Head and neck cancer

• 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 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)