This document discusses pre-management of head and neck cancers. It notes that head and neck cancers have a high incidence in India, especially lip and oral cavity cancers. The main risk factors are tobacco and alcohol use, which can have synergistic effects. Premalignant lesions that can develop include leukoplakia, erythroplakia, oral lichen planus, and oral submucous fibrosis. Squamous cell carcinoma is the most common histology. Staging follows the 8th edition AJCC TNM system and considers factors like tumor depth of invasion and lymph node involvement. The major head and neck cancer sites discussed are oral cavity, oropharynx, hypopharynx and their characteristics.
This document provides an overview of management for meningioma, pituitary gland tumors, and spinal cord tumors. It discusses:
1. Meningiomas are the most common primary intracranial tumors, mostly benign but some malignant. Treatment options include surgery, radiation therapy, and chemotherapy depending on tumor grade and extent of resection.
2. Pituitary tumors account for 10-15% of primary brain tumors and most are endocrinologically active. The pituitary gland anatomy and tumor epidemiology are outlined.
3. Spinal meningiomas are typically treated with surgical resection if possible, or with stereotactic radiosurgery or hypofractionated radiation if not. Management depends on tumor
This document discusses the management of penile carcinoma. Surgery is the mainstay of treatment and may involve circumcision, laser ablation, Mohs micrographic surgery, or penectomy depending on the location, size, and stage of the tumor. Radiotherapy options include brachytherapy and external beam radiation therapy. Chemotherapy has a limited role and is mainly used perioperatively for unresectable disease. Treatment aims to balance tumor control with organ preservation and minimizing psychosocial and sexual morbidity. Close multidisciplinary care and discussion of treatment expectations is important.
This document discusses various benign, premalignant, and malignant lesions of the penis. It covers the etiology, risk factors, diagnosis, staging, and management options for penile cancer including surgery, radiotherapy, and chemotherapy. The main types of penile cancer are squamous cell carcinoma (>95%) and mesenchymal tumors (<3%). Surgical options range from circumcision to partial or total penectomy. Radiotherapy can be delivered via brachytherapy or external beam radiation. Management depends on tumor stage, size, histology, and patient preferences regarding organ preservation.
Radiotherapy is an important treatment option for penile carcinoma. It can be used as curative treatment for early stage tumors, as adjuvant treatment after surgery to reduce the risk of recurrence, and for palliation of advanced tumors. The main radiotherapy techniques are external beam radiotherapy and brachytherapy. Brachytherapy involves placing radioactive sources inside or next to the tumor and is often used for small early stage tumors, providing good tumor control rates and organ preservation. External beam radiotherapy uses external radiation beams and can treat larger tumors or be used as adjuvant therapy. Proper patient positioning and immobilization is important for both techniques to precisely target the tumor while sparing surrounding organs. Radiotherapy is generally well-tol
This document discusses carcinoma of the vagina, including vaginal intraepithelial neoplasia (VAIN). It covers the anatomy, epidemiology, risk factors, clinical presentation, evaluation, and treatment of vaginal cancer. Vaginal cancer is a rare malignancy that usually presents with irregular vaginal bleeding. Diagnosis involves biopsy of any suspicious lesions. Treatment depends on the stage and may involve surgery, radiation therapy, or chemotherapy. For early stage disease, brachytherapy alone can often control the cancer with local control rates of 67-100%.
Recent guidelines in management of oral and oropharyngeal carcinoma barun kumar
This document provides guidelines for the management of oral and oropharyngeal cancer. It discusses the multi-disciplinary approach, TNM staging, diagnostic workup, treatment options based on stage, principles of surgery including resection, reconstruction and management of neck nodes, as well as follow up care. The guidelines emphasize a team-based approach and tailored treatment strategies based on specific tumor characteristics and stage.
This document discusses squamous cell carcinoma of the anal canal. It describes the anatomy of the anal canal and defines the anal canal, transitional zone, and anal margin. Risk factors for anal cancer include HPV infection and HIV/AIDS. Combined modality treatment including chemotherapy with mitomycin and 5-fluorouracil alongside radiation therapy is an effective standard of care based on clinical trials showing improved local control and survival compared to radiation alone.
This document provides information about cancer of the anal canal, including its anatomy, risk factors, staging, classification, and treatment. It notes that anal canal cancer is uncommon but increasing in incidence. The anal canal is approximately 4 cm long and lines by squamous epithelium. Risk factors include HPV infection and immunosuppression. Treatment typically involves chemoradiotherapy to preserve the sphincter, which provides high survival and local control rates of 60-90%. Combined modality therapy with 5-FU and mitomycin C or cisplatin is the standard of care.
This document provides an overview of management for meningioma, pituitary gland tumors, and spinal cord tumors. It discusses:
1. Meningiomas are the most common primary intracranial tumors, mostly benign but some malignant. Treatment options include surgery, radiation therapy, and chemotherapy depending on tumor grade and extent of resection.
2. Pituitary tumors account for 10-15% of primary brain tumors and most are endocrinologically active. The pituitary gland anatomy and tumor epidemiology are outlined.
3. Spinal meningiomas are typically treated with surgical resection if possible, or with stereotactic radiosurgery or hypofractionated radiation if not. Management depends on tumor
This document discusses the management of penile carcinoma. Surgery is the mainstay of treatment and may involve circumcision, laser ablation, Mohs micrographic surgery, or penectomy depending on the location, size, and stage of the tumor. Radiotherapy options include brachytherapy and external beam radiation therapy. Chemotherapy has a limited role and is mainly used perioperatively for unresectable disease. Treatment aims to balance tumor control with organ preservation and minimizing psychosocial and sexual morbidity. Close multidisciplinary care and discussion of treatment expectations is important.
This document discusses various benign, premalignant, and malignant lesions of the penis. It covers the etiology, risk factors, diagnosis, staging, and management options for penile cancer including surgery, radiotherapy, and chemotherapy. The main types of penile cancer are squamous cell carcinoma (>95%) and mesenchymal tumors (<3%). Surgical options range from circumcision to partial or total penectomy. Radiotherapy can be delivered via brachytherapy or external beam radiation. Management depends on tumor stage, size, histology, and patient preferences regarding organ preservation.
Radiotherapy is an important treatment option for penile carcinoma. It can be used as curative treatment for early stage tumors, as adjuvant treatment after surgery to reduce the risk of recurrence, and for palliation of advanced tumors. The main radiotherapy techniques are external beam radiotherapy and brachytherapy. Brachytherapy involves placing radioactive sources inside or next to the tumor and is often used for small early stage tumors, providing good tumor control rates and organ preservation. External beam radiotherapy uses external radiation beams and can treat larger tumors or be used as adjuvant therapy. Proper patient positioning and immobilization is important for both techniques to precisely target the tumor while sparing surrounding organs. Radiotherapy is generally well-tol
This document discusses carcinoma of the vagina, including vaginal intraepithelial neoplasia (VAIN). It covers the anatomy, epidemiology, risk factors, clinical presentation, evaluation, and treatment of vaginal cancer. Vaginal cancer is a rare malignancy that usually presents with irregular vaginal bleeding. Diagnosis involves biopsy of any suspicious lesions. Treatment depends on the stage and may involve surgery, radiation therapy, or chemotherapy. For early stage disease, brachytherapy alone can often control the cancer with local control rates of 67-100%.
Recent guidelines in management of oral and oropharyngeal carcinoma barun kumar
This document provides guidelines for the management of oral and oropharyngeal cancer. It discusses the multi-disciplinary approach, TNM staging, diagnostic workup, treatment options based on stage, principles of surgery including resection, reconstruction and management of neck nodes, as well as follow up care. The guidelines emphasize a team-based approach and tailored treatment strategies based on specific tumor characteristics and stage.
