Head and Neck Cancers Dr Muthu Kumar Murugesan MBBS (Malaya), FRCS ENT (Edinburgh), MS ORL Head & Neck Surgery (Malaya) Co...
Head and Neck Malignancies <ul><li>Basics </li></ul><ul><li>Sites </li></ul><ul><li>Treatment Options </li></ul>
What is head and neck cancer ? <ul><li>Excluding brain </li></ul><ul><li>Lymph node </li></ul><ul><li>Squamous cell carcin...
Aetiology <ul><li>alcohol and tobacco </li></ul><ul><ul><li>15 X greater than non smokers </li></ul></ul><ul><li>Epstein-B...
What are some symptoms of head and neck cancer ? <ul><li>any sore in the mouth or throat that does not heal  </li></ul><ul...
 
Common Sites <ul><li>Oral Cavity </li></ul><ul><li>Pharynx </li></ul><ul><li>Larynx </li></ul><ul><li>Sinuses </li></ul>
Oral Cavity-Anatomy
Oral Cavity Carcinoma
How would I know-Mouth Cancer <ul><li>Non healing Ulcer </li></ul><ul><li>White  or red patches </li></ul><ul><ul><li>Leuk...
How would I know-Mouth Cancer <ul><li>Lump-lip,,tongue mouth </li></ul><ul><li>Dentures not fitting properly </li></ul>
Carcinoma of the Oral Tongue
Carcinoma of the Tongue <ul><li>Middle aged to elderly </li></ul><ul><li>Young women </li></ul><ul><ul><li>Aggressive tumo...
Carcinoma of the Buccal Mucosa <ul><li>Indian community </li></ul><ul><ul><li>Forms 40% of all cancers </li></ul></ul><ul>...
Oral cancers- Treatment Options <ul><li>Surgery </li></ul><ul><ul><li>Wide excision </li></ul></ul><ul><ul><li>Reconstruct...
Carcinoma of the Buccal Mucosa
Carcinoma of the Buccal Mucosa
Pharynx
Nasopharyngeal Carcinoma <ul><li>Anteriorly -- nasal cavity </li></ul><ul><li>Posterosup-- skull base and vertebral bodies...
Nasopharyngeal Carcinoma <ul><li>Risiko Tinggi </li></ul><ul><ul><li>Racial </li></ul></ul><ul><ul><ul><li>Cantonese livin...
Clinical Presentation <ul><li>Often subtle initial symptoms </li></ul><ul><ul><li>painless, slowly enlarging neck mass </l...
Clinical Presentation <ul><li>Signs and symptoms </li></ul><ul><li>NOSE:   </li></ul><ul><ul><li>blocked nostril, mucus, b...
Examination
Clinical Presentation <ul><li>Nasopharyngeal examination </li></ul><ul><ul><li>Fossa of Rosenmuller most common location <...
Treatment <ul><li>External beam radiation </li></ul><ul><ul><li>Dose: 6500-7000 cGy </li></ul></ul><ul><ul><li>Primary, up...
Oropharynx <ul><li>Base of the tongue (posterior third of the tongue) </li></ul><ul><li>Soft palate and uvula </li></ul><u...
Carcinoma of the Oropharynx <ul><li>SCC is the commonest </li></ul><ul><ul><li>90% of all tumour </li></ul></ul><ul><li>Si...
Oropharyngeal Carcinoma
Treatment Options <ul><li>Curative </li></ul><ul><ul><li>Radiotherapy </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><u...
Hypopharyngeal carcinoma
Hypopharyngeal carcinoma <ul><li>Pyriform Fossa </li></ul><ul><ul><li>Most common </li></ul></ul><ul><ul><li>Half to 2/3s ...
Clinical Features <ul><li>generally has a very poor prognosis </li></ul><ul><li>heavy smoking and drinking </li></ul><ul><...
Clinical Features-Symptoms <ul><li>Sore throat  </li></ul><ul><li>Ear pain  </li></ul><ul><li>Voice change  </li></ul><ul>...
Examination
Treatment Option <ul><li>Radiotherapy alone </li></ul><ul><li>Surgery followed by radiotherapy </li></ul>
Laryngeal (Voice Box) Carcinoma
Laryngeal Carcinoma <ul><li>Commonly in men 60s </li></ul><ul><li>Smoking & alcohol </li></ul><ul><li>Hoarseness of voice ...
Laryngeal Cancer <ul><li>25% of patients diagnosed with laryngeal cancers have another cancer  </li></ul><ul><ul><li>mouth...
Laryngeal Carcinoma-treatment <ul><li>Radiotherapy </li></ul><ul><li>Surgery </li></ul><ul><ul><li>Partial or Complete rem...
Alaryngeal speech:  <ul><li>Oesophageal Speech:  </li></ul><ul><li>Electronic larynx:  </li></ul><ul><li>Voice Prosthesis ...
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C:\Fakepath\Head And Neck Malignanciespenang

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

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