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Head & Neck Cancer        Robert Miller MD      www.aboutcancer.com
Head and Neck Cancer1. Cause, the symptoms and the anatomy2. Histology: most common is squamous cancer3. Imaging: CT and P...
Risk Factors Associatedwith Oral Cancer1.Tobacco Use (5 to 25X)2. Alcohol (heavy drinkers double  their risk)3.Oral infect...
The cure rate is better for HPV cancers thanfor smoking related cancers                 SURVIVAL                          ...
Cure Rates are better for people whostop smoking during the radiation                           Years           JCO June 1...
Most Common Head and Neck            Cancers Pharynx     13,930 Tongue          13,590 Larynx          12,260 Mouth   ...
Lifetime Risk of GettingCancer   Site       Men     WomenAny Cancer    44%          37%Oral/Pharyn   1.39%    0.65%     x ...
Median Age for Oral/Pharynx is       62y in 2005-2009302520151050     20   35   45   55     65   75   85                  ...
Median Age for Larynx Cancer is       65y in 2005-20093025201510 5 0     20   35   45   55     65   75   85               ...
Stage and Survival 2002-2008         Oral Cavity and Pharynx Stage      Distribution     Survival                         ...
Stage and Survival 2002-2008            Larynx Cancer Stage     Distribution     Survival                              (5y...
Oral Cavity
Oral Cavity Cancer• Present with a sore in the mouth that does not  heal• Commonly in the oral tongue, the floor of the  m...
Cross Section Anatomy
CT Scan and Anatomy
CT-PET Anatomysmall cancer in the front of the tongue (oral tongue)
Oral Cavity Stage:   T(tumor) Tumor        Size T1           2cm T2            > 2 to 4cm T3           > 4cm T4           ...
Oral Cavity Stage: N (nodes)Nodes      SiteN1         Single node up to 3cmN2a        Node >3 to 6cmN2b        Multiple ip...
Oral Cavity StageStage       DefinitionStage 1     T1N0Stage 2     T2N0Stage 3     T3 or N1Stage 4A    T4a or N2Stage 4B  ...
Anatomy of the Pharynx
Cancer of the Nasopharynx                Uncommon cancer in the US,                related to EBV (Epstein-Barr           ...
Cancer of the Oropharynx                 Most common sites include the                 tonsil and the base of the         ...
normal              mandible                         tongue  throat                                  Cancer in(pharynx)   ...
Squamous Cancer Right Tonsil – VeryVisible on PET scan
Oropharynx Stage: T (tumor)Tumor          SizeT1             2 cmT2             >2 to 4cmT3             > 4cmT4           ...
Oropharynx Stage: N (nodes)Node         SizeN1           Single node up to 3cmN2a          Node >3 to 6cmN2b          Mult...
Oropharynx StageStage           DefinitionStage 1         T1N0Stage 2         T2N0Stage 3         T3 or N1Stage 4A        ...
PET CT Anatomy for TonsilCancer, Stage IVa with multiple    involved nodes (N2)
Cancer of the Hypopharynx                      Less common                      Low in the throat, most                   ...
Lymph Nodes
Neck Node Levels
PET Scan showing MultipleLevel Lymph Node Spread
PET Scans are Very GoodShowing Lymph Node Spread
Larynx Anatomy
Larynx Cancer                   If supraglottic larynx is                   commonly involves the                   epiglo...
Common site for larynx cancer is the spotwhere the two vocal cords come together inthe front of the larynx (called the ant...
Larynx Stage: T (tumor)Tumor   SizeT1      One siteT2      Two sites/ impaired mobilityT3      Paralyzed cordT4      Deepl...
Larynx Stage: N (nodes)Node          SizeN1            Single node up to 3cmN2a           Node >3 to 6cmN2b           Mult...
Larynx StageStage            DefinitionStage 1          T1N0Stage 2          T2N0Stage 3          T3 or N1Stage 4A        ...
NCCN.org
Increasing Complexity in theManagement of Head & Neck          Cancer
Treatment options for head      and neck cancer Early stages: surgery or radiation Advanced stage: surgery followed  by ...
Treatment decisions and management    should be made by a team of             physicians• Experienced cancer Surgeon and r...
Multidisciplinary Team
Support Team
Head & Neck Cancer       Robert Miller MD      www.aboutcancer.co      m
Head and neck video 1
Head and neck video 1
Head and neck video 1
Head and neck video 1
Head and neck video 1
Head and neck video 1
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Head and neck video 1

