H &amp; N cancer

H & N cancer for undergraduate level

Health & Medicine

Head and Neck Cancer
Mohammed Fathy Bayomy, MSc, MD
Lecturer of Clinical Oncology
Clinical Oncology & Nuclear Medicine Department
Faculty of Medicine
Zagazig University

The 6th most common
cancer worldwide
Incidence
increases with age
+60
More
common
in
men

Cigarette
Carcinogens
Human papilloma
virus (HPV)
Epstein-Barr virus
(EBV)
Alcohol intake
History of head &
neck cancer
Radiation
Nickel
Wood dust
Nitrosamine

Squamous cell carcinoma Other tumors
Lymphomas
(90%) Anaplastic Adenoid cystic Mucoepidermoid
Sarcoma Melanoma Plasmacytoma
Lymphoma
Oral Cavity
(40%)
Pharynx
(25%)
Larynx
(30%)

Painless
mass
Non-healing
ulcer
Referred pain
Dysphagia
Cranial nerve palsies
Dysarthria
Voice Ch. Change Persistent hoarseness
Stridor Nasal obstruction
Tonsillar enlargement Nasal bleeding
Persistent
sinusitis
Hearing
loss

Endoscopy CT &/or MRI of Head & Neck Pathological
confirmation
Biopsy
Plain X-ray Chest EBV testing FDG-PETHPV testing
IgA anti-
VCA
Ig-G
anti-EA

T stage
N stage
Nasopharyngeal Carcinoma
T1 T2 T3 T4
N1 N2 N3a N3b

T stage
M stageN stage
Non-Nasopharyngeal Carcinoma
N1 N2a N2b N2c N3
T1 T2 T3 T4a T4b
≤3cm >3-6cm ≤6cm ≤6cm >6cm
≤2cm≤2cm
>2-4cm
>4cm
M1

Cth
Early
Definitive
Radiotherapy
NPC
Locally
advanced
Concurrent
Chemotherapy
Cisplatin
Adjuvant
Chemotherapy
Cisplatin+5-
FU x 3 C
60-
70Gy
Non-NPC
Early
LA&/or
Unresectable
Radical
Surgery
Laryngectomy
Neck nodes
dissection
Adjuvant
Radiotherapy
Concurrent
Chemotherapy
±
Definitive
Radiotherapy
Induction
Chemotherapy
TPF
(Taxotere,
Platinol, 5-FU)
Definitive
Radiotherapy
+
Concurrent
Chemotherapy
Concurrent
Biological Treatment
Or
Cisplatin
Cetuximab
Metastatic
Carcinoma
Chemotherapy
Combination
Cisplatin+5-FU
Cisplatin or
carboplatin
+
Paclitaxel
or
Docetaxel
Single
Cisplatin+5-FUCisplatin
Carboplatin
5-FU
Paclitaxel Docetaxel
MTX
Biological
Treatment
Cetuximab
Immunotherapy
Checkpoint inhibitors
Pembrolizumab
Nivolumab

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