Head and neck cancers most commonly originate in the oral cavity, pharynx, larynx, and oral tissues. Risk factors include tobacco, alcohol, HPV infection, and sun exposure. Staging is based on tumor size and lymph node involvement. Treatment may involve surgery, radiation, chemotherapy, or combinations depending on cancer type and stage. Outcomes are best when care is provided by a multidisciplinary team that can address the medical, surgical, radiation, nutritional, and supportive needs of these complex patients.

1. Head & Neck Cancer
Robert Miller MD
www.aboutcancer.com

2. Head and Neck Cancer
1. Cause, the symptoms and the anatomy
2. Histology: most common is squamous cancer
3. Imaging: CT and PET scans
4. Stage is based on the size of the tumor and the
number or size of lymph nodes

3. Risk Factors Associated
with Oral Cancer
1.Tobacco Use (5 to 25X)
2. Alcohol (heavy drinkers double
their risk)
3.Oral infection with HPV16
4.Sun exposure for lip cancer
5.Reflux - ? Larynx cancer

4. The cure rate is better for HPV cancers than
for smoking related cancers
SURVIVAL
Non-smokers
smokers
Years
JCO June 10, 2012 vol. 30 no. 17 2102-2111

5. Cure Rates are better for people who
stop smoking during the radiation
Years
JCO June 10, 2012 vol. 30 no. 17 2102-
2111

6. Most Common Head and Neck
Cancers
 Pharynx
13,930
 Tongue 13,590
 Larynx 12,260
 Mouth 11,400
 Other oral 2,460
2013 data (note that same
year there were 228,190
lung cancers and 234,580
breast cancers)

7. Lifetime Risk of Getting
Cancer
Site Men Women
Any Cancer 44% 37%
Oral/Pharyn 1.39% 0.65%
x
Larynx 0.61% 0.14%

8. Median Age for Oral/Pharynx is
62y in 2005-2009
30
25
20
15
10
5
0
20 35 45 55 65 75 85
Age

9. Median Age for Larynx Cancer is
65y in 2005-2009
30
25
20
15
10
5
0
20 35 45 55 65 75 85
Age

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. 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. Oral Cavity

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. Cross Section Anatomy

15. CT Scan and Anatomy

16. CT-PET Anatomy
small cancer in the front of the tongue (oral tongue)

18. Oral Cavity Stage: T
(tumor)
Tumor Size
T1 2cm
T2 > 2 to 4cm
T3 > 4cm
T4 Deeply invasive

19. Oral Cavity Stage: N (nodes)
Nodes Site
N1 Single node up to 3cm
N2a Node >3 to 6cm
N2b Multiple ipsilateral
N2c Contralateral
N3 Node > 6cm

20. Oral Cavity Stage
Stage Definition
Stage 1 T1N0
Stage 2 T2N0
Stage 3 T3 or N1
Stage 4A T4a or N2
Stage 4B T4b or N3
Stage 4C Metastases

21. Anatomy of the Pharynx

22. 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 skull
can be cranial nerve problems or headaches
Other late symptoms include lymph node

23. 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 pain
radiating into the ear, trouble swallowing and
lymph node enlargement

25. normal
mandible
tongue
throat
Cancer in
(pharynx)
Base of
Tongue
salivary
gland normal
lymph
nodes
spinal cord
spine

26. Squamous Cancer Right Tonsil – Very
Visible on PET scan

27. Oropharynx Stage: T (tumor)
Tumor Size
T1 2 cm
T2 >2 to 4cm
T3 > 4cm
T4 Deeply Invasive

28. Oropharynx Stage: N (nodes)
Node Size
N1 Single node up to 3cm
N2a Node >3 to 6cm
N2b Multiple Ipsilateral
N2c Contralateral Nodes
N3 Node >6 cm

29. Oropharynx Stage
Stage Definition
Stage 1 T1N0
Stage 2 T2N0
Stage 3 T3 or N1
Stage 4A T4a or N2
Stage 4B T4b or N3
Stage 4C Metastases

30. PET CT Anatomy for Tonsil
Cancer, Stage IVa with multiple
involved nodes (N2)

31. Cancer of the Hypopharynx
Less common
Low in the throat, most
common site is in the
pyriform sinus
Symptoms are usually trouble swallowing or
hoarseness
Other late symptoms include lymph node
swelling

32. Lymph Nodes

33. Neck Node Levels

34. PET Scan showing Multiple
Level Lymph Node Spread

35. PET Scans are Very Good
Showing Lymph Node Spread

36. Larynx Anatomy

37. Larynx Cancer
If supraglottic larynx is
commonly involves the
epiglottis and symptoms
include sore throat and
trouble swallowing
If the true vocal cords the symptoms are almost
always hoarse voice
Late stage symptoms include lymph node
swelling in the neck and weight loss

38. Common site for larynx cancer is the spot
where the two vocal cords come together in
the front of the larynx (called the anterior
commissure)

40. Larynx Stage: T (tumor)
Tumor Size
T1 One site
T2 Two sites/ impaired mobility
T3 Paralyzed cord
T4 Deeply Invasive

41. Larynx Stage: N (nodes)
Node Size
N1 Single node up to 3cm
N2a Node >3 to 6cm
N2b Multiple Ipsilateral
N2c Contralateral Nodes
N3 Node >6 cm

42. Larynx Stage
Stage Definition
Stage 1 T1N0
Stage 2 T2N0
Stage 3 T3 or N1
Stage 4A T4a or N2
Stage 4B T4b or N3
Stage 4C Metastases

44. NCCN.org

46. Increasing Complexity in the
Management of Head & Neck
Cancer

48. 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

49. 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

50. Multidisciplinary Team

51. Support Team

52. Head & Neck Cancer
Robert Miller MD
www.aboutcancer.co
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