Post on 19-May-2015
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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