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  • 1. Head and Neck Cancers Dr Muthu Kumar Murugesan MBBS (Malaya), FRCS ENT (Edinburgh), MS ORL Head & Neck Surgery (Malaya) Consultant ENT, Head & Neck Surgeon Arunamari Specialist Medical Centre Klang
  • 2. Head and Neck Malignancies
    • Basics
    • Sites
    • Treatment Options
  • 3. What is head and neck cancer ?
    • Excluding brain
    • Lymph node
    • Squamous cell carcinoma (SCC)
  • 4. Aetiology
    • alcohol and tobacco
      • 15 X greater than non smokers
    • Epstein-Barr virus (EBV) - nasopharyngeal carcinoma
    • human papillomavirus-16
      • isolated in 36% of oral cavity cancers
    • mixing cured tobacco with betel nuts
      • 2.8 times
      • 10 times if with smoking
    • Irritation from poorly fitting dentures
  • 5. What are some symptoms of head and neck cancer ?
    • any sore in the mouth or throat that does not heal
    • neck or jaw pain that radiates to the ear
    • abnormal growth in the mouth
    • a lump in the neck that doesn't go away
    • chronic cough or hoarseness
    • sore throat that does not improve
    • coughing up blood
  • 6.  
  • 7. Common Sites
    • Oral Cavity
    • Pharynx
    • Larynx
    • Sinuses
  • 8. Oral Cavity-Anatomy
  • 9. Oral Cavity Carcinoma
  • 10. How would I know-Mouth Cancer
    • Non healing Ulcer
    • White or red patches
      • Leukoplakia
    • Bleeding,pain numbness
    • Change in your voice
    • Pain on Swallowing
  • 11. How would I know-Mouth Cancer
    • Lump-lip,,tongue mouth
    • Dentures not fitting properly
  • 12. Carcinoma of the Oral Tongue
  • 13. Carcinoma of the Tongue
    • Middle aged to elderly
    • Young women
      • Aggressive tumour
    • Risk Factors
      • Smoking
      • Spirits
      • Spicy food
      • Sharp tooth
      • glossitis
  • 14. Carcinoma of the Buccal Mucosa
    • Indian community
      • Forms 40% of all cancers
    • Chewing of betel nut
    • Reverse smoking
    • Late in diagnosis
      • Insensitive area
    • Common site
      • Retromolar area
  • 15. Oral cancers- Treatment Options
    • Surgery
      • Wide excision
      • Reconstruction
    • Radiotherapy
      • Smaller lesion
      • Function preserved
  • 16. Carcinoma of the Buccal Mucosa
  • 17. Carcinoma of the Buccal Mucosa
  • 18. Pharynx
  • 19. Nasopharyngeal Carcinoma
    • Anteriorly -- nasal cavity
    • Posterosup-- skull base and vertebral bodies
    • Inferiorly -- oropharynx and soft palate
    • Laterally --
      • Eustachian tubes and torus
      • Fossa of Rosenmuller - most common location
  • 20. Nasopharyngeal Carcinoma
    • Risiko Tinggi
      • Racial
        • Cantonese living in the central region of Guangdong Province in Southern China
        • age group 40-49 year
      • Diet
        • Salted fish and preserved soya
      • EB Virus
      • Family History
      • cigarette smoking, and occupational exposure to formaldehyde and wood
  • 21. Clinical Presentation
    • Often subtle initial symptoms
      • painless, slowly enlarging neck mass
    • Larger lesions
      • nasal obstruction
      • epistaxis
  • 22. Clinical Presentation
    • Signs and symptoms
    • NOSE:
      • blocked nostril, mucus, bleeding
    • EAR:
      • buzzing sound, change or loss of hearing, pain, drainage  
    • THROAT :
      • Hoarseness of voice, difficulty in swallowing, blood-stained phlegm     These symptoms do not always mean cancer, but if they persist, see your doctor at once. 
  • 23. Examination
  • 24. Clinical Presentation
    • Nasopharyngeal examination
      • Fossa of Rosenmuller most common location
      • Variable appearance - exophytic, submucosal
      • NP may appear normal
    • Regional spread
      • Usually ipsilateral first but bilateral not uncommon
    • Distant spread - lungs, liver, bones
  • 25. Treatment
    • External beam radiation
      • Dose: 6500-7000 cGy
      • Primary, upper cervical nodes, pos. lower nodes
      • Consider 5000 cGy prophylactic tx of clinically negative lower neck
    • Adjuvant chemotherapy
  • 26. Oropharynx
    • Base of the tongue (posterior third of the tongue)
    • Soft palate and uvula
    • Posterior wall of the oropharynx
    • Tonsil and faucial pillars and glossotonsillar sulci
  • 27. Carcinoma of the Oropharynx
    • SCC is the commonest
      • 90% of all tumour
    • Sites
      • Lateral wall 60%
      • Tongue Base 25%
      • Soft Palate 10%
        • MSG tumours
      • Posterior wall 5%
  • 28. Oropharyngeal Carcinoma
  • 29. Treatment Options
    • Curative
      • Radiotherapy
      • Surgery
      • Surgery and Post Op Radiotherapy
    • Palliative
      • Radiotherapy
      • Chemotherapy
      • Tracheostomy
      • Pain Relief
  • 30. Hypopharyngeal carcinoma
  • 31. Hypopharyngeal carcinoma
    • Pyriform Fossa
      • Most common
      • Half to 2/3s
    • Post Cricoid
      • 40% of all tumours
    • Posterior Pharyngeal wall
      • Rare in isolation
    • SCC
  • 32. Clinical Features
    • generally has a very poor prognosis
    • heavy smoking and drinking
    • Males are about eight times more susceptible
      • females have an increased incidence of cancer of the postcricoid area
        • Plummer-Vinson syndrome
        • Indian Woman
  • 33. Clinical Features-Symptoms
    • Sore throat
    • Ear pain
    • Voice change
    • Pain or difficulty in swallowing
    • Appearance of a lump in the neck
    • Feeling of food sticking in the throat.
    • Marked weight loss
  • 34. Examination
  • 35. Treatment Option
    • Radiotherapy alone
    • Surgery followed by radiotherapy
  • 36. Laryngeal (Voice Box) Carcinoma
  • 37. Laryngeal Carcinoma
    • Commonly in men 60s
    • Smoking & alcohol
    • Hoarseness of voice
    • A lump in the neck
    • A sore throat or ear ache
    • Difficulty in breathing
    • Pain and difficulty in swallowing
      • Pain is a late symptom
  • 38. Laryngeal Cancer
    • 25% of patients diagnosed with laryngeal cancers have another cancer
      • mouth, oesophagus or lung.
    • Another 15% will later develop cancer in one of these areas.
    • patients should continue with follow-up examinations throughout their lifetime.
  • 39. Laryngeal Carcinoma-treatment
    • Radiotherapy
    • Surgery
      • Partial or Complete removal of Voice Box
  • 40. Alaryngeal speech:
    • Oesophageal Speech:
    • Electronic larynx:
    • Voice Prosthesis