HEAD AND NECK SQUAMOUS CELL

CARINOMAUneke Edwards

MD5

#1607

TABLE OF CONTENTS Introduction Classification Etiology Signs and Symptoms Clinical features Diagnosing Treatment Prognosis References

INTRODUCTION: WHAT IS IT?

Squamous cell carcinomas (SCC) are cancers that arise from outer layer of skin and mucosa

Head and neck squamous cell carcinomas (HNSCC) affects oral cavity, oropharynx, nasal cavity, paranasal sinuses, larynx and hypopharynx

Sixth most cancer worldwide (affects men in 50’s and 60’s)

Accounts for 90% of all Head and neck cancers

INTRODUCTION: WHAT IS IT?

Affects men more than women

The major cause is tobacco smoking (75% cases)

Has a good prognosis, if caught early usually treatable.

Accounts for 90% of all Head and neck cancers

CLASSIFICATION HNSCC can present in the oral cavity,

oropharynx, larynx, nasal cavity, nasopharynx hypopharynx, paranasal sinuses and trachea. According to WHO, HNSCC can be categorized in these different types:

Conventional Verrucous Basaloid Papillary

Spindle cell Acantholytic Adenosquamous Cuniculatum (oral mucosa

only)

CLASSIFICATION contd…

HNSCC often develops from preexisting dysplastic lesions and these lesions can also be classified as:

Mild, moderate, severe (carcinoma in situ)

Well, moderate or poorly differentiated

Keratinizing or Non-keratinizing

ETIOLOGY Tobacco Smoking and Excess alcohol intake

The most common cause of HNSCC is associated with tobacco smoking. About 75% of cases are due to smoking. This is especially associated with oropharyngeal type of HNSCC

Human papillomavirus (HPV)

Particularly, HPV16 is a cause of HNSCC in about 15-25% of cases. They do this by the expression of viral oncoproteins (E6,E7) and by other mechanisms such as disruption of tumor suppressor genes. HPV associated HNSCC affects oropharynx, hypopharynx and oral cavity.

ETIOLOGY contd…

Radiation Exposure

Epstein-Barr Virus (EBV)

Highly associated with Nasopharyngeal cancer

Occupational Exposure

Exposure to wood dust, asbestos, synthetic fibers,

metal dust, formaldehyde can increase risk of

nasopharyngeal, laryngeal and sinus cancer

Leukoplakia

White patches on the mucosa of tongue have

increased risk of becoming cancerous

SIGNS AND SYMPTOMS

Neck Mass

Neck pain

Dysphagia

Mouth ulcers(painless)

Sore throat

Hoarse Voice

Enlarged lymph nodes

Lump on lips, mouth or gums

SIGNS AND SYMPTOMS Oral cavity: A white or red patch on the gums,

the tongue, or the lining of the mouth; a swelling of the jaw ; unusual bleeding or pain in the mouth; referred pain to ear, dysphagia. It includes inner lip, tongue, floor of mouth, gingiva and hard palate

Pharynx: Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing, hoarseness, hemoptysis.

SIGNS AND SYMPTOMS

Larynx: Pain when swallowing or ear pain.

Paranasal sinuses and nasal cavity: Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; epistaxis; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; rhinorrhea, paresthesia

DIAGNOSING The doctor evaluates a person’s medical

history, performs a physical examination, and orders diagnostic tests such as needle biopsy head and neck computed tomography (CT) scan or magnetic resonance imaging (MRI)

If the diagnoses is cancer, doctors discuss the severity and whether metastasis has occurred and discuss optimal treatment whether surgery, medicine or radiation is required

TREATMENT Radiation Therapy

The most common form of treatment. There are different forms of radiation therapy, including 3D conformal radiation therapy, intensity-modulated radiation therapy, and brachytherapy, which are commonly used in the treatments of cancers of the head and neck

TREATMENT Chemotherapy

Docetaxel-based chemotherapy has shown a very good response in locally advanced head and neck cancer. Taxotere is the only taxane approved by US FDA for Head and neck cancer, in combination with cisplatin and fluorouracil for the induction treatment of patients with inoperable

TREATMENT contd…

Surgery

In selected cases of localized recurrence, surgery (if operable) or re-irradiation can be considered.

PROGNOSIS If caught in early stages, HNSCC has a

very good prognosis, up to 50%.

Has a 5 year survival rate

If the cancer metastasize to lung and lymph node, prognosis becomes less than 50% and can be fatal

Clinical Case 1 A 61yr old man has had progressive hoarseness

over the past 8 months. he has smoked 2 packs of cigarettes for 40yrs. cervical LN are palpable. Laryngoscopy shows 1cm ulcerated mass involving the true vocal cord. histologic tissue from the mass is most likely to show??

a - adenocarcinomab - lymphoepitheliomac - papillomad - polype- squamous cell carcinoma

REFERENCES http://ghr.nlm.nih.gov/condition/head-and-

neck-squamous-cell-carcinoma http://www.esmo.org/Guidelines/Head-and-

Neck-Cancers/Squamous-Cell-Carcinoma-of-the-Head-and-Neck

Robin’s Pathology textbook 2014 http://www.cancer.gov/types/head-and-

neck/head-neck-fact-sheet#q1 http://www.nature.com/nature/journal/

v517/n7536/full/nature14129.html Google Images

THANK YOU!