Head and neck cancers are among the most common cancers in India, with over 200,000 new cases occurring annually. The majority are squamous cell carcinomas of the oral cavity, larynx, oropharynx, and hypopharynx. Risk factors include tobacco use, smoking, alcohol consumption, and infections like HPV and EBV. Treatment involves surgery such as wide local excision or mandibulectomy with neck dissection, followed by reconstruction with flaps. Post-operatively, patients may receive adjuvant radiation therapy or chemotherapy, depending on factors like margins and node status. Long term concerns after treatment include issues with nutrition, speech, swallowing, and appearance.

1. TREATMENT MODALITIES IN
HEAD AND NECK CANCERS
DR.NEELAM AHIRWAR
DNB RESIDENT,SURGICAL ONCOLOGY

2. INTRODUCTION
• One of the most common cancers in India
• Over 200,000 cases of HNC occur each year in India. Nearly 80,000 oral
cancers are diagnosed every year in our country
• Overall, 57.5% of global head and neck cancers occur in Asia, especially in
India
• Head and neck cancers in India accounted for 30% of all cancers. In India,
60 to 80% of patients present with advanced disease

4. CANCERS OF HEAD & NECK
Squamous cell carcinoma
• Cancer of oral cavity
• Cancer of larynx
• Cancer of Nasopharynx,
oropharynx & hypopharynx
• Cancer of nasal cavity & paranasal
sinuses
Non - Squamous cell carcinoma
• Cancer of thyroid
• Cancer of salivary glands
• Sarcomas

7. Distribution
• Oral cavity 41- 43%
• Larynx – 30%
• Oropharynx
• Hypophaynx -10%
• Nasopharynx -1-2%
• Nasal cavity Rare
• Paranasal sinuses Rare (60-70% in maxillary sinus)

8. Etiology
1. Tobacco
2. Alcohol
3. Dental factors
4. Occupational exposures
5. Infections
6. Nutritional factors
7. Inflammatory cause
8. Genetic factors
9. Immunologic factors
10. Endocrinal disturbances
11. Radiation

9. RISK FACTORS
• Tobacco use (smokeless)
• Smoking
• Alcohol consumption
• Human papillomavirus (HPV)
infection (oropharyngeal cancer)
• Epstein-barr virus (EBV) infection
(nasopharyngeal cancer)

10. It is a mixture of tobacco, crushed areca nut (also called betel
nut), spices, and other ingredients. It is used like
chewing tobacco and is placed in the mouth, usually between
the gum and cheek. Betel quid with tobacco contains nicotine
and many harmful, cancer-causing chemicals.

11. Areca nut contains
• Tannins- Arecatannin , gallic acid
• a fixed oil gum
• Alkaloids —arecoline, arecaidine,guvacine (vasoconstrictors)
Betel leaf contains eugenol, another vasoconstrictor.
Tobacco- nicotine, polyaromatic hydrocarbons,nitosamines

18. Premalignant lesions
Leukoplakia
Erythroplakia
Carcinoma in situ
Bowens disease
Actinic keratosis & chelitis
Premalignant conditions
Oral submucous fibrosis
Oral lichen planus
Syphilitic glossitis
Sideropenic dysphagia
Dyskeratosis congenita

19. Leukoplakia
Erythroplakia

20. Carcinoma in situ

21. Oral Submucosal fibrosis

22. SQUAMOUS CELL CARCINOMA
Buccal mucosa
Tongue
Oropharynx
Floor of mouth

24. Work up
• Biopsy
• CECT/ MRI Neck
• Chest Xray
• PET-CT
• Dental Examination/ Fluoride treatment
• Preoperative assessment
• Doppler (free flap)

28. • Surgery
• Neck dissection
• Management of the mandible
• Reconstruction
• COMMANDO – Combined mandible and neck dissection operation

29. Mandibulectomy

30. • Wide excision
• Marginal mandibulectomy , segmental mandibulectomy
• Modified Radical Neck Dissection (MRND) , Selective neck dissection
(SND)
• Pedicled flap , Free Flap

31. Neck Dissection

32. Reconstruction – PMMC (Pectoralis major myocutaneous flap)

33. Deltopectoral flap

34. Free Flap

35. ALT flap

38. Adjuvant RT– within 6 weeks , 60Gy/30 fractions
• T3/T4
• Node positive
• Perineural/vascular invasion
• Margins positive
Definitive RT
Adjuvant chemotherapy – ENE positive
- margins positive
- cisplatin based regimes

39. Concerns
• Nutrition – RT, PEG tube
• Speech
• Swallowing
• Respiration – Tracheostomy care
• Pain
• Appearance

40. • Wound care
• Stitch removal ?
• RT removal ?
• Physiotherapy
• Adjuvant therapy

41. Thankyou