Head&neck Cancer
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Contents |
More Specific Terms
Classification
Etiology
- risk factors:
- tobacco: 90% of patients are smokers
- alcohol: 75% of patients abuse alcohol
Pathology
- 2% of all cancers
- 95% are squamous cell carcinomas
- may arise from foci of leukoplakia
- 20% risk of 2nd cancer within 2 years
Genetics
Clinical-manifestations
- localized mouth, tooth throat or ear pain
- hoarseness
- hemoptysis
- painless, non- healing ulcer mucosal ulcer
- dysphagia or odynophagia
- proptosis
- diplopia or loss of vision
- hearing loss
- persistent unilateral sinusitis
- unilateral tonsillar enlargement in adults [1]
- presentation with mid to upper cervical lymph node involvement increases likelihood of head & neck primary tumor; lower cervical to supraclavicular nodes increase liklihood of primary lung tumor
Diagnostic-procedures
-
- laryngoscopy
- nasopharyngoscopy
- bronchoscopy
- esophagoscopy
- biopsy ( fine-needle aspiration generally sufficient)
- nasopharynx
- base of tongue
- pyriform sinus
- tonsil
Radiology
Complications
- 2nd cancer within 2 years (see pathology)
- disease interaction(s) of cancer with Alzheimer's disease
- 2nd cancer within 2 years (see pathology)
Differential-diagnosis
- leukoplaka
- lichen planus
- oropharyngeal Candidiasis
Management
- stages 1 or 2
- surgery or radiation with intent to cure
- stages 3 & 4 without distant metastases
- combination of radiation, chemotherapy surgery
- metasatic disease or recurrence
- chemotherapy is palliative, but does not prolong survival
- resectable disease
- neck dissection
- exceptions
- nasopharyngeal carcinoma (tumors are radiosensitive)
- laryngeal cancer
- voice preservation
- survival similar
- cisplatin
- may effect favorable response
- does not improve overall survival with metastatic disease
- prognosis:
- 5 year survival for stage 1 disease > 80%
- most patients diagnosed with stage 3-4 disease; 5 year survival < 40%
More General Terms
Additional Terms
Internet Database
OMIM: 275355
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
- Head and Neck Cancer: NIH Institute and Center Resources [1]
- National Guideline Clearinghouse
- Laryngeal cancer (Intracorp) ngc-guideline: [2]
- Chemotherapy with radiotherapy for nasopharyngeal cancer. (Program in Evidence-based Care) ngc-guideline: [3]
- Diagnosis and management of head and neck cancer. A national clinical guideline. Scottish Intercollegiate Guidelines Network ngc-guideline: [4]
- Cetuximab for the treatment of locally advanced squamous cell cancer of the head and neck. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [5]
- Cetuximab for the treatment of recurrent and/or metastatic squamous cell cancer of the head and neck. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [6]
- Epidermal growth factor receptor (EGFR) targeted therapy in stage III and IV head and neck cancer: guideline recommendations. Program in Evidence-based Care ngc-guideline: [7]
- PET imaging in head and neck cancer: recommendations. Program in Evidence-based Care ngc-guideline: [8]
- Head and neck cancer. In: Suspected cancer in primary care: guidelines for investigation, referral and reducing ethnic disparities New Zealand Guidelines Group ngc-guideline: [9]
- Retreatment of recurrent head and neck cancer after prior definitive radiation. American College of Radiology ngc-guideline: [10]
- The management of head and neck cancer in Ontario: organizational and clinical practice guideline recommendations. Program in Evidence-based Care ngc-guideline: [11]
- Adjuvant therapy for resected squamous cell carcinoma of the head and neck. American College of Radiology ngc-guideline: [12] - American Society of Clinical Oncology: Clinical Practice Guideline for the Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer [13]
