Head and neck cancer

Tumours of the head and neck include
- Eye and orbital tumours
- Oral cavity cancer
- Pharyngeal tumours
- Laryngeal tumours
  - Supraglottic
  - Glottic
  - Subglottic
- Tumours of the nasal cavity and paranasal sinuses
- Tumours of the salivary gland
- Tumours of the thyroid gland
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)