[19.1] Head and Neck Cancers

• Head and Neck cancer is the collective term for all types of cancer that develop in the head and neck
• Head and neck cancers involve Upper aerodigestive tract (UADT)
• Parts of upper aerodigestive tract

  1. nasal vestibule to upper vermillion border of the lips
  2. cricoid to cervical trachea
  3. hypopharynx to cervical esophagus
• Primary Location

  • Larynx
  • Oral Cavity
  • Oropharynx
• Less common sites

  • Nasal cavity
  • Nasopharynx
  • Paranasal sinuses
  • Hypopharynx
  • Salivary glands (major and minor)
• Types of cancer

  • squamous cell carcinoma
  • adenocarcinomas
  • sarcomas
  • lymphomas
• epidemiology

  • 10th placed cancer in the world
  • 0.5 million cases & 380,000 deaths annually
  • 3x more prevalent in men than women
  • 7,400 in PH, totaling 6% of the overall cancer case in 2015
• Risk factors

  • Men ages 50s who drinks alcohol and smokes actively
  • Drugs, Dietary
  • Sunlight
  • Betel Nut
  • X-ray
• Certain Viral infection

  • Human Papilloma Virus (HPV)
  • oropharynx
  • tonsillar bed and base of the tongue
  • subtype: 16-18
• Epstein-Barr Virus

  • Nasopharyngeal cancers
• Oral Cavity Signs

  • white or red patches
  • swelling of jaw
  • unusual blooding
  • pain
• Pharynx

  • Swallowing, communication, breathing
  • headaches
  • pain in neck and throat
  • ears
• Larynx

  • ear and swallowing
• Paranasal and Sinuses: Blocked sinuses
• Nasal Cavity

  • chronic sinus infection
  • headaches
  • bleeding through nose
  • eyes/denture/upper teeth
• General

  • Lumps
  • Sore throat
  • swallowing, voice
  • mucosal ulcerations and lesions
• advanced stages

  • severe pain
  • otalgia
  • airway obstruction
  • cranial neuropathies
  • Trismus
  • Odynophagia, Dysphagia
  • fistulas
• TNM

  • Tumor: size and site of tumor
  • Node: spread to nearby cervical node
  • Metastasis: spread to distant parts
• Stage 1 TNM

  • Tumor: Less than 2cm
  • Node: Less than 5mm
• Stage 2 TNM

  Tumor: 2 - 4 cm

  Node: 5 - 10 mm
• Stage 3 TNM

  Tumor: more than or equal to 4 cm

  Node: less than 3 cm, single/ipsilateral
• Stage IVa

  • Tumor: fascial nerve, skin, mandible, ear canal
  • Node
  • 2a: 3 - 6 cm, single/ipsilateral
  • 2b: more than 6cm, double/ipsilateral
  • 2c: more than 6cm, double/contralateral
• Stage IVb

  • Tumor: Skull, Pterygoid, Carotid
  • Node: More than 6 cm
• approaches for treatment

  • localized disease
  • localized or regional advance
  • recurrent or metastatic
• localized disease

  • 1/3 of the patient
  • stage 1 and 2
  • no nodes and metastatic
  • radiation: laryngeal
  • surgery: oral cavity
• localized or regionally advance

  • lymph-note positive
  • more than 50% of the patient
  • combination (surgery, chemotherapy, and radiation)
• Radiation complication

  • Acute (Dysphagia & Mucositis)
  • Long-term (Dysphagia, Xerostomia, Neck Fibrosis)
• Chemotherapy

  • Myelosuppression
  • Mucositis
  • Nausea
  • Vomiting
  • Nephrotoxicity
• Goals of Therapy (Head and Neck)

  • improve Quality of Life
  • communicate with the environment
  • best treatment
• In other countries, SPs administer them, but in PH its ENTs
• Swallowing

  • FEES: Flexible endoscopic examination of swallowing
  • VFS: videofluoroscopy
  • MBS: Median Barium Swallow
• Voice

  • endoscopy
  • Stroboscopy
  • Speech Studio/laryngograph
• Philippine Laryngectomee Club to New Vois Association of the Philippines
• Laryngectomy: removal of the Larynx
• Tracheotomy: creation of hole in trachea
• Tracheostomy: hole or stoma + the tube