This document discusses squamous cell carcinoma of the anal canal. It describes the anatomy of the anal canal and defines the anal canal, transitional zone, and anal margin. Risk factors for anal cancer include HPV infection and HIV/AIDS. Combined modality treatment including chemotherapy with mitomycin and 5-fluorouracil alongside radiation therapy is an effective standard of care based on clinical trials showing improved local control and survival compared to radiation alone.
This document provides information about cancer of the anal canal, including its anatomy, risk factors, staging, classification, and treatment. It notes that anal canal cancer is uncommon but increasing in incidence. The anal canal is approximately 4 cm long and lines by squamous epithelium. Risk factors include HPV infection and immunosuppression. Treatment typically involves chemoradiotherapy to preserve the sphincter, which provides high survival and local control rates of 60-90%. Combined modality therapy with 5-FU and mitomycin C or cisplatin is the standard of care.
This document discusses cancer of the anal canal. It compares mitomycin vs cisplatin for treating anal canal cancer and finds that mitomycin, 5-FU and radiation led to significantly lower rates of colostomy at 5 years compared to cisplatin. It recommends the combination of 5-FU, mitomycin and radiation as the standard of care. The combination was associated with 5-year survival rates of 80% for small cancers down to 45-55% for larger or more invasive cancers, with overall survival of 65-75%.
This document provides information on staging and treatment guidelines for cancers of the oropharynx and hypopharynx. It begins with an overview of AJCC 7th edition staging for these sites, including TNM classifications. It then reviews general principles of treatment, including the goals of treatment based on stage. The main treatment modalities of surgery, radiotherapy, chemotherapy, and their combinations are described. Finally, it provides more detailed site-specific guidelines for treatment of oropharynx and hypopharynx cancers.
This document discusses radiotherapy planning for vulvar cancer. It begins with an introduction that notes vulvar cancer is rare but usually presents as early stage squamous cell carcinoma in elderly women. It then covers anatomy, lymphatic spread, investigations, staging, indications for radiotherapy, patient positioning and immobilization, target volumes, field arrangements, doses, and toxicities. The target volumes include the vulvar tumor bed, inguinal lymph nodes, and sometimes pelvic lymph nodes. Doses depend on whether radiotherapy is adjuvant or definitive and if there is gross disease or positive margins. Toxicities are a concern especially for organs at risk like the bowels and bladder.
This document provides an overview of carcinoma of the anal canal, including its:
1) Anatomy, epidemiology, risk factors, pathology, presentation, diagnostic workup and staging. It describes the anal canal's structures and relations in detail.
2) Incidence rates globally and in India, with the highest rates seen in Caucasian females and lowest in Asian males. Major risk factors include HPV, HIV/AIDS, and number of sexual partners.
3) Evaluation involves history, examination, imaging like CT/MRI, and biopsy. Staging follows AJCC guidelines and prognostic factors include size, nodes, differentiation and HIV status.
This document provides information on anal malignancies, including:
- Anal cancer is uncommon but incidence has increased, making up 4% of anorectal malignancies.
- The anal canal anatomy and blood supply are described. Risk factors for anal cancer include human papillomavirus infection, HIV/AIDS, immunosuppression, and smoking.
- Symptoms typically include rectal bleeding, pain, or masses. Evaluation involves examination, imaging, and biopsy. Treatment is usually chemoradiation, while surgery is reserved for residual or recurrent disease. Prognosis depends on stage and response to treatment.
This document discusses the management of oropharyngeal cancer. It begins by stating the goals of treatment are functional organ preservation and minimizing treatment-induced morbidity while maintaining cure rates. For early stage disease, single modality radiotherapy or surgery is usually sufficient. For advanced stages, surgery plus radiation or chemoradiation are recommended based on risk factors. It then discusses treatment options and outcomes for different subsites within the oropharynx and the benefits of adjuvant therapy or altered fractionation schedules for radiotherapy.
This document discusses penile conservation for squamous cell carcinoma of the penis. It provides evidence that radiotherapy can successfully preserve the penis in over 50% of cases, with 5-year survival rates comparable to surgery. Brachytherapy is highlighted as an effective non-surgical approach, allowing for homogenous dose distribution and sparing of surrounding tissue. Complications are mostly mild to moderate, with urethral stenosis occurring in under 15% of cases. With close follow-up, radiotherapy can offer local control and penile preservation similar to surgery while maintaining patient quality of life and sexuality.
The document discusses the anatomy, epidemiology, staging, clinical presentation, evaluation, and management of oropharyngeal and hypopharyngeal cancers. Key points include:
- The oropharynx and hypopharynx are complex head and neck spaces divided by anatomical boundaries.
- Oropharyngeal cancer risk factors include tobacco, alcohol, and HPV infection. Hypopharyngeal cancer risk is strongly associated with tobacco and alcohol use.
- Staging evaluates tumor size, lymph node involvement, and distant metastasis according to the TNM system.
- Evaluation includes imaging like CT/PET to assess primary tumor and nodal disease. Fiberoptic examination aids in diagnosis.
This document discusses anal carcinoma. It covers the overview, risk factors which include HPV and anal intercourse, and the strong association with HPV-16 and HPV-18. It also discusses risk reduction through treatment of high-grade anal intraepithelial neoplasia, a precursor to anal cancer. The anatomy of the anal region and canal is described. Sentinel nodes are the inguinal nodes. Primary treatment of non-metastatic anal cancer involves chemotherapy with radiotherapy to improve local control and reduce colostomies.
The document summarizes radiation techniques used in treating nasopharyngeal carcinoma. It discusses 2D planning techniques including field borders and portals. It also discusses 3D conformal radiation therapy and intensity-modulated radiation therapy (IMRT), noting that IMRT allows a high dose to the tumor while limiting dose to surrounding tissues. The document reviews studies showing improved local control and reduced toxicity with 3D and IMRT techniques compared to 2D planning. It also discusses dose escalation techniques including brachytherapy and stereotactic radiosurgery boosts as well as altered fractionation schedules.
This document summarizes the surgical approach and management of oral cavity cancer. It discusses that single modality treatment is preferred for stage I-II cancer, while multimodality treatment is essential for stage III-IV cancer. A multidisciplinary tumor board is important to maximize survival while preserving function. The extent of surgery depends on factors like perineural invasion. Frozen section analysis during surgery helps ensure clear margins, and reconstruction is then performed. Sentinel lymph node biopsy is an alternative to elective neck dissection for early stage cancers.
The document discusses staging of cervical cancer according to FIGO staging criteria, with stages ranging from 0 to IVB. It then summarizes guidelines from ESMO on indications for adjuvant treatment, which include chemoradiation as the best option for stages IB2 to IVA. Finally, it reviews several studies that have investigated neoadjuvant chemotherapy followed by radiation therapy versus radiation therapy alone in advanced cervical cancer.
This document discusses carcinoma of the nasopharynx, including its detection in early stages using MRI imaging, patterns of local and lymphatic spread, association with EBV, clinical features, staging according to AJCC guidelines, pathological classification, and treatment using radiotherapy techniques like three-dimensional conformal radiation therapy and intensity-modulated radiotherapy. Key points covered are detection of early lesions via MRI, common sites of local extension like the parapharyngeal space and skull base, routes of lymphatic spread to cervical lymph nodes, and role of plasma EBV DNA levels in diagnosis and prognosis.
