1 Head and Neck. - CANCER algo epidemilogy .pdf

1. SQUAMOUS MALIGNANT
TUMOURS

2. Loading…
• INCLUDES MAINLY CANCERS OF ORAL CAVITY, OROPHARYNX, LARYNX,
AND HYPOPHARYNX, NSOPHARYNX, NASAL CAVITY, PARANASAL SINUSES.
• 8TH MOST COMMON CANCER IN MALES
• 16TH MOST COMMON CANCER IN FEMALES
• INDIA- HEAD AND NECK MALIGNANCIES CONSTITUE 45 % OF ALL
MALIGNANCY

3. Cancer of the oral cavity and oropharynx
• THE PREVALENCE OF ORAL CAVITY AND PHARYNGEAL CANCER (OCPC) IN
THE UNITED STATES IN 2014 WAS 340,902
• ESTIMATES MAKE OCPC THE NINTH MOST COMMONLY DIAGNOSED
CANCER IN MEN, COMPRISING 4% OF ALL NEW CANCER CASES DIAGNOSED
IN MEN.
• OVERALL 5-YEAR SURVIVAL FOR ALL OCPC WAS 64.7% BASED ON 2007 TO
2013 DATA
• INCIDENCE DIRECTLY PROPORTIONAL TO AGE
• 85 % CASES OCCUR AFTER 5TH DECADE OF LIFE
• 15 % CASES HAVE ANOTHER CANCER IN NEARBY AREA
• WHO ARE CURED OF ORAL OR OROPHARYNGEAL CANCER, 10–40 PER CENT
WILL DEVELOP A SECOND CANCER OF THE UPPER AERODIGESTIVE TRACT

4. AT A LATER TIME
Loading…
AETIOLOGY
• TOBACCO
• CIGARETTES
• SMOKELESS TOBACCO
• MARIJUANA
• ALCOHOL
• DENTAL FACTORS
• OCCUPATIONAL EXPOSURE
• INFECTIONS

5. cigarette
• 90 PER CENT OF PATIENTS HAVE A HISTORY OF SMOKING
• TOBACCO CONTAINS OVER 30 KNOWN CARCINOGENS, SUCH AS
POLYCYCLIC AROMATIC HYDROCARBONS AND NITROSAMINES.
• SYNERGISTIC TO ALCOHOL
• RISK OF ORAL CANCER IS REDUCED BY 30 PER CENT IN THOSE WHO HAVE
DISCONTINUED FOR BETWEEN ONE AND NINE YEARS AND BY 50 PER CENT
FOR THOSE OVER NINE YEARS
• BLACK TOBACCO CIGARETTE USERS HAVE A THREE-FOLD RELATIVE RISK
OF ORAL CAVITY AND PHARYNGEAL CANCER WHEN COMPARED TO BLOND
TOBACCO CIGARETTE USERS.
• CRYPTS OF THE TONSILS, THE GLOSSOTONSILLAR SULCUS AND THE
TONGUE BASE ARE BATHED IN SALIVA TO A GREATER EXTENT THAN THE
SOFT PALATE OR POST-PHARYNGEAL WALL AND ARE THUS MORE COMMON

6. • FILTERED CIGARETTES DECREASE THE EXPOSURE TO CARCINOGENS AND
ONLY CONFER A 1.5 TIMES INCREASED RISK OF HNSCC COMPARED WITH
NONSMOKERS,
• WHEREAS THE RISK WITH UNFILTERED CIGARETTE USE WAS 7.8 TIMES
HIGHER THAN NONSMOKERS.
• HAND-ROLLED CIGARETTES CONFER A RISK 8.7 TIMES HIGHER THAN
NONSMOKERS OF DEVELOPING HNSCC.
• DATA FROM THE INHANCE CONSORTIUM SHOWS THAT COMPARED WITH
NONSMOKERS, ANY CIGARETTE USE INCREASED THE RISK OF HNC (0–3
CIGARETTES PER DAY: OR, 1.52; 95% CI, 1.21–1.90),
• AND USE OF 5 TO 10 CIGARETTES DAILY MORE THAN DOUBLES THE RISK OF
DEVELOPING AN HNC (OVERALL OR, 2.6; 95% CI, 2.00–3.40)

