Squamous Cell Cancer of the Head and Neck at Fairview Ridges Hospital

Dr. Priya Kumar

Fairview Ridges Cancer Committee 2013

The Fairview Ridges Hospital Cancer Committee chose this study to fulfill Standard 4.6 for the American College of Surgeons Comprehensive Cancer Program Certification for 2013.

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Epidemiology

• 48,000 new cases

• 11,000 deaths estimated yearly in the US

• Median age of diagnosis- 60 years

• Male: Female is 4:1

• Strongly associated with tobacco and alcohol

• Epstein-Barr virus risk factor for nasopharynx cancer

• Human papillomavirus (HPV) increasingly appreciated as a risk factor

Human Papilloma Virus (HPV)

• HPV 16 is the viral subtype in the vast majority of patients

• Half of oro-pharynx cancer cases have HPV 16 DNA

• Often occurs in nonsmokers and nondrinkers

• Median age younger than HPV negative patients; incidence is increasing

• Associated with certain sexual practices

• Favorable prognosis

Treatment of HNSCCs

• 30-40% of HNSCCs present with early stage disease (Stage I/Stage II)

These patients are usually treated with primary surgery or definitive radiation

5 year over all survival is usually 70-90%

Treatment of HNSCCs

Loco-regionally advanced stage HNSCCs (Stage III/IV)

• Primary surgery followed by postoperative radiation (oral cavity)

• Concurrent chemo radiation or targeted treatment

Cetuximab with radiation

• Sequential treatment

induction chemo followed by chemo radiation

• Definitive radiation for elderly/low performance stage patients

• 5 year overall survival about 50%

• For HPV positive cancers 5 year overall survival upwards of 80%

Fairview Ridges Data

7

8

0

10

20

30

40

50

2008 2009 2010 2011 2012 Total

FRH Newly Diagnosed Head & Neck Cancer Patients (2008-2012) by Age Group

<50 50+

9

0

5

10

15

20

25

30

35

40

45

50

2008 2009 2010 2011 2012 Total

FRH Newly Diagnosed Head & Neck Cancer Patients (2008-2012) by Gender

Male Female

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FRH Newly Diagnosed Head & Neck Cancer Patients (2008-2012) by Tobacco History

Gender Yes No Unknown Total

Female 9 5 0 14

Male 29 11 4 44

Total 38 16 4 58

Percentage 65.5 27.6 6.9 100

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FRH Newly Diagnosed Head & Neck Cancer Patients (2008-2012) by Alcohol Usage

Gender Yes No Unknown Total

Female 8 5 1 14

Male 23 15 6 44

Total 31 20 7 58

Percentage 53.4 34.5 12.1 100

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FRH Newly Diagnosed Oropharynx Cancer Patients (2008-2012) by HVP Status

Gender Positive Negative Unknown Total

Female 0 1 1 2

Male 6 0 5 11

Total 6 1 6 13

Percentage 46.2% 7.7% 46.2%

FRH Newly Diagnosed Head & Neck Cancer Incidence (2008-2012) by Histology Type

• Squamous cell carcinoma 79.3%

• Other 20.7%

13

14

0

5

10

15

20

25

2008 2009 2010 2011 2012 Total

FRH Newly Diagnosed Head & Neck Cancer Patients (2008-2012) by Primary

Site

Oral Cavity Orophaynx Hypopharynx Larynx

15

0

5

10

15

20

25

2008 2009 2010 2011 2012 Total

FRH Newly Diagnosed Head & Neck Cancer Patients (2008-2012) by Stage

(Stage 0) (Stage I) (Stage II) (Stage III) (Stage IV) (Unknown Stage)

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FRH Newly Diagnosed Head & Neck Cancer Patients (2008-2012) 1st Course Treatment Type by Stage

Stage

Radiation only

Surgery

only

Surgery &

Radiation

Radiation and Chemotherapy

Surgery, Radiatio

n & Chemoth

erapy

No Treatment Total

Head & Neck (Stage 0) 0 4 0 0 0 0 4

Head & Neck (Stage I) 0 11 5 1 0 1 18

Head & Neck (Stage II) 2 0 0 3 0 0 5

Head & Neck (Stage III) 1 0 0 2 2 0 5

Head & Neck (Stage IV) 0 1 1 18 1 0 21

Head & Neck (Stage Unkn) 0 1 0 4 0 0 5

Total 3 17 6 28 3 1 58

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5-Year Observed Survival Rate by Stage - FRH Newly Diagnosed Head & Neck Cancer (2003-2007)

Dx year1 year 2year 3 year 4 year5

Head & Neck (Stage 0) 100 100.0 100.0 100.0 100.0 100.0

Head & Neck (Stage I) 100 94.1 76.5 76.5 76.5 76.5

Head & Neck (Stage II) 100 100.0 100.0 100.0 100.0 100.0

Head & Neck (Stage III) 100 100.0 80.0 80.0 80.0 80.0

Head & Neck (Stage IV) 100 86.7 68.4 63.9 59.3 54.6

All Cases 100 91.4 77.3 73.8 70.2 68.3

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5-Year Observed Survival Rate by Stage - FRH Newly Diagnosed Oropharynx Cancer (2003-2007)

Dx year 1 year 2 year 3 year 4 year 5

Oropharynx (Stage 0) NA NA NA NA NA NA

Oropharynx (Stage I) 100 100.0 100.0 100.0 100.0 100.0

Oropharynx (Stage II) NA NA NA NA NA NA

Oropharynx (Stage III) 100 100.0 75.0 75.0 75.0 75.0

Oropharynx (Stage IV) 100 88.9 88.9 88.9 88.9 88.9

All Cases 100 93.3 86.7 86.7 86.7 86.7

HPV related HNSCCs

• Major public health problem

• Need for identifying these cases

• HPV positive and negative cancers are distinct entities

• HPV positive cases demonstrate improved responses to therapy and bettersurvival