Chapter 23: Malignant Tumors of the Head and Neck Flashcards
- Comprises 90% of head and neck cancer
2. More common in men
Squamous cell carcinoma
Has been associated with nasopharyngeal carcinoma
Epstein-Barr virus
- Develops in a major or minor salivary gland, is the next most common type
- Occurs equally in men and women
Adenocarcinoma
- Develops as an ulcerative lesion with necrotic edges, usually surrounded by some inflammatory response
- Initially spreads along the mucosal surface, eventually extending into the underlying soft tissue
Squamous cell carcinoma
Occurs in the major or minor salivary glands located in the mucosal lining or in the immediately submucosal area
Adenocarcinoma
Classification of common tumors of salivary glands
- Acinic cell carcinoma
- Adenoid cystic carcinoma (cylindroma)
- Adenocarcinoma
- Mucoepidermoid carcinoma
- Carcinoma arising in pleomorphic adenoma
- Malignant mixed tumor
- May metastasize by both lymphogenous and hematogenous
2. May occur at any age
Adenocarcinoma
- Has a high propensity to spread along the neural sheaths
2. Known to recur after a disease free interval of 5-10 years
Adenoid cystic carcinoma
Generally submucosal, presenting as a smooth, firm, rounded mass that becomes ulcerated only late in the course of the disease or after biopsy
Adenocarcinoma
May present as a primary malignancy in the head and neck
Malignant lymphoma
Classification of Hodgkin’s lymphoma
- Lymphocyte predominance
- Nodular sclerosis
- Mixed cellularity
- Lymphocyte depletion
Reported to have the most favorable 5-year survival rates
- Lymphocyte predominance
2. Nodular sclerosis
Commonly localized to the cervical lymph nodes and upper mediastinum
Nodular sclerosing type
Systems used in the diagnosis of non-Hodgkin’s lymphoma
- Rappaport
- Lukes-Collin
- Lennert
Divides the tumors into well-differentiated lymphocytic, poorly differentiated lymphocytic, mixed histiocytic-lymphocytic and diffuse poorly differentiated
Rappaport
Dependent on immunologic identification
Lukes-Collin system
- Most common sarcoma in children
2. Occurs in the posterior nares, ethmoid, orbital and nasopharyngeal regions
Rhabdomyosarcoma
Most common sarcoma of the head and neck in adult
Malignant fibrous histocytoma
Most common tumor to metastasize to the paranasal sinuses
Hypernephroma
- Most common skin malignancy and arises in areas with a high exposure to sunlight
- Common sites: cheek, nose, forehead, ear
- Excellent prognosis
- Tx: excision
Basal cell carcinoma
- Arises in areas associated with high sunlight exposure
- Most common sites: pinna and lower lip
- Can metastasize regionally and distally
Squamous cell carcinoma
- Lesions involving only the epidermis
- Considered to be “atypical melanocytic hyperplasia” and not included in the staging of malignant melanoma, for they do not represent a malignant lesion
Clark's classification Level I (epidermis to epidermal-dermal interface)
- Invasion of the papillary dermis
2. Does not reach the papillary-reticular dermal interface
Clark's classification Level II (papillary dermis)
- Invasion involves the full thickness of, fills and expands the papillary dermis
- Abuts upon but does not penetrate the reticular dermis
Clark's classification Level III (papillary-reticular dermis interface)
Invasion occurs into the reticular dermis but not into the subcutaneous tissue
Clark's classification Level IV (reticular dermis)
Invasion occurs through the reticular dermis into the subcutaneous tissue
Clark's classification Level V (subcutaneous tissue)
Breslow’s classification by depth
- 0.75 mm or less
- 0.76 mm to 1.50 mm
- 1.51 mm to 4.0 mm
- More than 4.0 mm
- Arise on mucous membranes of the nose or throat
2. Most common sites: intranasal/hard palate/buccal mucosa
Malignant melanoma
Modalities of treatment of head and neck malignancies
- Radiation therapy
- En bloc surgical excision
- Laser excision
- Chemotherapy
- Combination of modalities
