Head and Neck CancersHead and Neck Cancers

Dr Muthu Kumar MurugesanMBBS (Malaya), FRCS ENT (Edinburgh), MS ORL Head & Neck Surgery (Malaya)

Consultant ENT, Head & Neck SurgeonArunamari Specialist Medical Centre

Klang

Head and Neck MalignanciesHead and Neck Malignancies Basics Sites Treatment Options

What is head and neck cancer?

What is head and neck cancer?

Excluding brain Lymph node Squamous cell

carcinoma (SCC)

AetiologyAetiology alcohol and tobacco

15 X greater than non smokers Epstein-Barr virus (EBV) - nasopharyngeal

carcinoma human papillomavirus-16

isolated in 36% of oral cavity cancers mixing cured tobacco with betel nuts

2.8 times10 times if with smoking

Irritation from poorly fitting dentures

What are some symptoms ofhead and neck cancer?

What are some symptoms ofhead and neck cancer?

any sore in the mouth or throat that does not heal

neck or jaw pain that radiates to the ear abnormal growth in the mouth a lump in the neck that doesn't go away chronic cough or hoarseness sore throat that does not improve coughing up blood

Common SitesCommon Sites

Oral Cavity Pharynx Larynx Sinuses

Oral Cavity-AnatomyOral Cavity-Anatomy

Oral Cavity CarcinomaOral Cavity Carcinoma

How would I know-Mouth CancerHow would I know-Mouth Cancer Non healing Ulcer White or red patches

Leukoplakia Bleeding,pain numbness Change in your voice Pain on Swallowing

How would I know-Mouth CancerHow would I know-Mouth Cancer Lump-lip,,tongue mouth Dentures not fitting

properly

Carcinoma of the Oral TongueCarcinoma of the Oral Tongue

Carcinoma of the TongueCarcinoma of the Tongue Middle aged to elderly Young women

Aggressive tumour Risk Factors

SmokingSpiritsSpicy foodSharp toothglossitis

Carcinoma of the Buccal MucosaCarcinoma of the Buccal Mucosa

Indian communityForms 40% of all cancers

Chewing of betel nut Reverse smoking Late in diagnosis

Insensitive area Common site

Retromolar area

Oral cancers- Treatment OptionsOral cancers- Treatment Options

SurgeryWide excisionReconstruction

RadiotherapySmaller lesionFunction preserved

Carcinoma of the Buccal MucosaCarcinoma of the Buccal Mucosa

Carcinoma of the Buccal MucosaCarcinoma of the Buccal Mucosa

PharynxPharynx

Nasopharyngeal CarcinomaNasopharyngeal Carcinoma Anteriorly -- nasal cavity Posterosup-- skull base

and vertebral bodies Inferiorly -- oropharynx

and soft palate Laterally --

Eustachian tubes and torusFossa of Rosenmuller - most common location

Nasopharyngeal CarcinomaNasopharyngeal Carcinoma Risiko Tinggi

Racial– Cantonese living in the central region of

Guangdong Province in Southern China – age group 40-49 year

Diet– Salted fish and preserved soya

EB VirusFamily Historycigarette smoking, and occupational exposure to formaldehyde and wood

Clinical Presentation

Often subtle initial symptoms

painless, slowly enlarging neck mass

Larger lesionsnasal obstructionepistaxis

Clinical Presentation

Signs and symptoms

NOSE: blocked nostril, mucus, bleeding

EAR: buzzing sound, change or loss of hearing, pain, drainage

THROAT: Hoarseness of voice, difficulty in swallowing, blood-stained phlegm These symptoms do not always mean cancer, but if they persist, see your doctor at once.

ExaminationExamination

Clinical Presentation

Nasopharyngeal examinationFossa of Rosenmuller most common locationVariable appearance - exophytic, submucosal NP may appear normal

Regional spreadUsually ipsilateral first but bilateral not uncommon

Distant spread - lungs, liver, bones

Treatment

External beam radiationDose: 6500-7000 cGyPrimary, upper cervical nodes, pos. lower nodesConsider 5000 cGy prophylactic tx of clinically negative lower neck

Adjuvant chemotherapy

OropharynxOropharynx Base of the tongue

(posterior third of the tongue)

Soft palate and uvula Posterior wall of the

oropharynx Tonsil and faucial pillars

and glossotonsillar sulci

Carcinoma of the OropharynxCarcinoma of the Oropharynx SCC is the commonest

90% of all tumour Sites

Lateral wall 60%Tongue Base 25%Soft Palate 10%

– MSG tumours

Posterior wall 5%

Oropharyngeal CarcinomaOropharyngeal Carcinoma

Treatment OptionsTreatment Options Curative

RadiotherapySurgerySurgery and Post Op Radiotherapy

PalliativeRadiotherapyChemotherapyTracheostomyPain Relief

Hypopharyngeal carcinomaHypopharyngeal carcinoma

Hypopharyngeal carcinomaHypopharyngeal carcinoma Pyriform Fossa

Most commonHalf to 2/3s

Post Cricoid40% of all tumours

Posterior Pharyngeal wall

Rare in isolation SCC

Clinical FeaturesClinical Features

generally has a very poor prognosis heavy smoking and drinking Males are about eight times more susceptible

females have an increased incidence of cancer of the postcricoid area

– Plummer-Vinson syndrome– Indian Woman

Clinical Features-SymptomsClinical Features-Symptoms

Sore throat Ear pain Voice change Pain or difficulty in swallowing Appearance of a lump in the neck Feeling of food sticking in the throat. Marked weight loss

ExaminationExamination

Treatment OptionTreatment Option

Radiotherapy alone Surgery followed by radiotherapy

Laryngeal (Voice Box) CarcinomaLaryngeal (Voice Box) Carcinoma

Laryngeal CarcinomaLaryngeal Carcinoma Commonly in men 60s Smoking & alcohol Hoarseness of voice A lump in the neck A sore throat or ear ache Difficulty in breathing Pain and difficulty in

swallowing Pain is a late symptom

Laryngeal CancerLaryngeal Cancer 25% of patients diagnosed

with laryngeal cancers have another cancer

mouth, oesophagus or lung. Another 15% will later

develop cancer in one of these areas.

patients should continue with follow-up examinations throughout their lifetime.

Laryngeal Carcinoma-treatmentLaryngeal Carcinoma-treatment Radiotherapy Surgery

Partial or Complete removal of Voice Box

Alaryngeal speech: Alaryngeal speech:

Oesophageal Speech: Electronic larynx: Voice Prosthesis