1) Tumors of the hypopharynx most commonly occur in the pyriform sinus, postcricoid region, and posterior pharyngeal wall.
2) Risk factors for hypopharyngeal tumors include smoking, alcohol use, poor nutrition, and human papillomavirus. Genetic factors and occupational exposures also contribute to cancer risk.
3) Diagnosis involves laryngoscopy, barium swallow, CT scan, and biopsy. Treatment depends on the size and extent of the tumor, and may involve radiation, surgery such as laryngectomy or pharyngectomy, or a combination of the two.
This document provides information on colorectal cancer epidemiology, anatomy, staging, diagnosis and treatment. It discusses:
- Colorectal cancer is the 3rd most common cancer in the US, with over 100,000 new cases annually and a lifetime risk of 1 in 10 for men and 1 in 14 for women.
- The rectum is located in the pelvis and is divided into lower, mid, and upper portions. It has various blood, nerve and lymphatic supplies.
- Staging involves determining the depth of invasion (T stage), lymph node involvement (N stage), and presence of metastases (M stage). Treatment involves surgery with the aim of local control and survival while preserving function
This document presents a case of a 60-year-old male patient with locally advanced oral cavity squamous cell carcinoma. It discusses the patient's history, investigations including imaging and biopsy results, staging, and initial treatment involving radiation therapy. It then provides introductions to oral cavity cancer epidemiology, clinical manifestations, diagnostic workup, staging, treatment considerations including surgery, radiation, and chemotherapy, as well as factors affecting treatment choices and outcomes from studies on post-operative radiation and chemoradiation.
This document discusses the role of radiation therapy (RT) in oropharynx cancer treatment. It notes that a multidisciplinary approach is optimal. For early stage disease, RT alone may be sufficient, while for advanced stages concurrent chemoradiation (CCRT) provides better control and survival than RT alone. Data from one center shows comparable outcomes for CCRT versus surgery plus RT. Advanced RT techniques like IMRT can lower toxicity compared to 3D conformal RT. Adaptive RT using parameters like tumor volume reduction may help predict outcomes. Future areas of refinement include improved imaging and de-intensified strategies guided by prognostic factors.
Management of anal canal tumors with emphasis on treatment(1)SabaMajid5
This document discusses the management of anal canal tumors with an emphasis on radiation therapy planning. It provides details on:
1) The anatomy of the anal canal and blood supply, lymphatic drainage, and nerve innervation.
2) Risk factors, staging, and patterns of spread for anal canal cancer.
3) The standard of care for anal canal cancer, which is concurrent chemoradiation therapy using radiation doses between 50-59 Gy along with chemotherapy drugs like 5-FU and mitomycin.
4) Techniques for radiation therapy planning including target volume delineation, field arrangements, and dose guidelines to maximize tumor coverage while minimizing dose to surrounding organs.
The document discusses medulloblastoma, the most common malignant brain tumor in children. It covers the pathology, molecular subtypes, clinical features, workup, management including surgery, radiation therapy, chemotherapy, and prognosis of medulloblastoma. Risk stratification is based on factors like age, extent of resection, and molecular markers to determine appropriate adjuvant treatment.
1. Carcinoma of the oral cavity is most commonly found on the tongue, floor of mouth, and lips. It spreads locally and via lymphatics, most often to cervical lymph nodes. Distant metastases occur in 15-20% of cases, most commonly to lungs.
2. Diagnosis involves history, physical exam, biopsy of the lesion and lymph nodes, imaging like OPG, CT/MRI to assess bone and lymph node involvement. Staging helps determine prognosis and management.
3. Treatment involves surgery, radiation, chemotherapy depending on stage. Close surveillance is needed due to high risk of recurrence and second primary cancers.
This document provides information on head and neck anatomy and cancers. It discusses the lymphatic drainage of structures in the head and neck region like the nasal cavity, paranasal sinuses, oral cavity, oropharynx, larynx and nasopharynx. It also covers the etiology, risk factors, pathology and classification of head and neck cancers. Specifically, it notes that over half a million new head and neck cancer cases occur globally each year, with squamous cell carcinoma making up 90% of cases. HPV and EBV viruses are also discussed as risk factors. The document reviews the anatomy and lymphatic drainage patterns of different head and neck structures to understand cancer spread.
This document discusses cancer of the anal canal. It compares mitomycin vs cisplatin for treating anal canal cancer and finds that mitomycin, 5-FU and radiation led to significantly lower rates of colostomy at 5 years compared to cisplatin. It recommends the combination of 5-FU, mitomycin and radiation as the standard of care. The combination was associated with 5-year survival rates of 80% for small cancers down to 45-55% for larger or more invasive cancers, with overall survival of 65-75%.
This document provides information on staging and treatment guidelines for cancers of the oropharynx and hypopharynx. It begins with an overview of AJCC 7th edition staging for these sites, including TNM classifications. It then reviews general principles of treatment, including the goals of treatment based on stage. The main treatment modalities of surgery, radiotherapy, chemotherapy, and their combinations are described. Finally, it provides more detailed site-specific guidelines for treatment of oropharynx and hypopharynx cancers.
This document discusses radiotherapy planning for vulvar cancer. It begins with an introduction that notes vulvar cancer is rare but usually presents as early stage squamous cell carcinoma in elderly women. It then covers anatomy, lymphatic spread, investigations, staging, indications for radiotherapy, patient positioning and immobilization, target volumes, field arrangements, doses, and toxicities. The target volumes include the vulvar tumor bed, inguinal lymph nodes, and sometimes pelvic lymph nodes. Doses depend on whether radiotherapy is adjuvant or definitive and if there is gross disease or positive margins. Toxicities are a concern especially for organs at risk like the bowels and bladder.
This document provides an overview of carcinoma of the anal canal, including its:
1) Anatomy, epidemiology, risk factors, pathology, presentation, diagnostic workup and staging. It describes the anal canal's structures and relations in detail.
2) Incidence rates globally and in India, with the highest rates seen in Caucasian females and lowest in Asian males. Major risk factors include HPV, HIV/AIDS, and number of sexual partners.
3) Evaluation involves history, examination, imaging like CT/MRI, and biopsy. Staging follows AJCC guidelines and prognostic factors include size, nodes, differentiation and HIV status.
This document provides information on anal malignancies, including:
- Anal cancer is uncommon but incidence has increased, making up 4% of anorectal malignancies.
- The anal canal anatomy and blood supply are described. Risk factors for anal cancer include human papillomavirus infection, HIV/AIDS, immunosuppression, and smoking.
- Symptoms typically include rectal bleeding, pain, or masses. Evaluation involves examination, imaging, and biopsy. Treatment is usually chemoradiation, while surgery is reserved for residual or recurrent disease. Prognosis depends on stage and response to treatment.
This document discusses the management of oropharyngeal cancer. It begins by stating the goals of treatment are functional organ preservation and minimizing treatment-induced morbidity while maintaining cure rates. For early stage disease, single modality radiotherapy or surgery is usually sufficient. For advanced stages, surgery plus radiation or chemoradiation are recommended based on risk factors. It then discusses treatment options and outcomes for different subsites within the oropharynx and the benefits of adjuvant therapy or altered fractionation schedules for radiotherapy.
This document discusses penile conservation for squamous cell carcinoma of the penis. It provides evidence that radiotherapy can successfully preserve the penis in over 50% of cases, with 5-year survival rates comparable to surgery. Brachytherapy is highlighted as an effective non-surgical approach, allowing for homogenous dose distribution and sparing of surrounding tissue. Complications are mostly mild to moderate, with urethral stenosis occurring in under 15% of cases. With close follow-up, radiotherapy can offer local control and penile preservation similar to surgery while maintaining patient quality of life and sexuality.
