TUMORS of the

HEAD and NECK

What particular problem(s) can tumors of the head and neck give

the patient?

HEAD and NECK TUMORS PHYSIOLOGIC DISTURBANCES

• BREATHING

• SPEECH

• MASTICATION

• SWALLOWING

• HEARING

• SIGHT

Scope of presentation

1. Skin and soft tissues of the head and

neck

2. Oral cavity

ETIOLOGY

• SMOKING

• ALCOHOL

• Human papilloma virus infection

• BETEL NUT CHEWING

• POOR ORAL HYGIENE

• EXPOSURE TO SUN

HEAD and NECK TUMORS DIAGNOSTIC WORK-UP

• COMPLETE HISTORY AND P.E.

• BIOPSY – FNA, INCISIONAL, PUNCH

• DIRECT LARYNGOSCOPY

• CERVICAL ESOPHAGOSCOPY

• CHEST X-RAY

• others: CT scan, panorex

TUMORS of the FACE and LIPS

Basal Cell Carcinoma - most common skin cancer - slow growing - ulcer with rolled, pearly borders - “rodent ulcers”

TUMORS of the FACE and LIPS

Squamous Cell Carcinoma - more aggressive than basal cell cancer - etiol.: exposure to sun - male:female – 20:1 - treatment: surgery radiation (depending on stage) Neck Dissection indicated if l.n. are (+)

THE ORAL CAVITY

• gingiva

• anterior 2/3 of tongue

• floor of the mouth

• hard palate

• buccal mucosa

Malignant Lesions of the Oral Cavity

• 95% are squam. cell ca • 10:1 male to female ratio • etiology: pipe/cigar smoking betel nut/tobacco chewing alcohol poor oral hygiene

Cervical Nodal Groups

pre-auricular/parotid retro-auricular/ sub-occipital submental submandibular superior jugular mid-jugular lower jugular spinal accessory supraclavicular pre-/paratracheal

ORAL CAVITY MALIGNANT LESIONS

• LOCATION: hard palate

• CELL TYPE: adenocarcinoma

• INVASIVENESS: (+)

• NODAL mets.: not usual in early stage

• TREATMENT: wide excision

• 5-YEAR SURVIVAL: 30-40%

ORAL CAVITY MALIGNANT LESION

• LOCATION: buccal mucosa

• CELL TYPE: squamous cell ca

• INVASIVENESS: (+)

• NODAL mets: submax., upper cervical

• TREATMENT: wide excision + neck

dissection +/- radiotx. (St. III/IV)

• 5-YEAR SURVIVAL: 55%

• uncommon; Stage I/II best treated with

radiotx.

ORAL CAVITY MALIGNANT LESIONS

• LOCATION: floor of mouth

• CELL TYPE: squamous cell ca

• INVASIVENESS: (++++)

• NODAL mets.: bilateral submaxillary n.

• TREATMENT: commando opn., + pre-

or post-op radiotx.

• 5-YEAR SURVIVAL: 40%

RECONSTRUCTIVE SURGERY

• Platysma Myocutaneous Flap

• Latissimus Dorsi Myocutaneous

• Pect. Major Myocutaneous Flap

• Radial Forearm Free Flap

TEAM APPROACH in the TREATMENT of H and N

CANCER

• Head and Neck Surgeon

• Radiation Onco., Medical Onco.

• Plastic/Reconstructive Surgeon

• Clinical Patho., Speech Patho.

• Dentist

• Nurse, Social Worker

• Nutritionist

• Physical Therapist

ORAL CAVITY MALIGNANT LESIONS

• LOCATION: tongue

• CELL TYPE: squamous cell ca

• INVASIVENESS: (+++)

• NODAL mets.: submental, submand.

• TREATMENT: same as floor of mouth

• 5-YEAR SURVIVAL: 30-50%

• 30-40% occult nodal mets. in early

stage; selective neck dissection

recommended

ORAL CAVITY MALIGNANT LESIONS

• LOCATION: gingiva

• CELL TYPE: squamous cell ca

• INVASIVENESS: (++)

• NODAL mets.: submaxillary nodes

• TREATMENT: commando operation

• 5-YEAR SURVIVAL: 45%

SALIVARY GLANDS

PAROTID GLANDS

SUBMAXILLARY GLANDS

SUBLINGUAL GLANDS

MINOR SALIVARY GLANDS

SALIVARY GLANDS MALIGNANT TUMORS

• 20% of PAROTID G. TUMORS

• 50% of SUBMAND. G. TUMORS

• 75% of MINOR SALIV. G.

TUMORS

SALIVARY GLANDS MALIGNANT TUMORS

Mucoepidermoid carcinoma - most common malignant tumor of the parotid gland - may be low or high grade - treatment: excision for low grade; radical surgery + neck dissection + radiotherapy for high grade

SALIVARY GLANDS MALIGNANT TUMORS

Adenoid Cystic carcinoma - common in submand. and minor salivary g. tumors - has propensity for perineural invasion - treatment: radical resection + post- op. radiotherapy for high grade tumors

SALIVARY GLANDS MALIGNANT TUMORS

Malignant Mixed Tumor - arises from a pre-existing benign mixed tumor Adenocarcinoma - most are high grade - most common in minor salivary glands

SECOND PRIMARY TUMORS

• overall incidence: 14%

• detected w/in 6 months – synchronous

• detected after 6 months – metachronous

• incidence increased if predisposing factor(s) still present

PALLIATIVE CARE

for those with advanced disease

radiation, chemotherapy

pain control

tracheostomy, gastrostomy

hospice care

TUMORS of the NECK (adults)

• Inflammatory 4%

• Congenital/Miscellaneous 12%

• Neoplastic 84%

metastatic 80%

primary to neck 20%

lymphomas 60%

saliv. g. tumors 40%

CONGENITAL LESIONS NECK

Thyroglossal duct cyst

Branchial cleft cyst

Cystic hygromas/lymphangiomas

Neck Tumors with Occult Primary

1. Thyroid carcinoma

2. Role of human papilloma virus infection

FOLLOW-UP, POST-TREATMENT OF H/N CANCER

Regular, for at least 5 years

Monitor for recurrence

Perform good history and PE

Look for side effects of treatment

Annual chest x-ray

Dental referral for post-radiotx.

SUMMARY

1. The head and neck is a confined area

where tumors can cause unique

problems

2. Majority of the tumors in the area are

squamous cell carcinomas

3. Tumors of the neck have differing

etiologies in the very young compared

to the old patient