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Head and neck video 1

  1. 1. Head & Neck Cancer Robert Miller MD www.aboutcancer.com
  2. 2. Head and Neck Cancer1. Cause, the symptoms and the anatomy2. Histology: most common is squamous cancer3. Imaging: CT and PET scans4. Stage is based on the size of the tumor and the number or size of lymph nodes
  3. 3. Risk Factors Associatedwith Oral Cancer1.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
  4. 4. The cure rate is better for HPV cancers thanfor smoking related cancers SURVIVAL Non-smokers smokers Years JCO June 10, 2012 vol. 30 no. 17 2102-2111
  5. 5. Cure Rates are better for people whostop smoking during the radiation Years JCO June 10, 2012 vol. 30 no. 17 2102- 2111
  6. 6. Most Common Head and Neck Cancers Pharynx 13,930 Tongue 13,590 Larynx 12,260 Mouth 11,400 Other oral 2,4602013 data (note that sameyear there were 228,190lung cancers and 234,580breast cancers)
  7. 7. Lifetime Risk of GettingCancer Site Men WomenAny Cancer 44% 37%Oral/Pharyn 1.39% 0.65% x Larynx 0.61% 0.14%
  8. 8. Median Age for Oral/Pharynx is 62y in 2005-2009302520151050 20 35 45 55 65 75 85 Age
  9. 9. Median Age for Larynx Cancer is 65y in 2005-20093025201510 5 0 20 35 45 55 65 75 85 Age
  10. 10. Stage and Survival 2002-2008 Oral Cavity and Pharynx Stage Distribution Survival (5y) All 100% 61.5% Local 32% 82.4%Regional 47% 57.3%Distant 16% 34.9%
  11. 11. Stage and Survival 2002-2008 Larynx Cancer Stage Distribution Survival (5y) All 100% 60.5% Local 57% 76.4%Regional 20% 41.8%Distant 18% 34.8%
  12. 12. Oral Cavity
  13. 13. 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
  14. 14. Cross Section Anatomy
  15. 15. CT Scan and Anatomy
  16. 16. CT-PET Anatomysmall cancer in the front of the tongue (oral tongue)
  17. 17. Oral Cavity Stage: T(tumor) Tumor Size T1 2cm T2 > 2 to 4cm T3 > 4cm T4 Deeply invasive
  18. 18. Oral Cavity Stage: N (nodes)Nodes SiteN1 Single node up to 3cmN2a Node >3 to 6cmN2b Multiple ipsilateralN2c ContralateralN3 Node > 6cm
  19. 19. Oral Cavity StageStage DefinitionStage 1 T1N0Stage 2 T2N0Stage 3 T3 or N1Stage 4A T4a or N2Stage 4B T4b or N3Stage 4C Metastases
  20. 20. Anatomy of the Pharynx
  21. 21. 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 skullcan be cranial nerve problems or headachesOther late symptoms include lymph node
  22. 22. 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 painradiating into the ear, trouble swallowing andlymph node enlargement
  23. 23. normal mandible tongue throat Cancer in(pharynx) Base of Tonguesalivarygland normal lymph nodesspinal cord spine
  24. 24. Squamous Cancer Right Tonsil – VeryVisible on PET scan
  25. 25. Oropharynx Stage: T (tumor)Tumor SizeT1 2 cmT2 >2 to 4cmT3 > 4cmT4 Deeply Invasive
  26. 26. Oropharynx Stage: N (nodes)Node SizeN1 Single node up to 3cmN2a Node >3 to 6cmN2b Multiple IpsilateralN2c Contralateral NodesN3 Node >6 cm
  27. 27. Oropharynx StageStage DefinitionStage 1 T1N0Stage 2 T2N0Stage 3 T3 or N1Stage 4A T4a or N2Stage 4B T4b or N3Stage 4C Metastases
  28. 28. PET CT Anatomy for TonsilCancer, Stage IVa with multiple involved nodes (N2)
  29. 29. Cancer of the Hypopharynx Less common Low in the throat, most common site is in the pyriform sinusSymptoms are usually trouble swallowing orhoarsenessOther late symptoms include lymph nodeswelling
  30. 30. Lymph Nodes
  31. 31. Neck Node Levels
  32. 32. PET Scan showing MultipleLevel Lymph Node Spread
  33. 33. PET Scans are Very GoodShowing Lymph Node Spread
  34. 34. Larynx Anatomy
  35. 35. Larynx Cancer If supraglottic larynx is commonly involves the epiglottis and symptoms include sore throat and trouble swallowingIf the true vocal cords the symptoms are almostalways hoarse voiceLate stage symptoms include lymph nodeswelling in the neck and weight loss
  36. 36. Common site for larynx cancer is the spotwhere the two vocal cords come together inthe front of the larynx (called the anteriorcommissure)
  37. 37. Larynx Stage: T (tumor)Tumor SizeT1 One siteT2 Two sites/ impaired mobilityT3 Paralyzed cordT4 Deeply Invasive
  38. 38. Larynx Stage: N (nodes)Node SizeN1 Single node up to 3cmN2a Node >3 to 6cmN2b Multiple IpsilateralN2c Contralateral NodesN3 Node >6 cm
  39. 39. Larynx StageStage DefinitionStage 1 T1N0Stage 2 T2N0Stage 3 T3 or N1Stage 4A T4a or N2Stage 4B T4b or N3Stage 4C Metastases
  40. 40. NCCN.org
  41. 41. Increasing Complexity in theManagement of Head & Neck Cancer
  42. 42. 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
  43. 43. 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
  44. 44. Multidisciplinary Team
  45. 45. Support Team
  46. 46. Head & Neck Cancer Robert Miller MD www.aboutcancer.co m

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