7. Loading…
ALCOHOL
POSSIBLE MECHANISMS INCLUDE:
1. ALCOHOL MAY ACT AS A SOLVENT INCREASING THE CELLULAR PERMEABILITY OF
TOBACCO CARCINOGENS THROUGH THE MUCOSA OF THE UPPER AERODIGESTIVE
TRACT.
2. THE NON-ALCOHOL CONSTITUENTS OF VARIOUS ALCOHOLIC BEVERAGES MAY HAVE
CARCINOGENIC ACTIVITIES.
3. THE IMMEDIATE METABOLITE OF ETHANOL IS ACETALDEHYDE AND THIS MAY HAVE
A LOCALLY DAMAGING EFFECT ON CELLS.
4. CHRONIC ALCOHOL USE MAY UPREGULATE ENZYMES OF THE CYTOCHROME P450
SYSTEM WHICH MAY RESULT IN THE ACTIVATION OF PROCARCINOGENS INTO
CARCINOGENS.
5. ALCOHOL CAN ALSO DECREASE THE ACTIVITY OF DNA REPAIR ENZYMES RESULTING
IN INCREASED CHROMOSOMAL DAMAGE.

8. NUTRITIONAL FACTORS
• HIGH FRUIT AND VEGETABLE INTAKE IS ASSOCIATED WITH A DECREASED
RISK OF HEAD AND NECK CANCER. THIS MAY BE DUE TO INCREASED
INTAKE OF THE ANTIOXIDANTS OR FREE RADICAL SCAVENGING VITAMINS
A, C AND E.
• UP TO 15 PER CENT OF ORAL AND PHARYNGEAL CANCERS IN EUROPE CAN
BE ATTRIBUTED TO DIETARY DEFICIENCIES.

9. INFLAMMATORY
GERD
• REFLUX HAS BEEN DOCUMENTED IN 36–54 PER CENT OF PATIENTS WHICH
COULD SUGGEST REFLUX TO BE A RISK FACTOR IN LARYNGEAL AND
PHARYNGEAL CANCER.
• LEUKOPLAKIA AND ERYTHROPLAKIA AETIOLOGY FOR ORAL CAVITY
CANCER.
• SUBMUCOUS FIBROSIS CAUSES OROPHARYNGEAL CANCER.

10. Genetic and immunologic predisposition
• Li–Fraumeni syndrome, an autosomal dominant condition involving mutation of the p53
gene, has been associated with head and neck cancer in patients with minimal tobacco
exposure.
• Fanconi’s anemia, Bloom syndrome and ataxia-telangiectasia are autosomal recessive
disorders associated with increased chromosomal fragility and cancer.
• Immunologic factors are also important. Patients treated for bone marrow transplants and
organ transplants have an increased incidence of skin cancer and oral cavity cancer.

11. CANCER OF LARYNX AND
HYPOPHARYNX
• LARYNGEAL CANCER IS AN UNCOMMON DISEASE, WITH AN INCIDENCE OF
3.1 IN 100,000.
• 20TH MOST COMMON MALIGNANCY DIAGNOSED IN THE UNITED STATES
• M>F
• OVERALL SURVIVAL FOR LARYNGEAL CANCER IS COMPARABLE WITH
OTHER HNC, WITH A 5-YEAR SURVIVAL OF 60.7% FOR ALL STAGES.

12. • ABOUT 60 PER CENT OF LARYNX CANCERS START IN THE GLOTTIS, 35 PER
CENT DEVELOP IN THE SUPRAGLOTTIC REGION AND THE REMAINING 5 PER
CENT OCCUR IN THE SUBGLOTTIS.
• CANCER OF THE HYPOPHARYNX ACCOUNTS FOR 10 PER CENT OF ALL
SQUAMOUS CELL CANCERS OF THE UPPER AERODIGESTIVE TRACT.
• SUBSITES OF THE HYPOPHARYNX INCLUDE PYRIFORM FOSSA (70 PER
CENT), POSTCRICOID AREA (15 PER CENT) AND POSTERIOR PHARYNGEAL
WALL (15 PER CENT).
• MEAN AGE AT PRESENTATION IS 60 YEARS.
• POSTCRICOID LESIONS SHOW A FEMALE PREPONDERANCE 1.5:1

