1. Head and Neck Cancers
PhD Tomasz Wiśniewski

2. What cancer site is the most popular in head and neck region?
Incidence (person/year)
Nasoparynx
Oropharynx
Hypopharynx
Larynx
Sinunasal cavity 160
Oral cavity
Parotids

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

4. 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

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

6. 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)

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

8. 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

9. 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

10. 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%

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

12. 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

13. 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)

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

15. 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.

16. 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).

17. Nasopharyngeal cancer
Signs
Adenopathy (neck tumor) most common
Clinical involvment 70%
Subclinical involvment 90%
Bilateral 50%
Epistaxis %
Hearing loss %
Headache %
Cranial nerve involvment 20 %
V i VI (most common)

18. 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.

19. 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%

20. 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.