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  • • Curable in 80% of cases when detected at an early stage

    • Most patients present with locoregional spread

    • Most important causative agents are tobacco and alcohol

    • A lesion that appears 3 years after a previous cancer is considered a new primary cancer

    • Potential sites include:

    • -Oral cavity

      -Bucca

      -Mucosa

      -Hard palate

      -Tongue

      -Tonsil

      -Oropharynx

      -Hypopharynx

      -Nasopharynx

      -Paranasal sinus

      -Larynx

      -Glottis

      -False vocal cords

      -External auditory canal

Epidemiology

  • • Approximately 47560 new cases and 11260 deaths in the US in 2008 for Oral Cavity, Pharynx and Larynx.

    • Tobacco and alcohol account for 75% of oral, oropharyngeal, and hypopharyngeal cancers

    • Cigarrette smoking causes 80% of laryngeal cancers

    • Second primary cancers develop in 10-15% of cases

Symptoms and Signs

  • • Leukoplakia and erythroplakia are important premalignant lesions

    • Pain (location correlates with tumor location)

    • Bleeding

    • Obstruction

    • Mass

    • Otalgia

    • Odynophagia

    • Dysphagia

    • Trismus

    • Hoarseness

    • Loss of hearing

    • Horner syndrome

Imaging Findings

  • • CT scan of head and neck can demonstrate involvement of the paranasal sinus, the parapharyngeal, and pterygomaxillary spaces; the orbits; and the anterior skull base

    • MRI of the head and neck can demonstrate cancer involvement at the skull base, in the parapharyngeal space, and in the orbit

  • • Complete exam may require topical anesthetic spray

    • Most sites are well seen with a headlight and laryngeal mirror

    • Flexible fiberoptic exam may be necessary

Rule Out

  • • Squamous cell carcinoma of the skin

    • Melanoma

  • • Biopsy for definitive diagnosis (punch or fine-needle aspiration)

    • Exam under anesthesia (including direct laryngoscopy, nasopharyngoscopy, rigid esophagoscopy, and bronchoscopy)

    • Chest film

    • Barium swallow

    • Panorex x-rays

    • CT scan of the head and neck

    • MRI of the head and neck

  • • Multimodal

    • -Surgery

      -Radiation oncology

      -Medical oncology

      -Maxillofacial prosthetics

      -Speech therapy

    • Priorities are to eradicate cancer, then to maintain function, then to preserve appearance

Surgery

Indications

  • • Almost all should be resected with neck dissections as directed by nodal disease or electively

Medications

  • • Vitamin A and its derivatives have been used to treat oral leukoplakia

    • Isotretinoin and fenretinide are potential chemopreventative agents

Treatment Monitoring

  • • Physical exam

Complications

  • • From radiation:

    • -Skin reaction

      -Mucositis

      -Fibrosis

      -Vascular sclerosis

      -Xerostomia

      -Osteoradionecrosis

Prognosis

  • • Curable in 80% of patients when diagnosed at an early stage

    • Depends on stage and tumor location

Prevention

  • • Discontinue tobacco and alcohol use

References

Carvalho AL et al: Trends in incidence and prognosis for head and neck cancer in the ...

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