13. AETIOLOGY
• TOBACCO
• ALCOHOL
• OCCUPATION
• RADIATION
• NUTRITIONAL FACTORS
• INFECTION

14. • RISK OF DEVELOPING LARYNGEAL CANCER IN NONDRINKERS WITH ANY
AMOUNT OF CIGARETTE SMOKING IS SIGNIFICANTLY INCREASED
COMPARED WITH NONSMOKERS (ODDS RATIO [OR], 6.84; 95% CONFIDENCE
INTERVAL [CI], 4.25–11.01)
• EVIDENCE SUGGESTS THAT THERE IS AN INCREASED RISK OF ALCOHOL
INTAKE FOR DEVELOPING CANCER OF THE SUPRAGLOTTIS COMPARED
WITH OTHER LARYNGEAL SUBSITES.
• COMBINED USE OF ALCOHOL TO CIGARETTE SMOKING, A SYNERGISTIC
MULTIPLICATIVE RISK EXISTS FOR DEVELOPING LARYNGEAL CANCER,
RANGING FROM 8.0 (95% CI, 2.0–22.80) FOR THE LIGHTEST LEVEL OF
SMOKING AND DRINKING, TO 177.2 (95% CI, 65.0–483.3) FOR THE HEAVIEST
LEVEL OF SMOKING AND DRINKING

15. CANCER OF NASOPHARYNX
• ACCOUNTS FOR 1–2 PER CENT OF ALL HEAD AND NECK CANCERS.
• IN SOUTHERN CHINA AND HONG KONG, THE DISEASE IS ENDEMIC WITH AN
INCIDENCE RATE OF 50 PER 100 000.
THERE ARE THREE SUBTYPES:
1. WHO TYPE 1: KERATINIZING SQUAMOUS CELL CARCINOMA
2. WHO TYPE 2: NON-KERATINIZING (DIFFERENTIATED) CARCINOMA
3. WHO TYPE 3: UNDIFFERENTIATED CARCINOMA.
• NPCS SHOW AMALE PREPONDERANCE OF 3:1

16. AETIOLOGY
• IN ETHNIC CHINESE, NPC IS ASSOCIATED WITH HLA TYPES A2, B17 AND
BW46.
• HLA B17 CARRIES THE SAME RISK AS BW46 AND ISNASSOCIATED WITH
YOUNGER ONSET DISEASE AND POORER PROGNOSIS
• STRONG ASSOCIATION BETWEEN UNDIFFERENTIATED NASOPHARYNX
CANCER AND POSITIVE SEROLOGY FOR EBV ANTIGENS.
• ANTIBODY TITRES TO EBV ANTIGENS CORRELATE WITH STAGE OF DISEASE
AND A FALL REFLECTS TUMOR RESPONSE TO TREATMENT, WHEREAS A
RISE IN ANTIBODY LEVELS MEANS PROGRESSION OF DISEASE
• PEOPLE WHO LIVE IN AREAS OF ASIA, NORTHERN AFRICA AND THE ARCTIC
REGION, WHERE NPC IS COMMON, TYPICALLY EAT DIETS VERY HIGH IN
SALT-CURED FISH AND MEAT. STUDIES INDICATE THAT FOODS PRESERVED
IN THIS WAY THAT ARE COOKED AT HIGH TEMPERATURES MAY PRODUCE

17. Cancer of nose and paranasal sinuses
• People who live in areas of Asia, northern Africa and the Arctic region, where NPC is
common, typically eat diets very high in salt-cured fish and meat. Studies indicate that
foods preserved in this way that are cooked at high temperatures may produce chemicals
that can damage DNA.
• 60–70 per cent of cancers of the nasal cavity and paranasal sinuses occur in the maxillary
sinus, 20–30 per cent in the nasal cavity, 10–15 per cent in the ethmoid sinuses, and less
than 5 per cent in the frontal and sphenoid sinuses.
• Occupational exposure to dusts from wood, textiles and leather, and even perhaps flour.
Other substances linked to this type of cancer are glues, formaldehyde, solvents used in
furniture and shoe production, Nickel and Chromium dust, mustard gas, isopropyl
(‘rubbing’) alcohol and radium.

