Event of Nasopharyngeal Carcinoma in Coastal Area: Review Article

Introduction: Communities in coastal areas have a high level of consumption of salted marine products, such as salted fish. Consuming salted fish is one of the factors causing the incidence of nasopharyngeal carcinoma (NPC). Content: NPC is a type of cancer found in the head and neck that can be caused by various factors, such as smoking, formaldehyde exposure, and consumption of salted fish. Clinical manifestations can arise in the patient's NPC, such as epistaxis, nasal congestion, ringing in the ears, headaches, facial pain, and visible lumps Conclusion: NPC is a type of cancer found in the head and neck that can be caused by various factors, such as smoking, formaldehyde exposure, and consumption of salted fish. Clinical manifestations can arise in the patient's NPC, such as epistaxis, nasal congestion, ringing in the ears, headaches, facial pain, and visible lumps


Introduction
Indonesia is an archipelagic country that stretches from 60 North Latitude to 110 Latitude and 920 to 1420 East Longitude with a coastline of 81,000 km most of Indonesia's area is an ocean, so most of the area is an ocean. Most of Indonesia's territory consists of the coast. 2,12 Indonesia is a country consisting of islands and oceans that are rich in potential natural resources. 2 Abundant marine products make the Indonesian people empower fish catches into long-lasting salted fish processed foods. In research (Rusliafa, Amiruddin, and Noor, 2014), it has been found that people living in coastal areas have a higher level of sodium consumption due to the consumption of salted seafood compared to people living in the mountains. Eating salted foods, such as salted fish, is one of the factors causing the incidence of nasopharyngeal carcinoma. 7,8 Nasopharyngeal carcinoma (NPC) is a type of cancer found in the head and neck. 9 NPC is the fourth most common malignant tumor in Indonesia after cervical cancer, breast cancer, and skin cancer. 15 Meanwhile, in the world, Indonesia ranks third for NPC cases with the highest number of occurrences. NPC originates from the epithelial surface of the nasopharynx, precisely in the narrow gap behind the nasal cavity above the back of the throat (Rossmuller fossa). Nasopharyngeal carcinoma, previously known as lymphoepithelioma. 9 Besides being caused by fish consumption, this malignancy can also be caused by various factors, such as viruses, genetics, and environmental factors. 1 Among these factors, the consumption of salted fish is the most common cause of NPC due to its association with carcinogenic substances. 7

Epidemiology
Nasopharyngeal carcinoma is an endemic disease in certain regions of the world, especially in Southeast Asia. According to data from the World Cancer Research Fund International (WCRFI), there were more than 133,000 new cases of nasopharyngeal cancer in 2020 with an average recorded prevalence of 1.5/100,000. Indonesia ranks third with the highest nasopharyngeal carcinoma in the world with an incidence of 6.8/100,000 people or there are 19,943 new cases of NPC every year. Meanwhile, the mortality rate of NPC in the world is 80,000 cases or there are 0.9/100,000 cases of death due to NPC in 2020. Indonesia ranks second highest after Brunei Darussalam with a prevalence of 0.9/100,000 or there are 13,399 deaths due to NPC in 2020. 14

Risk Factors
NPC cases are most commonly found in men compared to women in the 45-55 year age group. 10 According to research from (Tsao et al., 2014) states that male sex is 2-3 times more at risk of suffering from NPC compared to women. 13 Based on data from Global Cancer Statistics (GLOBOCAN) 2020, also stated that NPC in men was 3 times more than the number of NPC cases in women with a total of 96,371 new cases in men and 36,983 new cases in women. 11 Age factors also increase the risk of this NPC incident. NPC cases began to increase in the population aged 30 years and cases peaked in the 40-60 year age group. After reaching the age of 60 years, the incidence of NPC began to decrease. 5,13 Apart seen from age and gender, NPC cases are also often found in people with high consumption of salted fish. 4 In the study of Kasim and his colleagues, it was found that most of the NPC patients at Abdul Moeloek Hospital Bandar Lampung often consumed salted fish with a frequency of > 3 times a month. 4

Clinical Manifestasions
Mostly, NPC appears in the fossa of Rosenmuller and spreads intracranially or locally as a mass in the head. Based on the anatomical location, NPC has 4 main symptom groups; namely first, nasal symptoms such as epistaxis, nasal obstruction, and rhinorrhea; second, ear symptoms such as ear fullness, hearing loss, and ringing in the ears (tinnitus) associated with eustachian tube dysfunction due to lateral-posterior tumor expansion; third, cranial nerve palsy due to tumor expansion into the para cavernous sinus which causes

Conflict of Interest
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