The document discusses the anatomy, epidemiology, staging, clinical presentation, evaluation, and management of oropharyngeal and hypopharyngeal cancers. Key points include:
- The oropharynx and hypopharynx are complex head and neck spaces divided by anatomical boundaries.
- Oropharyngeal cancer risk factors include tobacco, alcohol, and HPV infection. Hypopharyngeal cancer risk is strongly associated with tobacco and alcohol use.
- Staging evaluates tumor size, lymph node involvement, and distant metastasis according to the TNM system.
- Evaluation includes imaging like CT/PET to assess primary tumor and nodal disease. Fiberoptic examination aids in diagnosis.
This document discusses anal carcinoma. It covers the overview, risk factors which include HPV and anal intercourse, and the strong association with HPV-16 and HPV-18. It also discusses risk reduction through treatment of high-grade anal intraepithelial neoplasia, a precursor to anal cancer. The anatomy of the anal region and canal is described. Sentinel nodes are the inguinal nodes. Primary treatment of non-metastatic anal cancer involves chemotherapy with radiotherapy to improve local control and reduce colostomies.
The document summarizes radiation techniques used in treating nasopharyngeal carcinoma. It discusses 2D planning techniques including field borders and portals. It also discusses 3D conformal radiation therapy and intensity-modulated radiation therapy (IMRT), noting that IMRT allows a high dose to the tumor while limiting dose to surrounding tissues. The document reviews studies showing improved local control and reduced toxicity with 3D and IMRT techniques compared to 2D planning. It also discusses dose escalation techniques including brachytherapy and stereotactic radiosurgery boosts as well as altered fractionation schedules.
This document summarizes the surgical approach and management of oral cavity cancer. It discusses that single modality treatment is preferred for stage I-II cancer, while multimodality treatment is essential for stage III-IV cancer. A multidisciplinary tumor board is important to maximize survival while preserving function. The extent of surgery depends on factors like perineural invasion. Frozen section analysis during surgery helps ensure clear margins, and reconstruction is then performed. Sentinel lymph node biopsy is an alternative to elective neck dissection for early stage cancers.
The document discusses staging of cervical cancer according to FIGO staging criteria, with stages ranging from 0 to IVB. It then summarizes guidelines from ESMO on indications for adjuvant treatment, which include chemoradiation as the best option for stages IB2 to IVA. Finally, it reviews several studies that have investigated neoadjuvant chemotherapy followed by radiation therapy versus radiation therapy alone in advanced cervical cancer.
This document discusses carcinoma of the nasopharynx, including its detection in early stages using MRI imaging, patterns of local and lymphatic spread, association with EBV, clinical features, staging according to AJCC guidelines, pathological classification, and treatment using radiotherapy techniques like three-dimensional conformal radiation therapy and intensity-modulated radiotherapy. Key points covered are detection of early lesions via MRI, common sites of local extension like the parapharyngeal space and skull base, routes of lymphatic spread to cervical lymph nodes, and role of plasma EBV DNA levels in diagnosis and prognosis.
1) Tumors of the hypopharynx most commonly occur in the pyriform sinus, postcricoid region, and posterior pharyngeal wall.
2) Risk factors for hypopharyngeal tumors include smoking, alcohol use, poor nutrition, and human papillomavirus. Genetic factors and occupational exposures also contribute to cancer risk.
3) Diagnosis involves laryngoscopy, barium swallow, CT scan, and biopsy. Treatment depends on the size and extent of the tumor, and may involve radiation, surgery such as laryngectomy or pharyngectomy, or a combination of the two.
This document provides information on colorectal cancer epidemiology, anatomy, staging, diagnosis and treatment. It discusses:
- Colorectal cancer is the 3rd most common cancer in the US, with over 100,000 new cases annually and a lifetime risk of 1 in 10 for men and 1 in 14 for women.
- The rectum is located in the pelvis and is divided into lower, mid, and upper portions. It has various blood, nerve and lymphatic supplies.
- Staging involves determining the depth of invasion (T stage), lymph node involvement (N stage), and presence of metastases (M stage). Treatment involves surgery with the aim of local control and survival while preserving function
This document presents a case of a 60-year-old male patient with locally advanced oral cavity squamous cell carcinoma. It discusses the patient's history, investigations including imaging and biopsy results, staging, and initial treatment involving radiation therapy. It then provides introductions to oral cavity cancer epidemiology, clinical manifestations, diagnostic workup, staging, treatment considerations including surgery, radiation, and chemotherapy, as well as factors affecting treatment choices and outcomes from studies on post-operative radiation and chemoradiation.
This document discusses the role of radiation therapy (RT) in oropharynx cancer treatment. It notes that a multidisciplinary approach is optimal. For early stage disease, RT alone may be sufficient, while for advanced stages concurrent chemoradiation (CCRT) provides better control and survival than RT alone. Data from one center shows comparable outcomes for CCRT versus surgery plus RT. Advanced RT techniques like IMRT can lower toxicity compared to 3D conformal RT. Adaptive RT using parameters like tumor volume reduction may help predict outcomes. Future areas of refinement include improved imaging and de-intensified strategies guided by prognostic factors.
Management of anal canal tumors with emphasis on treatment(1)SabaMajid5
This document discusses the management of anal canal tumors with an emphasis on radiation therapy planning. It provides details on:
1) The anatomy of the anal canal and blood supply, lymphatic drainage, and nerve innervation.
2) Risk factors, staging, and patterns of spread for anal canal cancer.
3) The standard of care for anal canal cancer, which is concurrent chemoradiation therapy using radiation doses between 50-59 Gy along with chemotherapy drugs like 5-FU and mitomycin.
4) Techniques for radiation therapy planning including target volume delineation, field arrangements, and dose guidelines to maximize tumor coverage while minimizing dose to surrounding organs.
The document discusses medulloblastoma, the most common malignant brain tumor in children. It covers the pathology, molecular subtypes, clinical features, workup, management including surgery, radiation therapy, chemotherapy, and prognosis of medulloblastoma. Risk stratification is based on factors like age, extent of resection, and molecular markers to determine appropriate adjuvant treatment.
1. Carcinoma of the oral cavity is most commonly found on the tongue, floor of mouth, and lips. It spreads locally and via lymphatics, most often to cervical lymph nodes. Distant metastases occur in 15-20% of cases, most commonly to lungs.
2. Diagnosis involves history, physical exam, biopsy of the lesion and lymph nodes, imaging like OPG, CT/MRI to assess bone and lymph node involvement. Staging helps determine prognosis and management.
3. Treatment involves surgery, radiation, chemotherapy depending on stage. Close surveillance is needed due to high risk of recurrence and second primary cancers.
This document provides information on head and neck anatomy and cancers. It discusses the lymphatic drainage of structures in the head and neck region like the nasal cavity, paranasal sinuses, oral cavity, oropharynx, larynx and nasopharynx. It also covers the etiology, risk factors, pathology and classification of head and neck cancers. Specifically, it notes that over half a million new head and neck cancer cases occur globally each year, with squamous cell carcinoma making up 90% of cases. HPV and EBV viruses are also discussed as risk factors. The document reviews the anatomy and lymphatic drainage patterns of different head and neck structures to understand cancer spread.
