Head and Neck Cancers PhD Tomasz Wiśniewski

What cancer site is the most popular in head and neck region? Incidence (person/year) Nasoparynx 180 Oropharynx 1000 Hypopharynx 380 Larynx 2400 Sinunasal cavity 160 Oral cavity 1100 Parotids 340

Etiology in H&N Tobacco Alcohol Human Papilloma Virus HPV type 16 (60-70% in USA) Oropharyngeal ca Ebstein Barr Virus Nasopharyngeal ca

Signs & symptoms Not healing ulceration oral cavity Sore throat oral cavity Hot potato voice base of tongue Hoarsenes larynx Dysfagia, odynofagia hypopharynx Adenopathy nasopharynx Cranial nerve involv. nasopharynx Epistaxis nasal cavity

Treatment in early H&N ca Surgery Radiotherapy VS similar OS and LC differences: Side effects Cosmetic effects Duration of treatment

Treatment in Advanced H&N ca 2 options: surgery +/- postoperative RT-CHTH (often) Radical RT-CHTH (preffered) Better outcome (tumor more sensitive) Better side effects (only one treatment)

Treatment options in H&N ca site Surgery Radiotherapy Chemotherapy Nasoparynx +++ ++ Oropharynx + Hypopharynx Larynx Sinunasal cavity Oral cavity Parotids

What are the main features of larynx cancer? 1) The most popular head and neck cancer 2) Prognosis depend on localization epiglottis- rapid growth and early N+ glottis – slow growth, high grade, early detection subglottic - medium growth , N+ also in mediastinum 3) High risk of developing second independent cancer of pulmonary tract or upper digestive system

What means transglottic or multiregional cancer? transglottic ca – glottic carcinoma that extends to epi- or subglottic area multiregional cancer- tumor 2 or 3 levels of larynx but without primary site

Cancer of Hypopharynx Pearls Local growth with early extension to adjacent structures esp. larynx and nodal spread M+ rare The worst prognosis in H&N cancers 5yOS 15% Risk second primary cancer- 25%

Cancer of hypopharynx Localization / site Piriform sinus 65% Posterior pharyngeal wall 25-30% Postcricoid region 5%

Oral cavity cancers Pearls High risk lymph node spreading ( rich lymphatic drainage) Important : elective nodal excision or RTH when N+ chance of cure 50% less Treatment Excision of primary (preferred) ± unilateral or bilateral selective neck dissection. Often PORT

Oropharyngeal cancer Pearls Subsites: soft palate, palatine tonsils, tonsillar pillars, base of tongue (lingual tonsils), pharyngeal wall. Rapid growth nad early N+ Rare M+ Second primary tumors in the upper aerodigestive tract and lung occur in ~25% of patients due to risk factors and lifestyle Etiologies include consumption of alcohol, tobacco, betal and areca nuts, and HPV infection HPV type 16 (60-70% in USA)

Oropharyngeal cancer The location: tonsil - 60% Base of tongue - 28% Soft palate - 11% Lateral/posteror wall - 1% Soft palate – early diagnosis – good view

Nasopharyngeal cancer WHO type 1 (keratinizing SCC, 25% of cases in the US), WHO type 2 (nonskeratinizing SCC, 12% of the US cases), WHO type 3 (undifferentiated carcinoma, 99% of cases where endemic). Lymphoepithelioma = WHO III with high lymphoid component. It has higher LRC, but the same OS due to an increased rate of DM.

Nasopharyngeal cancer WHO III (undifferentiated) common in Southern China and Hong Kong (e.g., third most common cancer among men in Hong Kong) Two peak ages: 15–25 years and 50–60 years. More common among men (2:1). Strongly associated with EBV (70% of patients have + titers). Alcohol and tobacco are associated with WHO type I (keratinizing SCC).

Nasopharyngeal cancer Signs Adenopathy (neck tumor) most common Clinical involvment 70% Subclinical involvment 90% Bilateral 50% Epistaxis 37-73% Hearing loss 41-62% Headache 5-40% Cranial nerve involvment 20 % V i VI (most common)

Nasal Cavity and Paranasal Sinus Cancer PEARLS Maxillary cancers are most common (70%). Incidence higher in Japan and South Africa. More common in males (4:1). Ohngren’s line runs from the medial canthus to the angle of the mandible. Tumors superior-posterior to Ohngren’s line have a poorer prognosis. Histology: most common is SCC. Adenoid cystic, esthesioneuroblastoma,plasmacytoma, lymphoma, melanoma, and sarcoma also seen.

Salivary Gland Tumors Histology Majority of salivary gland neoplasms are benign. Inverse relationship exists between size of parotid gland and ratio of malignant to benign cancer Glands Incidence Malignant tumor Parotid 80%- 90% 15% Submandibular 10-20% 40% Sublingual few % 80%

Salivary Gland Tumors Most parotid tumors present as painless swelling. Salivary gland cancer is notable for its remarkable histologic diversity: Pleomorphic adenoma is most common benign salivary gland neoplasm. Most common malignant histology of parotid gland is mucoepidermoid carcinoma. Most common malignant histology of submandibular and minor salivary glands is adenoid cystic carcinoma Adenoid cystic carcinoma has the lowest frequency of cervical node metastasis (5–8%), but the highest propensity for perineural spread.