18. • SINONASAL MALIGNANCIES ARE A RARE ENTITY, ACCOUNTING FOR LESS
THAN1% OF ALL MALIGNANCIES AND LESS THAN 5%
• INCIDENCE IS 0.556 PER 100,000
• SINONASAL MALIGNANCIES OCCUR MOST COMMONLY IN THE NASAL
CAVITY (43.9% OF ALL SINONASAL MALIGNANCIES), FOLLOWED BY THE
MAXILLARY SINUSES (35.9%), ETHMOID SINUSES (9.5%), SPHENOID SINUSES
(3.3%), AND FRONTAL SINUSES (1.1%).
• SINONASAL CANCER PRESENTS AT ADVANCED STAGES AND CARRIES A
POOR PROGNOSIS WITH AN OVERALL 5-YEAR SURVIVAL RANGING
BETWEEN 30%AND 40%

19. NON SQUAMOUS
MALIGNANT TUMOURS

20. CARCINOMA THYROID
• More Common In Women With A Ratio Of 3:1
• Affects Mainly Young People With Nearly Two-thirds Of Cases In The Age Group 20–55
Years.
• The Most Common Type Is Differentiated (80 Per Cent), Which Includes Papillary (85
Per Cent) And Follicular (15 Per Cent) Cancer.
• Poorly Differentiated Cancer Accounts For 10 Per Cent Of Cases, Anaplastic 5 Per Cent
And Medullary Thyroid Cancer 5 Per Cent.
• The Increase Is The Result Of The Incidental Detection Of Early Thyroid Cancer Because
Of Increasing Use Of Imaging, Such As Computed Tomography (Ct), Magnetic
Resonance Imaging (Mri), Ultrasound (Us) And Positron Emission Tomography (Pet)
• Medullary Thyroid Cancer (MTC), Which Constitutes Approximately 5 Per Cent Of All
Thyroid Malignancies

21. Loading…
AETIOLOGY
• Diet Low In Iodine
• Radiation
• Hereditiary Condition- Gardner Syndrome, Familial Polyposis And Cowden Disease,
Have An Increased Incidence Of Thyroid Cancer.

22. SALIVARY GLAND CARCINOMA
• Malignancies Of The Major And Minor Salivary Glands Are Uncommon, With An
Incidence Of 1.3 In 100,000, Representing Less Than 9% Of HNC, And An Overall 5-
year Survival Of 71.9%
• Recent Study By Boukheris And Coworkers Reassessed This Topic Using The World
Health Organization 2005 Classification. The Study Reported The Most Commonly
Diagnosed Major Salivary Malignancies Were Mucoepidermoid Carcinoma (2.85 Per
1,000,000 Person-years), Followed By Squamous Cell Carcinoma (1.83 Per 1,000,000
Person-years),
• Acinic Cells Carcinoma (1.38 Per 1,000,000 Personyears),
• Adenoid Cystic Carcinoma (1.30 Per 1,000,000 Person-years)
• Adenocarcinoma Not Otherwise Specified (1.22 Per 1,000,000 Personyears).

23. • Incidence Of Other Histologic Types Of Salivary Gland Malignancies Had An Incidence
Rate Less Than1 Case Per 1,000,000 Person-years, For Carcinoma Ex-pleomorphic,
Epithelial-myoepithelial Carcinoma, Lymphoepithelial Carcinoma, Salivary Duct
Carcinoma, Basal Cell Carcinoma, Oncocyctic Carcinoma, And Other Even Rarer
Subtypes.
• Men Are 50% More Likely Than Women To Develop A Salivary Gland Malignancy
• 80 Per Cent Of All Salivary Gland Tumours Are In The Parotid Gland.
• 10–15 Per Cent In The Submandibular Gland
• Rest In The Sublingual And Minor Salivary Glands.
• Most Tumors Of The Parotid Gland Are Benign, Whereas 40 Per Cent Of Submandibular
Gland Tumors And 80 Per Cent Of Minor Salivary Gland Tumors Are Malignant.

24. • Exposure To Ionizing Radiation, Such As A Nuclear Event, Dental Radiographs, External
Beam Radiotherapy, Or Iodine 131 Treatment, Increases The Risk Of Developing Benign
And Malignant Tumors Of The Salivary Glands. Other Risk Factors For Malignant
Salivary Tumors Include Early Menarche, And Exposure To Silica Dust, Kerosene,
Nickel, Chromium, Asbestos, And Cement Dust

25. THANK YOU