The document discusses management of oropharyngeal cancers. The oropharynx includes areas like the base of the tongue, soft palate, tonsils and posterior pharyngeal walls. Oropharyngeal cancers commonly spread to cervical lymph nodes in levels II, III and IV. Risk factors include age, gender, smoking, alcohol and HPV infection. Treatment may involve surgery, radiation therapy or chemotherapy depending on the stage of cancer. Imaging tests like CT, MRI and PET scans are used to stage the cancer and detect metastases.
This document discusses management of oral cavity cancer. It covers the incidence, risk factors, patterns of spread, staging, and treatment approaches for oral cavity cancer. The main treatment approaches are surgery, radiotherapy including external beam radiotherapy and brachytherapy, and concurrent chemoradiotherapy. Surgery involves excision of the primary tumor with margins and neck dissection. Reconstruction options after surgery include skin grafts, regional flaps, and free flaps. Brachytherapy is used as monotherapy or with external beam radiotherapy for early stage tumors. Selection criteria for brachytherapy include early stage disease localized to the organ of origin.
This document provides information about pharyngeal cancers, including nasopharyngeal carcinoma, oropharyngeal cancer, and hypopharyngeal carcinoma. It discusses the relevant anatomy, risk factors, signs and symptoms, diagnostic tests, staging, treatment options including radiation, chemotherapy, and surgery, as well as reconstruction techniques and prognosis. The surgical approaches covered include transoral, transcervical, mandibular swing, and others. Reconstruction options like skin grafts, flaps, and free tissue transfer are also summarized.
This document discusses the anatomy, etiology, clinical presentation, staging, and treatment options for carcinoma of the tongue. It notes that carcinoma of the tongue most commonly presents as a non-healing ulcer and can cause symptoms like otalgia, odynophagia, and bleeding. Treatment depends on staging and may involve surgery, radiation therapy, chemotherapy, or a combination. Prognosis decreases with more advanced stage at diagnosis.
Carcinomatongue 150622043025-lva1-app6891Liju Rajan
The document discusses carcinoma of the tongue. It begins by describing the anatomy of the oral cavity and structures included. It then discusses the tongue's muscles and functions. Risk factors for oral cancer include tobacco, alcohol, poor oral hygiene, and HPV infection. Premalignant lesions of the tongue include leukoplakia and erythroplakia. Treatment options depend on the stage and size of the tumor and include surgery, radiation therapy, chemotherapy, and neck dissection. Prognosis depends on stage, with earlier stages having better survival rates.
This document summarizes the anatomy, epidemiology, etiology, pathology, clinical features, investigations, staging, and treatment of oral and oropharyngeal cancers. It describes the anatomy of the oral cavity, blood supply, and cervical lymph nodes. It notes that oral cancers are one of the most common malignancies in India, often involving the tongue, tonsils, or gums. Main risk factors are tobacco and alcohol use. Diagnosis involves biopsy and imaging like CT or MRI. Treatment depends on cancer stage but typically involves surgery, radiation, and chemotherapy.
The document discusses the anatomy and functions of the soft palate, including its role in separating the nasopharynx from the oropharynx and in speech, swallowing, and respiratory functions. It then provides statistics on the annual incidence of oral cancer worldwide and risk factors such as tobacco, alcohol, HPV infection, and poor oral hygiene. The stages of oral cancer are described based on tumor size and spread.
The document discusses the anatomy and structures of the oral cavity, including the lips, buccal mucosa, hard palate, retromolar trigone, floor of the mouth, and tongue. It describes the etiology of oral cancers, noting that tobacco and alcohol use are major risk factors. Squamous cell carcinoma accounts for 95% of oral cavity cancers. Treatment options depend on the stage of cancer, and may include surgery, radiation therapy, chemotherapy, or a combination of these. Prognosis decreases with more advanced stage at diagnosis.
The document describes the anatomy and boundaries of the oropharynx, including the retromolar trigone. Squamous cell carcinoma is the most common malignancy, with the lateral wall, tongue base, and soft palate being the most frequent sites. Lymphomas also commonly affect the lateral wall and tongue base. Presenting symptoms are often nonspecific. Diagnostic tests include CT/MRI, PET scan, and biopsy. Treatment depends on stage and includes radiation therapy, surgery, chemoradiation, and palliative care. Advanced cases may be treated with surgery like a commando operation.
1. Carcinoma of the oral cavity most commonly arises from the lips, tongue, floor of mouth, cheek and retromolar trigone. Major risk factors include smoking, alcohol, betel nut chewing and HPV infection.
2. Early lesions are typically treated with wide local excision or radiotherapy. More advanced tumors involving surrounding bone or lymph nodes may require surgery such as partial glossectomy or mandibulectomy combined with neck dissection followed by postoperative radiotherapy.
3. Prognosis depends on tumor size, location and extent of spread - tumors of the posterior tongue or those invading surrounding structures carry a worse prognosis.
This document summarizes pathology related to the head and neck region. It discusses various structures like the nose, sinuses, larynx and ears. It describes common inflammatory and infectious conditions like rhinitis, sinusitis, laryngitis and otitis. It also discusses some benign and malignant tumors that can arise in these areas like angiofibroma, papilloma, neuroblastoma and nasopharyngeal carcinoma. It provides images to illustrate normal anatomy and examples of different pathological conditions mentioned in the text like vocal cord nodules, papillomas, leukoplakia and squamous cell carcinoma.
The oral cavity includes the following:
1. The front two thirds of the tongue
2. The gingiva (gums)
3. The buccal mucosa (the lining of the inside of the cheeks)
4. The floor (bottom) of the mouth under the tongue
5. The hard palate (the roof of the mouth)
6. The retromolar trigone (the small area behind the wisdom teeth)
Oral cancer, also called mouth cancer, forms in the oral cavity, which includes all parts of your mouth that you can see if you open wide and look in the mirror. Your lips, gums, tongue, cheeks, roof or floor of the mouth. Oral cancer forms when cells on the lips or in the mouth mutate.
The document discusses tumors of the pharynx, including anatomy, histology, risk factors, types, diagnosis, staging, and treatment. The pharynx is divided into nasopharynx, oropharynx, and hypopharynx. Common pharyngeal cancers include squamous cell carcinoma and nasopharyngeal carcinoma. Risk factors include smoking, alcohol, radiation exposure, and viruses. Diagnosis involves medical history, examination, and imaging tests. Treatment depends on cancer type and stage but may include surgery, radiation therapy, or chemoradiation.
The document discusses tumors of the pharynx, including anatomy, histology, risk factors, types, diagnosis, staging, and treatment. The pharynx is divided into nasopharynx, oropharynx, and hypopharynx. Common pharyngeal cancers include squamous cell carcinoma and nasopharyngeal carcinoma. Risk factors include smoking, alcohol, radiation exposure, and viruses. Diagnosis involves medical history, examination, and imaging tests. Treatment depends on cancer type and stage but may include surgery, radiation therapy, or chemoradiation.
Carcinoma Buccal Mucosa- Anatomy to ManagementDrAyush Garg
This document provides information on carcinoma of the buccal mucosa, including its anatomy, epidemiology, risk factors, clinical features, diagnosis, staging, treatment, and prognosis. Carcinoma of the buccal mucosa is most common in India, Malaysia, and Taiwan, where it affects men more than women. Risk factors include tobacco and betel nut chewing. Treatment depends on the stage, with surgery or radiation typically used for early stages and chemoradiation for advanced stages. Prognosis depends on factors like tumor size and nodal involvement.
oral cavity cancers based on general surgery .pdfsrujankatta
This document summarizes oral cavity tumors. It notes that oral cancers account for 1.5% of malignancies globally and are most common in India. The oral cavity is lined by squamous epithelium and exposed to carcinogens through smoking, alcohol, pan, and gutka use. Premalignant lesions include leukoplakia and erythroplakia. The most common oral cancer is squamous cell carcinoma of the tongue or lips. Diagnosis involves biopsy and imaging. Treatment depends on tumor size and extent but may include surgery, radiation, or chemoradiation. Recurrence and second primary tumors are common due to field cancerization effects from chronic carcinogen exposure.
