1) Head and neck cancer accounts for 6.7% of all cancer cases in Al-Qassim, Saudi Arabia between 1987-2000. 2) The most common site is the nasopharynx and the most common histology is squamous cell carcinoma. 3) Most patients present with advanced stage disease, and the majority have undifferentiated or poorly differentiated tumors.

1. Head and Neck Cancer
in
Al-Qassim
Dr. Shad Salim Akhtar
MBBS, MD, FRCP(Edin), MAFUICC
Consultant Medical Oncologist
Prince Faisal Oncology Center
King Fahd Specialist Hospital,
Buraidah, Al-Qassim

2. Collaborators
Dept of ENT
Dr. Fadl A Fadl
Dr. Nooreni MA Oyetungi
Prince Faisal Oncology Center
Dr. Imran-ul-Haq (Histopathology)
Dr. Yasser (Histopathology)
Ms Lolita M Reyes (Histopathology)
Dr. Farhat A Khan
Mrs. Rosily Patsy (Oncology Nurse Specialist)
Mrs. Masoodeh Keivan (Cancer Reg Office)
Ms. Elaina (CME)

3. Head & Neck Cancer-definition
• Specific anatomical sites
– Oral cavity
– Pharynx
– Nasopharynx
– Larynx
– Nose/sinuses
– Salivary glands
– Temporal bone & neck
• Squamous cell carcinoma (~60-90%)

4. • Period of study 1987-2000
• Pathology data 87-1993
• NCR data 1994-2000
• All H/P confirmed at H&N sites included
• Exclusions
– Lymphoma
– Unknown primary
– Thyroid
– Skin
Head & Neck Ca- Al-Qassim

5. Head & Neck Ca-Al-Qassim-relative frequency
Other
sites
Head &
neck 6.7% of
all sites
M:F ratio
92:43
2.2:1
1875
135
All cases=2010

6. Head & Neck Ca- frequency
• USA 3.5% (SEER data)
• KSA 7.5% (NCR data (94-96))
KSA published series
– KFSH&RC 10.6% (Mehboobi E: ASM 1987)
– Al-Qassim 6.9% (Akhtar SS: ASM 1997)
– Asir 9.6% (Al-Ghamdi S : ASM 1994)
– Al-Baha 9% (Willen R: SMJ 1989)

7. Head & Neck Ca-Al-Qassim-age distribution
2
13
12
22
27
23
20
10
6
<11
11-20
21-30
31-40
41-50
51-60
61-70
71-80
>80
Mean=48.79 (+11.25) Range=7-90
Male=50.55 (+19.3) Females=45 (+18.65)
68% pts
25%

8. H & N Ca -NCR 94-96- site vs regions
Ry Naj Eas Mak Nor Jez Ha Mad Bah Tab Asr Jou Qas
Sal gl
Larynx
N/Sin
Pharyn
Hypoph
Nasoph
Oroph
Mouth
Gum
Tong
Lip

9. 10.4
12.9
19.1
3.7
8.4
3.6
27.7
5.6
8.6
40
20
30
10
2.6
12
15.89
30.5
8.4
4.5
14.7
4
5.9
17.2
21
31
6
7.5
5.2
6.7
USA Europe KSA(NCR) KSA RMC
Lip
Tong
Oral
Nasoph
Phary
N/Sin
Larynx
Saliv
Other
Head & Neck Ca-Al-Qassim-epidemiology

10. Head & neck ca-Al-Qassim-sites
2
12
9 7 7
67
8
3
13
7
Lip
Tongue
Mouth
Palate
Sal gl
Nasophy
Pharynx
Nose/Sin
Larynx
Others

11. Head & Neck Ca-Al-Qassim-epidemiology
0
10
20
30
40
50
USA Europe KSA(NCR) KSA RMC AL-Qassim
Lip Tong Oral Nasoph Phary N/Sin Larynx Saliv Other

12. Head & neck ca-Al-Qassim- site vs sex
2
0
8
4
5
4
3
4
3
4
47
20
21
11
2
10
4
Lip Tong Mouth Palate SalGl Nasoph No/S Larynx Other
Male Female
Highest M:F

13. Head & neck ca-Al-Qassim-histology
63
37
14
21
Others
NOS
Undiff
Sq CC
RMC 50.7%
USA 88.6%
Nigeria 75%
Sudan 67%
Egypt 85%
Alcohol
Tobacco
Poor OD hygiene
Ionising radiation

14. Head & nek ca-Al-Qassim-grade
10 3
9
19
94
Well diff Mod diff Poor diff Undiff Unk

15. Head & neck ca-Al-Qassim-extent
20
13 13
7
3
79
Local Region LN Reg+LN Distant Unk
64%
42%

16. Nasopharyngeal Ca-Al-Qassim-histology
5
4
24
9
11
6
3
0
4
1
NOS Undiff Sq Lymep Other
Male
Female
Male:Female::42:20 (2:1)
Mean age 43.7 (+17.8) M=44.8 (+18.25) F=41(16.4)
EBV
Fam clustering
Dietary factors
Less veg/fruits
Domestic smoke

17. 55
68
12
Unknown
Saudis
Non Saudi
Head & neck ca-Al-Qassim-nationality

18. Head & neck ca-Al-Qassim-no/yr
2
10
6 7 8
6 7
9
16
8
11
19
12
14
0
5
10
15
20
87 88 89 90 91 92 93 94 95 96 97 98 99 2000
Pt Number
Year of diagnosis

19. • Head neck cancer common
• SCC is the commonest histology
• Nasopharynx commonest site
– Undifferentiated histology
– Other etiological factors?
• The majority present in advances stage
• Incidence may be increasing??
Head & neck ca-Al-Qassim-conclusions