Neoplasms of Head & Neck - Lecture 7 Flashcards
where do neoplasms of head and neck arise from?
- epithelial carcinomas
- arise from mucosal surfaces
what type of carcinoma are most epithelial carcinomas of head and neck?
squamous cell carcinoma
where can lesions occur?
nasopharynx, oral cavity, oropharynx, larynx
tumors and precancerous lesions?
- SCC
- leukoplakia
- melanoma
SCC is most commonly malignancy where?
head and neck
what can increase risk of oropharyngeal cancer?
Smoking, ETOH abuse, and/or being infected with HPV
what are oral cavity cancers associated with?
- Non-healing ulcers or masses
- Dental changes or poorly fitting dentures
are oral cavity cancers anterior or posterior cancers?
anterior
how do tongue and lip cancers present as?
exophytic or ulcerative leasions often associated with pain
what is most affected with cancer, tongue or lip?
tongue
what is major risk factor for tongue and lip cancers?
tobacco/ETOH
-also synergistic effect
where do posterior cancers occur?
oropharynx
- SCC most common
- HPV major risk factor
do malignant oral lesions have big or little improvement in early detection?
-Little improvement in early detection as many patients do not present until late (Stage III or IV)
who do most tobacco-related malignant oral lesions occur in?
Pts older than 60
who is affected more by malignant oral lesions, male or female?
males
-including HPV positive tumors
malignant oral lesions clinical presentation
- SCC preceded by premalignant changes of oral mucosa (leukoplakia or erythroplakia)
- as cancer develops, notice presence of non-healing ulcer
symptoms of later stage of malignant oral lesions?
- bleeding
- Loosening of teeth
- Difficulty wearing dentures
- Dysphagia
- Dysarthria
- Hoarseness
- Development of neck mass
who do you maintain a high index of suspicion for malignant oral lesions?
tobacco and alcohol users
where do HPV-related malignant head and neck SCC’s arise from?
oropharynx, particularly palatine and lingual tonsils
what does HPV-16 affect?
posterior part of the tongue
- does NOT produce visible lesions/discolorations
- NO early warning signs
who have oral tongue cancers increased in?
young women - often with NO significant tobacco or alcohol exposure
(22-44 y.o)
what do head and neck lesions NOT present with?
Most head and neck lesions do NOT present with history of premalignant lesions
symptoms of malignant head and neck lesions?
- Pain – minimal
- Otalgia
- Dysphagia
- Odynophagia
- Airway obstruction
signs of malignant head and neck lesions?
- Cervical lymphadenopathy
- Cranial neuropathies
- Decreased tongue mobility
- Fistulas
- Skin involvement
locations of malignant head and neck lesions in pharynx?
nasopharynx
locations of malignant head and neck lesions in oropharynx?
- Tongue base
- Soft palate
- Palatine tonsils
- Posterior wall of pharynx
locations of malignant head and neck lesions in hypopharynx?
Piriform sinuses and post-cricoid area leading to esophagus below
locations of malignant head and neck lesions in glottis?
- True vocal cords
- Most common site of laryngeal cancer
- Present with hoarseness
locations of malignant head and neck lesions in larynx?
Supraglottis
- Epiglottis and false vocal cords
- Cancers here spread early to lymph nodes
3 categories of oral cavity cancers
-Well differentiated
-Moderately well differentiated
-Poorly differentiated
(worse prognosis than well-differentiated)
Oral cavity SCC locations
- Lips
- Tongue
- Floor of mouth
- Maxillary alveolar ridge/hard palate
- Mandibular alveolar ridge
- Buccal vesitbules
what is Oral cavity SCC preceded by?
Leukoplakia, erythroplakia, and speckled erythroplakia
will most leukoplakia progress to oral cavity SCC?
NO, most will not
erythroplakia
Red, velvety patch similar to white patch
- Fiery red patch
- Often well demarcated
- Cannot be identified clinically or pathologically as any other definable disease
- Will show evidence of high-grade dysplasia, carcinoma in situ, or invasive SCC
speckled erythroplakia
- Combination of red and white features
- May have rough, granular surface
what can OC-SCC appear as?
ulcer without adjacent mucosal change
what will continued growth of OC-SCC result in?
a mass with raised, rolled border
when does pain/tenderness develop in OC-SCC?
develop later in disease
-many other lesions are PAINLESS
what is the most common site of OCC-SC in western world?
tongue
2nd most common oral site is floor of mouth
SCC of tongue lesions appear where?
-lateral aspect and ventrolateral aspect of tongue
where does oropharyngeal SCC develop?
tonsillar region and base of tongue
what is appearance in oropharyngeal SCC?
ulcerated mass, fullness, or irregular erythematous mucosal change
most common chief complaint of oropharyngeal SCC?
- Presence of a neck mass
- Sore throat
- Dysphagia (because of location of the mass)
how to do PE for all oral cancers?
- Should include inspection of all visible mucosal surfaces
- Palpation of the floor of the mouth, tongue, and neck
when do patients usually present in oral cancers?
when have enlarged cervical lymph node
-don’t present until stage III or IV
stage 1 OC-SCC, how big and do not involve what?
<2 cm
-do not involve deep (extrinsic) tongue muscles or mandible
T2 cancers, size and involve?
- 2-4 cm
- May involve adjacent structures
- May have higher incidence of occult lymph node metastasis
if pts have lymph node involvement and no visible primary, what do you do to dx?
lymph node excision
what imaging is most commonly used for head and neck cancers?
- CT scan
- look for bone involvement
what imaging for complete assessment and staging of head and neck cancers?
MRI and/or CT/PET
-MRI to look for lymph node or soft tissue involvement
what do you do for patients at risk for distant metastasis of head and neck cancers?
- Plain radiography
- And/or CT of chest
- And/or CT/PET full body
where is metastasis common in pts with advanced neck lymph node disease?
lungs, bones, liver
pt categories for head and neck cancers
- localized disease
- advanced disease (local or regionally)
- recurrent and/or metastatic disease
people with advanced disease of head and neck cancers will have what?
lymph node positive
localized diseased patients graded how?
1/3 of pts
-have T1 or T2 lesions without detectable lymph node involvement or distant metastases
localized diseased patients treatment?
treated with curative intent
- surgery (for small lesions)
- radiation therapy (for laryngeal cancer to preserve voice fxn)
when do recurrences occur for localized disease?
within first 2 years following dx (usually local)
advanced disease - how many patients?
50% of patients
how are advanced disease pts treated?
- w/curative intent
- combine modality therapy (surgery, radiation, chemo)
when do you do chemo in advanced disease?
before surgery or radiation
concomitant treatment for advanced disease
- Simultaneous chemo and radiation
- Most commonly used and supported by best evidence
where do pts with advanced disease experience recurrence?
outside the head and neck region
for recurrent or metastatic disease, how are they treated?
palliative intent
- radiation (for pain control)
- chemo