This document provides an overview of head and neck tumors and principles of neck dissection. It discusses the surgical anatomy and outlines seven levels of regional lymph node groups. Common tumor sites include the oral cavity (oral tongue, lip, floor of mouth), salivary glands, and larynx. Risk factors include tobacco, alcohol, and betel nut chewing. Treatment involves surgery, with or without radiation or chemotherapy depending on tumor stage, size, and lymph node involvement. Reconstruction techniques are discussed for different tumor resection defects. Neck dissection principles and specific management of different tumor sites are also reviewed.
A clinical approach to oral cavity cancers for undergraduate students. An overview of anatomy, precancerous conditions, cancerous lesions and how to examine and approach a patient of Carcinoma oral cavity. An undergraduate can benefit greatly with the content. Even postgraduates can also benefit from the presentation. How to approach a case of Carcinoma oral cavity is comprehensively discussed in this presentation
Similar to Pre-management in Head and Neck Cancers.pptx (20)
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
2. Epidemiology
• As per the GLOBOCON 2020 data, among Head and Neck cancers (HNC):
Gender specific incidence of Head and Cancers:
- MC in males (16.2%)
- 4th MC in females (4.6%)
So, from the figures, it is crystal clear, the overall burden of HNC is very high in India, compared to the world and that of lip and oral cavity cancers
exceeds that of other sites by a much greater margin in India.
*2nd MC cancer after Breast Cancer
**3rd MC cause of cancer related deaths after Breast and cervical cancers
INCIDENCE DEATHS
Worldwide India Worldwide India
Lip and Oral Cavity 3,70,000 1,35,000* 1,70,000 75,000**
Larynx 1,84,000 34,000 99,000 21,000
Nasopharynx 1,33,000 5,600 80,000 4,000
Oropharynx 98,000 20,000 48,000 12,000
Hypopharynx 84,000 28,000 38,000 11,000
Salivary Gland 53,000 7,800 22,000 5,000
3. Risk Factors
• Tobacco consumption (chewing betel/ smoking)
• Most important known risk factor for the development of head and neck
cancer.
• There is some evidence for a genetic predisposition to the carcinogenic
effects of tobacco.
• In addition, tobacco and alcohol consumption appear to have a synergistic
effect.
• Alcohol drinking
• Field Cancerisation
Carcinogens like tobacco and alcohol tend to get exposed to a vast mucosal
area of the UADT. This may induce generation of multiple patches of gentically
altered mucosa, in which, the epithelium has many independent foci of
abnormal tissue. These tissue patches can inturn give rise to potentially
malignant and malignant lesions.
Development of recurrences and 2nd primary tumors in completely treated
cases of HNC (even after LVI/PNI -ve and margin free tumor resection),
corroborates the concept of field cancerisation.
4. • Human Papilloma Virus (HPV) infection:
• Typically in younger men who are non users of tobacco/ alcohol (or have remote smoking
history)
• MC HPV 16, esp. in oropharyngeal cancers arising from the base of tongue and tonsils,
presents with an early stage primary tumor and an advanced stage nodal disease (N2/N3).
• Usually, they tend to haver better OS and DFS (better prognosis). Also, tend to be more
responsive to therapy. But simultaneous use of tobacco decreases survival and treatment
response in HPV-positive HNC patients. The risk of progression/mortality and second primary
with oral squamous cell carcinoma (OSCC) increases by 1% and 1.5%, respectively.
• Methods of detection-
• PCR and ISH of HPV DNA are highly sensitive tests
• The tumor p16 status (detected via IHC) is a recommended surrogate marker for HPV.
• If we look at individual Indian studies,
• Elango et al. and Ramshankar et al. reported a prevalence of 48% and 51.2%, respectively, in oral tongue
cancers.
• Balaram et al. reported a high prevalence of 73.6% in the South
• Prevalence in the North and Northeast ranged from 7 to 29%
• D’Costa et al. reported 15% prevalence in the western region
• 33.6% prevalence in the Eastern region
• The only study from Central India by Gheit et al. reported 27.5% prevalence
• Hepatitis B Virus (HBV) infection:
• least common; primarily responsible for Nasopharyngeal Cancers
5. Grossly, premalignant lesions can present as:
Leukoplakia:
Characterised by hyperkeratosis
Usually a/w underlying epithelial hyperplasia
In absence of underlying dysplasia, probability of malignant changes is <5%
Erythroplakia:
Characterised by red superficial patch adjacent to normal mucosa
Commonly a/w epithelial dysplasia and CA- in situ or invasive CA in up to 40% of
cases
Oral Lichen Planus:
chronic, autoimmune, inflammatory disease which may affect skin, oral mucosa,
genital mucosa, scalp, and nails
most commonly affected areas are in oral cavity are dorsum of the tongue, buccal
mucosa and gingiva.
Malignant transformation ratio has been reported in 0% to 10% of patients
Increased malignant transformation risk occurs greater in erosive and atrophic forms
and in cases of lesions of lateral border of the tongue
Oral submucous fibrosis
chronic and potentially malignant disorder characterized by juxtaepithelial fibrosis of
the oral cavity.
eventually, stiffness of oral mucosa, trismus and an inability to eat develops
strongest risk factor is the chewing of betel quid containing areca nut
Pathology
6. • Majority of tumors arising in Head and Neck (other than non melanoma
skin cancers) arise from the squamous mucosal lining of the UADT (Upper
Aero Digestive Tract). Hence, Squamous Cell Cancers account for 90-95% of
lesions in Head and Neck region, which can further be classified into:
• Well Differentiated
• Moderately Differentiated
• Poorly Differentiated
• Other less common histologies include:
• Verrucous Carcinoma
(a variant of Squamous Cell Carcinoma)
• Adenocarcinoma
• Adenoid cystic carcinoma
• Mucoepidermoid carcinoma
7. Sites of Head and Neck Cancers
• The major sites of HNC are a/w or tend to lie along the UADT:
• Begins: where the skin meets mucosa
of nasal vestibule and vermillion
borders of lip
• Ends: at the level of cricoid, marked by
the junction of cricoid cartilage & trachea
and hypopharynx & esophagus
8. • It includes the following major sites:
• Oral Cavity
• Oropharynx
• Nasopharynx
• Hypopharynx
• Larynx
• Nasal Cavity (along with the paranasal sinuses)
• Salivary Glands
11. Lymph Node Groups
• The head region consists of the following major
Lymph Nodes (LNs):
• Tonsillar (Jugulodiagastric) LNs
• Parotid LNs
• Preauricular LNs
• Postauricular LNs
• Occipital LNs
• The neck region has a level system to describe the location of LNs:
• Level Ia: Submental LNs
• Level Ib: Submandibular LNs
• Level II: Upper Deep cervical/jugular LNs
• Level III: Middle Deep cervical/jugular LNs
• Level IV: Lower Deep cervical/jugular LNs
• Level V: Posterior Triangle group of LNs
• Va: Spinal Accessory LNs
• Vb: Transverse Cervical and Supraclavicular LNs
• Level VI: Pre and Para tracheal
Lindbergh series
Robert Lindbergh had reported on the incidence and topographical distribution of
lymph node metastasis on admission in patients with squamous cell carcinomas of
the major anatomical sites of the upper respiratory and digestive tracts.
