Among all head and neck (H&N) cancers, nasopharyngeal carcinoma (NPC) represents a distinct entity regarding epidemiology, clinical presentation, biological markers, carcinogenic risk factors, and prognostic factors. NPC is endemic in certain regions of the world, especially in Southeast Asia, and has a poor prognosis. In Indonesia, the recorded mean prevalence is 6.2/100 000, with 13 000 yearly new NPC cases, but otherwise little is documented on NPC in Indonesia. Here, we report on a group of 1121 NPC patients diagnosed and treated at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia between 1996 and 2005. We studied NPC incidence among all H&N cancer cases (n=6000) observed in that period, focusing on age and gender distribution, the ethnic background of patients, and the disease etiology. We also analyzed most prevalent signs and symptoms and staging of NPC patients at first presentation. In this study population, NPC was the most frequent H&N cancer (28.4%), with a male-to-female ratio of 2.4, and was endemic in the Javanese population. Interestingly, NPC appeared to affect patients at a relatively young age (20% juvenile cases) without a bimodal age distribution. Mostly, NPC initiated in the fossa of Rosenmuller and spreaded intracranially or locally as a mass in the head. Occasionally, NPC developed at the submucosal level spreading outside the anatomic limits of the nasopharynx. At presentation, NPC associated with hearing problems, serous otitis media, tinnitus, nasal obstruction, anosmia, bleeding, difficulty in swallowing and dysphonia, and even eye symptoms with diplopia and pain. The initial diagnosis is difficult to make because early signs and symptoms of NPC are not specific to the disease. Early-age Epstein-Barr virus (EBV) infection combined with frequent exposure to environmental carcinogenic co-factors is suggested to cause NPC development. Undifferentiated NPC is the most frequent histological type and is closely associated with EBV. Expression of the EBV-encoded latent membrane protein 1(LMP1) oncogene in biopsy material was compared between NPC patients of <30 years old and those of ≥30 years old, matched for sex and tumor stage. Higher LMP1 expression in patients of <30 years old was observed, which was related to more locoregional progressivity. Increased medical awareness of prevailing early stage signs and symptoms coupled to use of EBV-related diagnostic tumor markers may lead to down-staging and timely treatment to improve survival of patients with this aggressive disease.
Adolescent ; Adult ; Age Distribution ; Aged ; Child ; Epstein-Barr Virus Infections ; Female ; Herpesvirus 4, Human ; isolation & purification ; Humans ; Incidence ; Indonesia ; epidemiology ; ethnology ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; epidemiology ; ethnology ; pathology ; virology ; Sex Factors ; Viral Matrix Proteins ; metabolism ; Young Adult

Prostate adenocarcinoma accounts for majority of prostate cancer cases, and it was found to be highly radioresistant. Gallic acid is a phenolic acid naturally occurring in many plants, reported to exhibit biological activities in eliminating cancer cell lines and xenografts. The purpose of this study is to review gallic acid as a potential radiosensitizer agent in prostate cancer treatment. Article search was conducted in PubMed, EBSCO, and Scopus. 11 studies using different cell lines including DU145, PC-3, LNCaP, and 22Rv1 xenograft of human prostate cancer were reviewed in this paper. Gallic acid acts as a radiosensitizer mainly by increasing caspase-3 and caspase-9 activation resulting in apoptosis, while also reducing intracellular CDKs, cyclins, and cdc25 phosphatases ultimately causing G2-M cell cycle arrest. Gallic acid has a potential to be a new radiosensitizer compound in prostate cancer treatment. Additional clinical studies using gallic acid derivatives with lower hydrophilicity are needed.