rate due to it being diagnosed in a later advanced stage. A 58 year old male with history of nasal blockage and nasal bleeding, accompanied by hearing problem and ear fullness. He also complained of a severe headache as well as the appearance of a left neck mass since a few months prior. The patient has been repeatedly seek medical assistance in primer health care due to nasal blockage. During nasopharyngocopy a gelatinous mass in the right nasal cavity and a nasopharyngeal mass extending to both nasal cavities was found. The biopsy results were polyp nasi Hellquist Type I and Undifferentiated Nonkeratinizing Carcinoma. CT with contrast showed the nasopharyngeal mass has extended intracranially. Patient was diagnosed as chronic rhinosinusitis with nasal polyp and nasopharyngeal carcinoma stage IVA. Our patient initially had nasal obstruction but was not detected as an early diagnosis of nasopharyngeal cancer. Until a few months later, neck symptoms appeared so that the patient was referred with a suspicion of advanced NPC. More than 80% of NPC’s therapeutic success occurs in the early stages with five-year survival rate around 72%. Its sign and symptom can mimic as an inflamation of upper respiratory airways. Therefore it is important for Family doctors or general practitioners in primary health care to detect in early stage then manage it properly. So periodic refreshing to diagnose the disease must be done continously.