anatomy, diagnosis, and work-up of head and neck cancers...anatomy, diagnosis, and work-up of head...
TRANSCRIPT
Anatomy, diagnosis, and work-up of head
and neck cancers
Pr. Christian Simon
Service d’Oto-Rhino-Laryngologie
CHUV, UNIL
2
DISCLOSURE:
- PFIZER: TRIAL STEERING COMMITTEE- MERCK: CONSULTANT
Diagnostic measures
Pan-endoscopy:
1) Histopathology: >90% squamous cell carcinoma
2) Extension of the primary tumor
3) Presence of secondary tumors
Pan-endoscopy
Rigid oesophagoscopy
Video removed for online publication
Risk of secondary primaries
Gan et al. Cancer 2013
Imaging
CT, MRI, US, PET
1) Extension of the disease
2) Lymph node metastases
3) Distant metastases: Lung, liver, bone
Oral cavity cancers
Anatomy of the oral cavity: General
Histological types and symptoms of oral cavity cancers
• Squamous cell carcinomas
• Adenocarcinomas
• Lymphomas
– T-cell lymphomas
– Non-Hodgkin Lymphomas
• Kaposi’s sarcoma
• Dysphagia
• Pain
• Odynophagia
• Fetor
• Otalgia
• Trismus
• Adenopathy
High likelihood
Low likelihood
Cummings 2005
Work-up for oral cavity cancers
Presentation: Oral cavity cancer
Reconstruction of a tongue
Cancers of the pharynx
Anatomy: Pharynx
Exposure of the parapharyngealspace
Video removed for online publication
Hypopharynx and piriform sinus
Nasopharyngeal Cancer
Epidemiology: Countries with high incidence of nasopharyngeal
cancer Age standardized incidence rates
(ASIR):
A) For men
B) For women
Countries with highest ASIR:
- China
- Hong Kong
- Singapore
- Malaysia
- Algeria
Histology types and etiology of nasopharyngeal cancers
• Histological subtypes:
– Keratinising (associated with HPV)
– Non-keratinising(differentiated or undifferentiated; associated with EBV)
– Basaloid (no association known)
Chua et al. Lancet 2016
Symptoms: Nasopharynx cancer
• Neck mass
• Blood in saliva
• Deafness
• Epistaxis
• Nasal obstruction
• Tinnitus
• Cranial nerve palsy
High likelihood
Low likelihood
Cummings 2005
Presentation and work-up
Oropharyngeal Cancer
Histological types and symptoms of oropharyngeal malignancies
• Malignant epithelial tumors
– Squamous cell carcinoma
– Lympho-epithelial carcinoma
• Salivary gland tumors
– Salivary gland carcinomas
• Adenoid cystic carcinoma etc.
• Myoepithelial carcinoma
• Soft tissue tumors
• Hemato-lymphoid tumors
• Mucosal malignant melanoma
• Secondary tumors
• Neck mass
• Dysphagia
• Odynophagia
• Otalgia
• Oral bleeding
High likelihood
Low likelihood
Cummings 2005
Work-up for oropharyngealcarcinomas
History of present illness• 55 year old female
patient
• Sore throat and dysphagia since 4,5 weeks mainly on the left side, does not respond to antibiotics
• Smoking history of 40 package years
• Drinks one bottle of wine a day since 10-15 years
Panendoscopy: Reveals a 4,5 cm lesion in the left tonsillar region, histology is consistent with squamous
cell carcioma
The tonsillar region belongs to the oropharynx
Imaging: Reveals a tonsillar tumor on the left side
Imaging: Reveals bilateral lymph node metastasis
Cases55 year old female patient with a tonsillar cancer
36 year old female patient with a base-of-tongue cancer
History of present illness
• 36 year old female patient
• Sore throat and dysphagia since 5 weeks mainly on the left side, does not respond to antibiotics
• Never smoked, occasional alcohol
This patient has an HPV+ tumor
Panendoscopy: Reveals a 3 cm lesion in the left base-of-tongue, histology is consistent with
squamous cell carcioma
Imaging: Reveals a left base-of-tongue cancer …
Hypopharyngeal cancer
Histologies and symptoms: Hypopharynx cancer
• Dysphagia
• Neck mass
• Sore throat
• Hoarseness
• Otalgia
• Shortness of breath
• Hemoptysis
High likelihood
Low likelihood
Hoffmann et al. Laryngoscope 1997
• Squamous cell carcinomas
• Lympho-epithelial carcinomas
• Lymphomas
– T-cell lymphomas
– Non-Hodgkin Lymphomas
• Adenocarcinomas
• Soft tissue tumors
• Secondary tumors (i.e. thyroid cancer by direct infiltration)
Presentation and work-up: Hypopharynx
Laryngeal cancer
Laryngeal anatomy
Histologies and symptoms: Laryngeal cancer
• Hoarseness
• Dysphagia
• Neck mass
• Sore throat
• Otalgia
• Stridor
• Adenopathy
High likelihood
Low likelihood
Cummings 2005
• Squamous cell carcinomas
• Lympho-epithelial carcinomas
• Malignant salivary gland tumors (i.e. Adenocarcinomas)
• Lymphomas
– T-cell lymphomas
– Non-Hodgkin Lymphomas
• Neuroendocrine tumors
• Soft tissue tumors
• Secondary tumors (i.e. thyroid cancer by direct infiltration)
Presentation: Laryngeal cancer
Work-up for laryngeal carcinomas
Thank you for your attention