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Head and neck video 1

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Information about Head and neck video 1

Published on March 17, 2013

Author: doctorbobm

Source: slideshare.net

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Head & Neck Cancer Robert Miller MD www.aboutcancer.com

Head and Neck Cancer1. Cause, the symptoms and the anatomy2. Histology: most common is squamous cancer3. Imaging: CT and PET scans4. Stage is based on the size of the tumor and the number or size of lymph nodes

Risk Factors Associatedwith Oral Cancer1.Tobacco Use (5 to 25X)2. Alcohol (heavy drinkers double their risk)3.Oral infection with HPV164.Sun exposure for lip cancer5.Reflux - ? Larynx cancer

The cure rate is better for HPV cancers thanfor smoking related cancers SURVIVAL Non-smokers smokers Years JCO June 10, 2012 vol. 30 no. 17 2102-2111

Cure Rates are better for people whostop smoking during the radiation Years JCO June 10, 2012 vol. 30 no. 17 2102- 2111

Most Common Head and Neck Cancers Pharynx 13,930 Tongue 13,590 Larynx 12,260 Mouth 11,400 Other oral 2,4602013 data (note that sameyear there were 228,190lung cancers and 234,580breast cancers)

Lifetime Risk of GettingCancer Site Men WomenAny Cancer 44% 37%Oral/Pharyn 1.39% 0.65% x Larynx 0.61% 0.14%

Median Age for Oral/Pharynx is 62y in 2005-2009302520151050 20 35 45 55 65 75 85 Age

Median Age for Larynx Cancer is 65y in 2005-20093025201510 5 0 20 35 45 55 65 75 85 Age

Stage and Survival 2002-2008 Oral Cavity and Pharynx Stage Distribution Survival (5y) All 100% 61.5% Local 32% 82.4%Regional 47% 57.3%Distant 16% 34.9%

Stage and Survival 2002-2008 Larynx Cancer Stage Distribution Survival (5y) All 100% 60.5% Local 57% 76.4%Regional 20% 41.8%Distant 18% 34.8%

Oral Cavity

Oral Cavity Cancer• Present with a sore in the mouth that does not heal• Commonly in the oral tongue, the floor of the mouth or the inside of the cheek (buccal mucosa)• Sometimes present with a swollen lymph node in the neck

Cross Section Anatomy

CT Scan and Anatomy

CT-PET Anatomysmall cancer in the front of the tongue (oral tongue)

Oral Cavity Stage: T(tumor) Tumor Size T1 2cm T2 > 2 to 4cm T3 > 4cm T4 Deeply invasive

Oral Cavity Stage: N (nodes)Nodes SiteN1 Single node up to 3cmN2a Node >3 to 6cmN2b Multiple ipsilateralN2c ContralateralN3 Node > 6cm

Oral Cavity StageStage DefinitionStage 1 T1N0Stage 2 T2N0Stage 3 T3 or N1Stage 4A T4a or N2Stage 4B T4b or N3Stage 4C Metastases

Anatomy of the Pharynx

Cancer of the Nasopharynx Uncommon cancer in the US, related to EBV (Epstein-Barr virus). Located high in the back of the throat Symptoms: include nasal congestion, hearing problems (fluid behind the ear drums)Late symptoms: if the cancer invade the skullcan be cranial nerve problems or headachesOther late symptoms include lymph node

Cancer of the Oropharynx Most common sites include the tonsil and the base of the tongue May be related to HPV virus (so more common in non smokers)Symptoms include sore throat with painradiating into the ear, trouble swallowing andlymph node enlargement

normal mandible tongue throat Cancer in(pharynx) Base of Tonguesalivarygland normal lymph nodesspinal cord spine

Squamous Cancer Right Tonsil – VeryVisible on PET scan

Oropharynx Stage: T (tumor)Tumor SizeT1 2 cmT2 >2 to 4cmT3 > 4cmT4 Deeply Invasive

Oropharynx Stage: N (nodes)Node SizeN1 Single node up to 3cmN2a Node >3 to 6cmN2b Multiple IpsilateralN2c Contralateral NodesN3 Node >6 cm

Oropharynx StageStage DefinitionStage 1 T1N0Stage 2 T2N0Stage 3 T3 or N1Stage 4A T4a or N2Stage 4B T4b or N3Stage 4C Metastases

PET CT Anatomy for TonsilCancer, Stage IVa with multiple involved nodes (N2)

Cancer of the Hypopharynx Less common Low in the throat, most common site is in the pyriform sinusSymptoms are usually trouble swallowing orhoarsenessOther late symptoms include lymph nodeswelling

Lymph Nodes

Neck Node Levels

PET Scan showing MultipleLevel Lymph Node Spread

PET Scans are Very GoodShowing Lymph Node Spread

Larynx Anatomy

Larynx Cancer If supraglottic larynx is commonly involves the epiglottis and symptoms include sore throat and trouble swallowingIf the true vocal cords the symptoms are almostalways hoarse voiceLate stage symptoms include lymph nodeswelling in the neck and weight loss

Common site for larynx cancer is the spotwhere the two vocal cords come together inthe front of the larynx (called the anteriorcommissure)

Larynx Stage: T (tumor)Tumor SizeT1 One siteT2 Two sites/ impaired mobilityT3 Paralyzed cordT4 Deeply Invasive

Larynx Stage: N (nodes)Node SizeN1 Single node up to 3cmN2a Node >3 to 6cmN2b Multiple IpsilateralN2c Contralateral NodesN3 Node >6 cm

Larynx StageStage DefinitionStage 1 T1N0Stage 2 T2N0Stage 3 T3 or N1Stage 4A T4a or N2Stage 4B T4b or N3Stage 4C Metastases

NCCN.org

Increasing Complexity in theManagement of Head & Neck Cancer

Treatment options for head and neck cancer Early stages: surgery or radiation Advanced stage: surgery followed by radiation and chemotherapy or chemoradiation alone Very advanced cases: radiation and chemotherapy

Treatment decisions and management should be made by a team of physicians• Experienced cancer Surgeon and reconstruction team• Radiation oncologist with access to state of the art equipment (IGRT or Tomotherapy)• Medical Oncologist (chemotherapy and targeted therapy)• Support personnel including nutritional support and

Multidisciplinary Team

Support Team

Head & Neck Cancer Robert Miller MD www.aboutcancer.co m

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