Head and neck cancer

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Revision as of 13:36, 28 July 2024 by Nikolas (talk | contribs) (Created page with "<section begin="oncology" /> * Tumours of the head and neck include ** Eye and orbital tumours ** Oral cavity cancer ** Pharyngeal tumours *** Nasopharynx *** Oropharynx *** Hypopharynx ** Laryngeal tumours *** Supraglottic *** Glottic *** Subglottic ** Tumours of the nasal cavity and paranasal sinuses ** Tumours of the salivary gland ** Tumours of the thyroid gla...")
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  • Tumours of the head and neck include
  • Epidemiology
    • Head and neck cancer is the 6th most common cancer worldwide
  • Etiology
    • Smoking
    • Alcohol
    • Poor oral hygiene
    • EBV – for nasopharyngeal carcinoma
    • HPV – for oropharyngeal and laryngeal cancer
  • Pathology
    • 80% are squamous cell
    • 20% are adenocarcinoma, lymphoma, sarcoma, etc.
    • Precancerous lesions
      • Leukoplakia
      • Erythroplakia
      • Lichen planus
    • Metastasizes most often to lung
  • Clinical features
    • Ulceration of mucosa
    • Exophytic growth of mucosa
    • Neck mass
    • Sore throat
    • Hoarseness
    • Pain radiating into the ear
      • Due to cranial nerve affection
    • Dysphagia
  • Diagnosis
    • FNAB or direct excision biopsy
  • Work-up after diagnosis
    • CT with contrast or MRI of head and neck
    • Laryngoscopy
    • Neck US
    • PET scan
  • Treatment
    • Majority of cases are treated with multiple modalities
    • Surgery
      • Only used if R0 resection with acceptable functional results is expected
        • This means that surgery is not performed unless the surgeon believes that he can completely resect the tumour
      • If early stage cancer -> transoral surgery (TORS)
      • If cancer has spread to lymph nodes, neck dissection must be performed
        • Modified radical neck dissection
        • Selective neck dissection
      • Surgery, especially of pharynx and larynx, impairs quality of life, which must be taken into account when deciding treatment modality
    • Radiotherapy
      • External beam radiotherapy or brachytherapy
      • Can be given with curative or palliative intention
      • Can be given postoperatively or primarily
      • Primary radiotherapy alone is usually sufficient in
        • Cancer of the lip
        • Cancer of the nose
        • Cancer of the floor of the mouth (brachytherapy)
        • Cutaneous lymphoma
    • Chemotherapy
      • Cisplatin
      • Taxanes
      • 5-FU
    • Biological and immunotherapy
      • Cetuximab (anti-EGFR)
      • Nivolumab (anti-PD-1)
      • Pembrolizumab (anti-PD-1)