We will see these with the respective sites
13. Oral Cavity
• Most common site for Squamous Cell Carcinoma of UADT among HNC
• It extends:
• Anteriorly: Skin Vermillion Junction of lip
• Posteriorly:
• Superiorly: Junc. Of Hard and Soft Palate
• Laterally: Anterior Tonsillar Pillar
• Inferiorly: Line of circumvallate papillae
• The various subsites of Oral Cavity include:
• Mucosal Lips
• Alveolar ridges (Lined by gingiva)
• Hard Palate
• Buccal Mucosa
• Anterior 2/3rd of Tongue: 4 parts – Tip, Lateral Borders, Dorsum,
Under surface
• Floor of Mouth
• Retromolar Trigone (RMT)
14. Lymphatic Drainage
• Lip:
• Level Ia and Level Ib LNs (Neck nodes a
potential site for relapse)
• Nodal involvement rare (<5%at presentation)
• Incidence higher in large, PD, mucosa invading
tumors; those at angle of the mouth, in
recurrent cases
• Remaining Oral Cavity:
• Level Ia, Ib and Level II LNs
• Ds. can SKIP directly to Level III and IV LNs
(Skip LNs)
• Midline tumors may present with B/L
nodal involvement
15. Clinical Presentation
• Tongue:
• Longstanding h/o leukoplakia or erythroplakia
• Infiltrative/ Exophytic lesion
• c/o dysarthria s/o deep ms. involvement
• Remaining subsites:
• Non healing ulcer ± Bleeding
• Mouth pain
• Loosening of teeth/ ill fitting dentures
• Dysphagia/ odynophagia
• Referred otalgia
16. TNM staging of Primary Tumor (T)
• Recent data has shown that primary tumor
depth of invasion (DOI) has a significant
impact on disease outcomes and
compliments the previous criteria used for
T-stage classification. As a result, the new
8th edition of AJJC - TNM staging system
incorporated DOI to reflect this influence on
prognosis.
17. Oropharynx
• It extends:
• Anteriorly: marked
• Superiorly by hard palate- soft palate junction
• Inferiorly by line of circumvallate papilla
• Superiorly: level of superior surface of soft palate
• Posterolaterally: Pharyngeal wall (C2-C3)
• Inferiorly: level of superior surface of hyoid bone
• The various subsites of oropharynx include:
• Soft palate
• Tonsillar Pillars
• Palatine Tonsils
• Base of Tongue
• Lat. And Post. Pharyngeal wall
18. Lymphatic drainage
• 60% cases of Oropharyngeal Carcinomas
present with LN involvement
• Cancers of Base of Tongue, Soft Palate
and posterior pharyngeal wall can
present with B/L nodal involvement as
they are midline structures
• Primarily drainage to Level II, III > IV LNs.
• Tonsillar LNs with Tonsillar Carcinomas
• Retropharyngeal LNs with Tumors of Soft
Palate and Posterior Pharyngeal Wall
19. Clinical Presentation
• Dysphagia
• Pain (Odynophagia or otalgia)
• Snoring
• Hypersalivation and Hot potato (change in) voice (esp. with BoT
tumors)
• Neck Mass
• Especially in pt.’s of HPV+ve oropharyngeal CAs.
• Often cystic in nature
20. TNM staging of Primary
Tumor
• Staging of oropharyngeal cancers now is different for HPV(+) and HPV(-)
cancers, reflecting the different biologic behaviour of these two different
disease entities.
• Mucosal extension to lingual surface of epiglottis from primary tumors of the
base of the tongue and vallecula does not constitute invasion of larynx.
21. Hypopharynx
• It extends:
• Superiorly: Level of Hyoid Bone
• Inferiorly: Level of Cricopharyngeus Muscle
(UES)
• The various subsites of hypopharynx
includes:
• Anteriorly: Post Cricoid region (MUCOSAL
IMORESSION/BULGE INTO HYPOPHARYNX)
and Pyriform Sinus (B/L GUTTERS FORMED
ON EITHER SIDES OF THE POST CRICOID
AREA)
• Posterolaterally: Hypopharyngeal Wall (C4 –
C6)
22. Lymphatic Drainage
• The hypopharynx has an extensive lymphatic
supply.
• The majority of piriform fossae cancers have
nodal involvement at presentation. There is early
spread to Level II, III >> IV LNs, but the drainage
can include all levels including the
supraclavicular nodes.
• The posterior pharyngeal wall drains to the
retropharyngeal nodes (of Ranviour) and deep
cervical lymph nodes (Level II, III, IV >> V).
• The postcricoid region drains to levels III, IV and
VI LNs.
23. Clinical Presentation
• Due to the large volume available to grow, tumours of
hypopharynx tend to present symptomatically at
advanced stages (though nodal staging may be seen at
presentation):
• Difficulty with swallowing
• Difficulty with speech
• Sore Throat
25. Larynx
• It is lined entirely by squamous epithelium, except for the
ventricles and subglottis (lined by respiratory
pseudostratified ciliated columnar epithelium).
• Extends b/w C3 to C6 cervical vertebrae:
• Speriorly: Oropharynx
• Posterolaterally: Hypopharynx
• Inferiorly: Trachea
• The larynx has 3 major subsites:
• Supraglottis
• Glottis
• Subglottis
26. Supraglottis
It contains the following structures:
• Epiglottis
• Aryepiglottic folds
• False Vocal Cords (VC)
• Arytenoid cartilages
Pre-epiglottic Space:
• Lies sup-ant. to the epiglottis
• Has a rich network of lymphatic drainage -
early and (USUALLY) b/l nodal spread to Level
II, III and IV >> VI LNs.
27. Glottis
• It extends upto 1 cm below the True VC
• It is marked by the following structures:
• Anterior Commisure
• True Vocal cords
• Posterior Commisure
• Ventricle (space b/w the VC)
• Routes of Spread:
• No definite lymphatic drainage – regional LN
involvement is less common
• Paraglottic Space
• Allows (Transglottic) spread of tumors from glottis to
supra/subglottis and vice versa
28. Subglottis
• Extends from 1cm below the True VC to level of inferior aspect of
cricoid cartilage
• Lymphatic Drainage
• Level III, IV and VI LNs
• Tumors are rare; usually present with transglottic spread of
supraglottic tumors
29. Clinical Presentation:
• The first symptom in more than 90% of patients with true glottic
cancer is hoarseness. Loss of laryngeal crepitus.
• Advanced tumours of the vocal cords may narrow the airway,
especially if a vocal cord is paralysed, leading to stridor.
• Hoarseness is less common as a symptom for early supraglottic
cancer - complain initially of either a sore throat or a foreignbody-like
sensation
• Hoarseness only develops when the tumour reaches the vocal cord.
More advanced tumours may have pain referred to the ear (BY VAGUS
NERVE AND IT’S AURICULAR BRANCH (N. OF ARNOLD)) and patients
may occasionally cough up blood (haemoptysis).
31. Nasopharynx
• Extends:
• Anteriorly: Posterior choana of the nasal cavity
• Superiorly: Base of Skull formed by the Sphenoid
bone (above which, lies the sphenoid sinus)
• Posteriorly: Tissue of the prevertebral fascia
adjacent to C1 and C2 cervical vertebrae in
continuation with the posterior pharyngeal wall
• Laterally: Pharyngobasilar fascia – contains 2
important structures –
• Opening of Eustachian Tube
• Fossa of Rossenmuller
• Inferiorly: Level of superior surface of soft palate
32. Routes of Spread:
• Rich lymphatic supply – therefore, commonly spread and,
indeed, present with neck nodes (70% to 90% of cases have
nodes at some point).
