Tumors - Head and Neck

TUMORS
of the
HEAD and NECK
What particular problem(s) can
tumors of the head and neck give
the patient?
HEAD and NECK TUMORS
PHYSIOLOGIC DISTURBANCES
• BREATHING
• SPEECH
• MASTICATION
• SWALLOWING
• HEARING
• SIGHT

Scope of presentation
1. Skin and soft tissues of the head and
neck
2. Oral cavity
ETIOLOGY
• SMOKING
• ALCOHOL
• Human papilloma virus infection
• BETEL NUT CHEWING
• POOR ORAL HYGIENE
• EXPOSURE TO SUN
HEAD and NECK TUMORS
DIAGNOSTIC WORK-UP
• COMPLETE HISTORY AND P.E.
• BIOPSY – FNA, INCISIONAL, PUNCH
• DIRECT LARYNGOSCOPY
• CERVICAL ESOPHAGOSCOPY
• CHEST X-RAY
• others: CT scan, panorex
TUMORS of the FACE
and LIPS
Basal Cell Carcinoma
- most common skin
cancer
- slow growing
- ulcer with rolled, pearly
borders
- “rodent ulcers”

TUMORS of the FACE
and LIPS
Squamous Cell Carcinoma
- more aggressive than basal
cell cancer
- etiol.: exposure to sun
- male:female – 20:1
- treatment: surgery
radiation
(depending on stage)
Neck Dissection indicated if l.n. are (+)

THE ORAL CAVITY

• gingiva
• anterior 2/3 of tongue
• floor of the mouth
• hard palate
• buccal mucosa
Malignant Lesions
of the Oral Cavity
• 95% are squam. cell ca
• 10:1 male to female ratio
• etiology:
pipe/cigar smoking
betel nut/tobacco chewing
alcohol
poor oral hygiene
Cervical Nodal Groups
pre-auricular/parotid
retro-auricular/ sub-occipital
submental
submandibular
superior jugular
mid-jugular
lower jugular
spinal accessory
supraclavicular
pre-/paratracheal
ORAL CAVITY
MALIGNANT LESIONS
• LOCATION: hard palate
• CELL TYPE: adenocarcinoma
• INVASIVENESS: (+)
• NODAL mets.: not usual in early stage
• TREATMENT: wide excision
• 5-YEAR SURVIVAL: 30-40%
ORAL CAVITY
MALIGNANT LESION
• LOCATION: buccal mucosa
• CELL TYPE: squamous cell ca
• INVASIVENESS: (+)
• NODAL mets: submax., upper cervical
• TREATMENT: wide excision + neck
dissection +/- radiotx. (St. III/IV)
• 5-YEAR SURVIVAL: 55%
• uncommon; Stage I/II best treated with
radiotx.



ORAL CAVITY
MALIGNANT LESIONS
• LOCATION: floor of mouth
• CELL TYPE: squamous cell ca
• INVASIVENESS: (++++)
• NODAL mets.: bilateral submaxillary n.
• TREATMENT: commando opn., + pre-
or post-op radiotx.
• 5-YEAR SURVIVAL: 40%
RECONSTRUCTIVE SURGERY
• Platysma Myocutaneous Flap
• Latissimus Dorsi Myocutaneous
• Pect. Major Myocutaneous Flap
• Radial Forearm Free Flap
TEAM APPROACH in the
TREATMENT of H and N
CANCER
• Head and Neck Surgeon
• Radiation Onco., Medical Onco.
• Plastic/Reconstructive Surgeon
• Clinical Patho., Speech Patho.
• Dentist
• Nurse, Social Worker
• Nutritionist
• Physical Therapist
ORAL CAVITY
MALIGNANT LESIONS
• LOCATION: tongue
• CELL TYPE: squamous cell ca
• INVASIVENESS: (+++)
• NODAL mets.: submental, submand.
• TREATMENT: same as floor of mouth
• 5-YEAR SURVIVAL: 30-50%
• 30-40% occult nodal mets. in early
stage; selective neck dissection
recommended
ORAL CAVITY
MALIGNANT LESIONS
• LOCATION: gingiva
• CELL TYPE: squamous cell ca
• INVASIVENESS: (++)
• NODAL mets.: submaxillary nodes
• TREATMENT: commando operation
• 5-YEAR SURVIVAL: 45%
SALIVARY GLANDS
PAROTID GLANDS
SUBMAXILLARY GLANDS
SUBLINGUAL GLANDS
MINOR SALIVARY GLANDS
SALIVARY GLANDS
MALIGNANT TUMORS
• 20% of PAROTID G. TUMORS
• 50% of SUBMAND. G. TUMORS
• 75% of MINOR SALIV. G.
TUMORS
SALIVARY GLANDS
MALIGNANT TUMORS
Mucoepidermoid carcinoma
- most common malignant tumor
of the parotid gland
- may be low or high grade
- treatment: excision for low
grade; radical surgery + neck
dissection + radiotherapy for
high grade
SALIVARY GLANDS
MALIGNANT TUMORS
Adenoid Cystic carcinoma
- common in submand. and minor
salivary g. tumors
- has propensity for perineural
invasion
- treatment: radical resection + post-
op. radiotherapy for high grade
tumors
SALIVARY GLANDS
MALIGNANT TUMORS
Malignant Mixed Tumor
- arises from a pre-existing benign
mixed tumor
Adenocarcinoma
- most are high grade
- most common in minor salivary glands


SECOND PRIMARY TUMORS
• overall incidence: 14%
• detected w/in 6 months –
synchronous
• detected after 6 months –
metachronous
• incidence increased if predisposing
factor(s) still present

PALLIATIVE CARE
 for those with advanced disease
 radiation, chemotherapy
 pain control
 tracheostomy, gastrostomy
 hospice care
TUMORS of the NECK
(adults)
• Inflammatory 4%
• Congenital/Miscellaneous 12%
• Neoplastic 84%
metastatic 80%
primary to neck 20%
lymphomas 60%
saliv. g. tumors 40%
CONGENITAL LESIONS
NECK
 Thyroglossal duct cyst

 Branchial cleft cyst

 Cystic hygromas/lymphangiomas
Neck Tumors with Occult
Primary
1. Thyroid carcinoma
2. Role of human papilloma virus infection
FOLLOW-UP, POST-TREATMENT OF
H/N CANCER
Regular, for at least 5 years
Monitor for recurrence
Perform good history and PE
Look for side effects of treatment
Annual chest x-ray
Dental referral for post-radiotx.
SUMMARY
1. The head and neck is a confined area
where tumors can cause unique
problems
2. Majority of the tumors in the area are
squamous cell carcinomas
3. Tumors of the neck have differing
etiologies in the very young compared
to the old patient