Head & Neck Squamous Cell Cancer

• • 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