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Head and Neck Cancers

James P. Neifeld, MDVCU School of Medicine

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Background

The oral cavity is the most accessible area to inspection, but the most neglected in the physical examination.

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Head and Neck Cancers

SkinMucosaSalivary glandsBoneSoft tissues

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Clinical Presentation

Sore mouthSore throatLump in the throatDifficulty swallowingHoarsenessDifficulty breathingLump in the neck

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History

Symptom(s)– duration

SmokingDrinkingFamily history

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Physical examination

InspectionPalpationIndirect laryngoscopy– fiberoptic laryngscopy

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7 8

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Preoperative EvaluationHistoryPhysical– Indirect laryngoscopy– Pelvic and rectal exam

Chest x-rayPanendoscopy and biopsyCT (±)MR (±)PET (±)

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13 14

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Management Involves a TeamSurgeonRadiation OncologistPlastic SurgeonMedical OncologistDentistOral SurgeonProsthodonistSpeech Therapist

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Management of Head and Neck Tumors

Objectives are to:1. Control the tumor2. Provide cosmetic and functional

rehabilitation

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Risk of Oral Cancer According to Presence or Absence of Smoking and Alcohol Consumption

5.711.23YES

1.531.00NO

YESNO

Smoking

Alcohol

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New Cancers and Deaths

40012007002400Other600110024004700Tongue600140020006300Pharynx

800110044004800Oral Cavity

800300024007100LarynxFMFM

DeathsNew CancersSite

ACS, 2003 50

Treatment

SurgeryRadiationChemotherapySurgery + radiationSurgery + radiation + chemotherapyRadiation + chemotherapyOther

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Survival rate of patients with head and neck cancer

182045Pharynx

10558095Larynx

10407090Oral

265680Tongue

T4T3T2T1site

% survival

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Relative Survival Rates (5 year) (%)

3070Larynx2040Pharynx

3060Floor of Mouth

2050Tongue

3055Nose, nasal cavities

5590LipRegionalLocalized

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Oro-pharyngeal Cancer

5% of all malignancies90% are epidermoidcancer60% will develop neck node metastasisTreatment:– stage I – II: surgery or

radiation– stage III – IV: surgery

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Trends in Cancer Survival: Relative 5-year Survival rate (%)

565353Oral cavity

646766Larynx

1992-19981983-19851974-1976site

ACS, 2003

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55 56

57 58

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Conclusion

Early diagnosisCaused by tobacco / alcoholHigh incidence of second primariesTreat aggressivelySTOP SMOKING

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Future Outlook

Earlier diagnosisImproved imagingCombined modality treatmentSTOP SMOKING