Nasopharynx cancer

Nasopharynx cancer is a rare type of head and neck cancer. The most common histological types are squamous cell carcinoma and lymphoepithelial carcinoma. It can cause symptoms like unilateral conductive hearing loss, middle ear effusion, and lymph node metastasis at the mandibular angle.

These tumours are very radiosensitive, which is lucky because surgery is difficult. Radiochemotherapy is the preferred treatment.

Oral cavity and oropharynx cancer

Oral cavity cancer or (simply oral cancer) and oropharynx cancer are forms of head and neck cancer. These have similar etiology and pathology and are therefore often considered together. Squamous cell carcinoma is the most common histological type of oral cavity and oropharynx cancer. Oropharynx cancer is most commonly located in the tonsils and tongue base but may affect all parts of the oropharynx.

Etiology

These types of cancer are highly related to tobacco use, smoking, alcohol, and HPV. The combined use of tobacco and alcohol has a multiplicative effect on cancer risk.

Leukoplakia is a precursor to oral cavity cancer.

Clinical features

Oral cavity cancer most commonly presents as a non-healing ulcer or lesion. Oropharyngeal cancer is usually asymptomatic early, leading to late diagnosis. Later, it may cause sore throat, globus sensation, bloody saliva, halitosis, and pain. Lymph node metastasis may cause swollen lymph nodes on the neck, especially the mandibular angle.

Diagnosis and evaluation

Ultrasound is useful in the evaluation of oropharynx cancer, not usually necessary for oral cavity cancer. Biopsy is essential for the diagnosis.

Management

Oral cavity cancer

Management includes surgical removal, sometimes with adjuvant radiotherapy. Postoperative radiotherapy or radiochemotherapy is indicated if high-risk features are present

R1 or R2 resection
T3 or T4 tumours
Lymph node spread

Before radiotherapy of the oral cavity, dental care is essential. Dental infections can act as a source of inflammation after radiotherapy.

Oropharyngeal cancer

Oropharyngeal cancer is moderately radiosensitive. For this reason, radiochemotherapy is the preferred modality, but surgery is an option.

Hypopharynx cancer

Hypopharynx cancer is a rare form of head and neck cancer. The most common histological type is squamous cell carcinoma, and like oral cavity and oropharynx cancer it's related to alcohol and nicotine consumption.

Hypopharynx cancer causes symptoms late, delaying diagnosis. Symptoms include dysphagia, halitosis, cervical lymph node metastasis, and referred ear pain.

Hypopharyngeal cancer is not particularly radiosensitive so the treatment is mostly surgical. Treatment includes local surgical excision and sometimes neck dissection. Laryngectomy is often necessary.