head & neck cancers

Head & Neck Cancers

Prof. Igor Y. Galaychuk, MDChief, Department of Oncology

and RadiologyTernopil State Medical University

Epidemiology. In Ukraine every year:

Lip cancer >2000 pts. Cancer of oral cavity

4500 pts. Larynx cancer 3000 pts.

Thyroid cancer >2000 pts.

Died: Lip cancer 400 pts.

52% within year 38% within year

400 pts.

Oral cavity and pharynx: 28,260 – New Cases; 7230 – DeathsTongue: 7320 1700

Larynx: 10,270 3830 USA2004

25.6%23.2%37.3%

Etiology and risk factors

Tobacco Alcohol Insolation Work factors (out of doors) Viruses (EBV, Herpes 1, Papilloma

viruses) Diet (Vit. А, -carotene, -токоферол)

Cancer of the vermilion surface

TNM Classification of Lip & Oral Cavity Cancers

Тis – carcinoma in situ T1 – tumour less than 2 cm T2 – 2-4 cm in greatest dimension T3 – > 4 cm T4 – tumour invades bone, muscle, skin N0, N1 <3 cm, N2= 3-6 cm, N3 >6

cm M0, М1

Lower Lip Cancer, Т4N0M0

Precancerous lesions:

Leukoplakia (<5% transformation) Erythroplakia (40%) Hyperkeratosis Papilloma

Hyperkeratosis of lip

Hyperkeratosis: triangle lip biopsy and vermilionectomy

Lower Lip Cancer, T2N0M0

Rectangular resection of lip with reconstruction

Treatment modalities for Lip Cancers:

Surgery: rectangular resection (Т1-Т4), vermilionectomy (Тis), crio (Тis)

X-ray therapy (Тis, N1-2) Gamma-ray therapy (Т3-Т4) Chemotherapy (при ІІІ-ІV ст.): 5-FU,

Cisplatin regional lymph node dissection (N1-

3)

Tongue Cancer

Localization: lateral borders – 60%,radix – 20-27%, tip – 3%, dorsal surface – 7%.

Clinical presentation: nodular tumor, ulcer tumor, inflammatory type

Precancerous lesions: leukoplakia, papilloma, ulcers, fissure, glossitis

Papilloma of Tongue

Tongue cancer: hemiresection

Cancer of Tongue: 5-year survival

І st. – 80% ІІ st. – 60% ІІІ-ІV st. – 15-35% Lymph node metastases decrease

survival on 50%.

Cancer of Oral Cavity – Floor of Mouth

Regression of cancer after gamma-ray therapy

Lymphatic drainage

Levels of lymphatic drainage

Submandibular lymph node dissection

Neck lymph node Mts

Superficial neck lymph node dissection

Extensive lymph node dissection (Crile oper.)

Thyroid cancer

Thyroid cancer: etiology and risk factors

Irradiation (papillary CA), Iodine deficiency (follicular CA) Goiter (anaplastic CA) Multiple endocrine neoplasia MEN-

2A, MEN-2B (medullary CA)

Histology of Thyroid Cancers

Papillary carcinoma (50%) – from А-cells

Follicular CA (30%) – from А-cells Hurthle cell carcinoma – from В-cells

Medullary carcinoma (5-10%) – С-cells

Anaplastic (undifferentiated) CA (5%)

Diagnostics:

USD – 7,5 МГц Scintigraphy: J-131 (“cold” node), Tc-99m (“hot” node) FNA Biopsy Laryngoscopy CТ, MRI Calcitonin in plasma (Medullary

cancer)

TNM Classification (2002)

Т1 < 2 cm T2 2-4 cm T3 > 4 cm T4 t-r invades soft tissues of neck,

larynx, trachea, oesophagus, rec.laryng. nerve.

N0, N1a, N1b (bilateral lymph.nodes) M0, M1

Thyroid carcinomas: staging

Thyroid CA (papillary-follicular), <45 yr.Stage І : T any N any M0Stage ІІ: T any N any M1

Thyr.CA (papil./follic.+medullary) > 45 yr.:Stage: І, ІІ, ІІІ, ІV

Thyr.CA anaplastic – all cancers are IV st.

Thyroid Cancer, T4 st.

After thyroidectomy

Laryngeal cancer.Anatomy of Larynx

Direct laryngoscopy:normal (1); fibroma (2)

1 2

Polyp of vocal cord

Laryngeal carcinoma (1), (2)

1 2

TNM Classification of Laryngeal Carcinoma (glottis part)

Т1 – t-r limited to vocal cords with normal mobility

Т2 – t-r extends to supraglottis or subglottis with impaired v/cord mobility

Т3 - t-r limited to larynx with vocal cord fixation Т4 - t-r invades through the thyroid cartilage or

soft tissues of neck

N1 л/в <3 cm, N2 3-6 cm, N3 >6 cm. M0, M1

Partial resection of larynx

Laryngeal carcinoma with neck infiltration

Larynx (surgical specimen)

RL

Tracheostomy after laryngectomy

Rehabilitation: voice prosthesis

Дякую за увагу! Thanks!