head and neck video 1
TRANSCRIPT
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Head & Neck Cancer
Robert Miller MD
www.aboutcancer.com
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1. Cause, the symptoms and the anatomy
2. Histology: most common is squamous cancer
3. Imaging: CT and PET scans
4. Stage is based on the size of the tumor and the number or size of lymph nodes
Head and Neck Cancer
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Risk Factors Associated with Oral Cancer
1.Tobacco Use (5 to 25X)2. Alcohol (heavy drinkers double
their risk)3.Oral infection with HPV164.Sun exposure for lip cancer5.Reflux - ? Larynx cancer
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The cure rate is better for HPV cancers than for smoking related cancers
JCO June 10, 2012 vol. 30 no. 17 2102-2111
Non-smokers
smokers
SURVIVAL
Years
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Cure Rates are better for people who stop smoking during the radiation
JCO June 10, 2012 vol. 30 no. 17 2102-2111
Years
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Most Common Head and Neck Cancers
Pharynx13,930
Tongue13,590
Larynx12,260
Mouth11,400
Other oral 2,460
2013 data (note that same year there were 228,190 lung cancers and 234,580 breast cancers)
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Lifetime Risk of Getting Cancer
Site Men Women
Any Cancer 44% 37%
Oral/Pharynx
1.39% 0.65%
Larynx 0.61% 0.14%
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Median Age for Oral/Pharynx is 62y in 2005-2009
20 35 45 55 65 75 850
5
10
15
20
25
30
Age
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Median Age for Larynx Cancer is 65y in 2005-2009
20 35 45 55 65 75 850
5
10
15
20
25
30
Age
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Stage and Survival 2002-2008Oral Cavity and Pharynx
Stage Distribution
Survival (5y)
All 100% 61.5%
Local 32% 82.4%
Regional 47% 57.3%
Distant 16% 34.9%
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Stage and Survival 2002-2008Larynx Cancer
Stage Distribution
Survival (5y)
All 100% 60.5%
Local 57% 76.4%
Regional 20% 41.8%
Distant 18% 34.8%
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Oral Cavity
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Oral Cavity Cancer• Present with a sore in the mouth that
does not heal• Commonly in the oral tongue, the floor
of the mouth or the inside of the cheek (buccal mucosa)
• Sometimes present with a swollen lymph node in the neck
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Cross Section Anatomy
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CT Scan and Anatomy
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CT-PET Anatomysmall cancer in the front of the tongue (oral tongue)
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Oral Cavity Stage: T (tumor)
Tumor Size
T1 2cm
T2 > 2 to 4cm
T3 > 4cm
T4 Deeply invasive
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Oral Cavity Stage: N (nodes)
Nodes Site
N1 Single node up to 3cm
N2a Node >3 to 6cm
N2b Multiple ipsilateral
N2c Contralateral
N3 Node > 6cm
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Oral Cavity Stage
Stage Definition
Stage 1 T1N0
Stage 2 T2N0
Stage 3 T3 or N1
Stage 4A T4a or N2
Stage 4B T4b or N3
Stage 4C Metastases
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Anatomy of the Pharynx
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Cancer of the Nasopharynx
Uncommon cancer in the US, related to EBV (Epstein-Barr virus). Located high in the back of the throat
Symptoms: include nasal congestion, hearing problems (fluid behind the ear drums)
Late symptoms: if the cancer invade the skull can be cranial nerve problems or headaches
Other late symptoms include lymph node swelling
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Cancer of the Oropharynx
Most common sites include the tonsil and the base of the tongue
May be related to HPV virus (so more common in non smokers)
Symptoms include sore throat with pain radiating into the ear, trouble swallowing and lymph node enlargement
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mandible normal tongue
throat (pharynx)
spinespinal cord
salivarygland normal
lymph nodes
Cancer in Base of Tongue
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Squamous Cancer Right Tonsil – Very Visible on PET scan
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Oropharynx Stage: T (tumor)
Tumor Size
T1 2 cm
T2 >2 to 4cm
T3 > 4cm
T4 Deeply Invasive
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Oropharynx Stage: N (nodes)
Node Size
N1 Single node up to 3cm
N2a Node >3 to 6cm
N2b Multiple Ipsilateral
N2c Contralateral Nodes
N3 Node >6 cm
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Oropharynx Stage
Stage Definition
Stage 1 T1N0
Stage 2 T2N0
Stage 3 T3 or N1
Stage 4A T4a or N2
Stage 4B T4b or N3
Stage 4C Metastases
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PET CT Anatomy for Tonsil Cancer, Stage IVa with multiple
involved nodes (N2)
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Cancer of the Hypopharynx
Less common
Low in the throat, most common site is in the pyriform sinus
Symptoms are usually trouble swallowing or hoarseness
Other late symptoms include lymph node swelling
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Lymph Nodes
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Neck Node Levels
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PET Scan showing Multiple Level Lymph Node Spread
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PET Scans are Very Good Showing Lymph Node Spread
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Larynx Anatomy
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Larynx Cancer
If supraglottic larynx is commonly involves the epiglottis and symptoms include sore throat and trouble swallowing
If the true vocal cords the symptoms are almost always hoarse voice
Late stage symptoms include lymph node swelling in the neck and weight loss
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Common site for larynx cancer is the spot where the two vocal cords come together in the front of the larynx (called the anterior commissure)
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Larynx Stage: T (tumor)
Tumor Size
T1 One site
T2 Two sites/ impaired mobility
T3 Paralyzed cord
T4 Deeply Invasive
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Larynx Stage: N (nodes)
Node Size
N1 Single node up to 3cm
N2a Node >3 to 6cm
N2b Multiple Ipsilateral
N2c Contralateral Nodes
N3 Node >6 cm
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Larynx Stage
Stage Definition
Stage 1 T1N0
Stage 2 T2N0
Stage 3 T3 or N1
Stage 4A T4a or N2
Stage 4B T4b or N3
Stage 4C Metastases
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NCCN.org
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Increasing Complexity in the Management of Head & Neck Cancer
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Treatment options for head and neck cancer
Early stages: surgery or radiation
Advanced stage: surgery followed by radiation and chemotherapy or chemoradiation alone
Very advanced cases: radiation and chemotherapy
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Treatment decisions and management should be made by
a team of physicians
• Experienced cancer Surgeon and reconstruction team
• Radiation oncologist with access to state of the art equipment (IGRT or Tomotherapy)
• Medical Oncologist (chemotherapy and targeted therapy)
• Support personnel including nutritional support and dental care
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Multidisciplinary Team
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Support Team
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Head & Neck Cancer
Robert Miller MD
www.aboutcancer.com