• Levels Ia and Ib are rarely involved
• Levels II to V can be considered the first echelon nodes for this
tumour site.
• Can spread to Retropharyngeal LNs too.
• Nasopharyngeal cancers have a high propensity for distal
haematogenous spread and, as a consequence, distal failure.
Clinical Presentation:
• The first presenting symptom is often painless node
enlargement confirmed on examination typically involving the
posterior cervical chain (Level V LNs).
• Other common symptoms:
• nasal obstruction and epistaxis through expansion into the nasal
cavity; Sore Throat
• auditory disturbances, especially unilateral deafness and recurrent
otitis media (d/t blockage of Eustachian tube).
33. TNM staging of Primary
Tumor & Regional LNs and
Group Staging
34. Nasal Cavity (and paranasal sinuses)
Nasal Cavity
• The normal lining of nasal cavity is
pseudostratified ciliated columnar epithelium
except for the vestibule lined by squamous
epithelium (containing sweat and sebaceous
glands)
• It extends:
• Superiorly: Cribriform plate of the ethmoidal bone
with olfactory apparatus
• Inferiorly: Hard palate
• Anteriorly: Nasal bones and cartilage
• Posteriorly: Posterior choana
• Laterally: marked by 3 bony turbinates
• Superiorly: medial wall of ethmoid sinus
• Inferiorly: medial wall of maxillary sinus
• Medially: Nasal Septum
35. Lymphatic drainage:
• Lymphatic drainage of the nasal cavity can be
divided into 2 pathways:
• Primarily, it drains via the nasopharynx to
retropharyngeal and Level II LNs
• Lower anterior portion (nasal vestibule) drains to
Level Ib, Level II and preauricular (parotid) LNs
• Paranasal sinuses has either no or very sparse
capillary lymphatics
Clinical Presentation:
• Epistaxis
• Nasal obstruction
• Mass protruding from nostril
• Facial and/or head pain may be seen in later
stages, due to pressure or tumor infiltration
into nerves or periosteum
36. Paranasal Sinuses
• They are lined by pseudostratified
ciliated columnar epithelium
• 4 in number: Maxillary Sinus,
Ethmoidal sinus (anterior, middle and
posterior group), Frontal sinus,
Sphenoid sinus
Lymphatic drainage:
• Overall, the sinuses have sparse
lymphatic drainage (typically towards
retropharyngeal and Level II LNs). As a
result, these tumors can become
quite large without LN involvement.
38. Salivary Glands
• These include:
• Major Salivary Glands:
• Parotid gland
• Submandibular gland
• Sublingual gland
• Minor Salivary Glands
• Histologically, the most common type
of benign salivary gland tumor is
pleomorphic adenoma, which
comprises approximately half of all
salivary tumors. Other rarer benign
salivary gland tumors include Warthin
tumor, basal cell adenoma, and
canalicular adenoma.
• The most common malignant salivary
gland tumors are mucoepidermoid
carcinoma and adenoid cystic
carcinoma, which together comprise
approximately one-half of all malignant
salivary gland tumors.
39. • Lymphatic Drainage:
• Parotid glands – Parotid LNs >> Level I, II and III LNs
• Submandibular glands – Level Ib LNs and perivascular LNs >> Level II and III
LNs
• Sublingual glands – Level Ia and Ib LNs
• Minor salivary glands (in the oropharynx) – Retropharyngeal LNs
• Clinical presentation
• Major salivary glands: Painless mass/swelling ± sign/symptoms of adjacent
nerve involvement
• Minor salivary glands: Depends upon the location –
• Oral cavity: Painless submucosal mass or mucosal ulceration
• Nasal Cavity/ Paranasal sinuses: Nasal obstruction/ congestion, vision changes
• Nasopharynx: Invasion of skull base, intracranial extension, CN involvement
41. Nodal staging for HNC under the 8th edition of
AJCC TNM Staging System
• There are 3 variations:
• Specific for HPV +ve Oropharyngeal CA
• Specific for Nasopharyngeal CA
• Common for CA of rest of the sites (Oral Cavity, Nasal Cavity,
Hypopharynx and Larynx) & HPV –ve Oropharyngeal Cancers
• There is a clinical staging system (pre-operative staging or for patients
undergoing non-surgical therapy) and a pathologic post op staging system (for
individuals undergoing neck dissection as part of their management).
45. Diagnosis and Staging Evaluation
• All pts. of suspected HNC should be assessed via a thorough history and
physical examination-
• History:
• Disease and pt. related information
• Detailed h/o habits and addictions
• Medical and family history, including any prior malignancy
• Co-morbidities
• Clinical Examination:
• Performance and nutritional status
• Physical Examination
• Inspection
• Palpation
46. Investigations:
• Baseline Investigations:
• Blood Investigations:
• CBC: Gives a baseline idea about the marrow functioning
• LFT: If deranged, can give an idea about any liver metastasis
• KFT: Check renal status of the pt., especially for chemotherapy purposes
• Blood Sugar: To get an idea about the glycaemic status of the pt.
• CXR:
• Done as part of the initial metastatic work up to exclude any pulmonary metastasis or
synchronous lung primary (seen in 2-5% cases of HNC, as they too are tobacco related)
• To see for aspirational changes the pt. might have as a result of their symptomatic
burden
• Radio-imaging of primary tumor site:
• CE-CT/MRI Face and Neck
47. Other Investigations:
• USG W/A:
• Done as part of metastatic work up to r/o any abdominal metastasis (especially for liver
secondaries)
• GFR:
• Tells about the renal status of the pt. in terms of clearance
• PTA:
• To check for the baseline status of hearing of the pt. for chemotherapeutic clearance
• Cardiological assessment
48. Dental Examination:
• RT for HNC often have treatment volume involve the mandible and salivary
glands.
• Throughout and after RT, pt. develop xerostomia (despite parotid sparing
approaches) - Increased risk for tooth decay and other dental problems
• Hence the need for full dental assessment and clearance before RT (a
minimum of 2 weeks prior) to get any dental problems removed
• Dental extraction
• Ensure dentures are well fitting
• Risk of dental problems post RT, especially osteoradionecrosis of mandible
are increased when RT is given after dental procedures
49. Dietary Consultation:
• HNC pts. are at increased risk of malnourishment before their diagnosis
• Excessive alcohol intake
• Impaired swallowing, mouth opening, oral discomfort
• Success of any radical treatment will be compromised by inadequate
nutrition – increased morbidity.
• Hence the need for dietary assessment
• Increase calorie intake
• Need for enteral feeding
• Before treatment
• Following reconstructive surgery
• Overcome s/e of oral mucositis, glossitis or dysphagia during acute phase of radical RT
• Need for regular dietary assessment
• Throughout the course of RT – ongoing wt. loss a negative prognostic factor
• During f/u period until parenteral nutrition no longer required and patients have
returned to sufficient oral intake and proven maintained weight.
50. Laryngoscopy (Indirect/ Direct/ Flexible):
• Allows direct visualisation of lesions beyond the oral cavity
• Examine for
• Mucosal irregularities in pharynx and larynx
• Vocal cord mobility (MI), anatomical asymmetries
• Pooling of secretions, bleeding
• Histological diagnosis:
• FNAC:
• For initial tissue diagnosis of HNC from cervical lymphadenopathy,
especially in pts. of unknown primary tumours (Diagnostic accuracy of 89-98%)
• If initial FNA is –ve, repeat FNA before an excisional biopsy from a suspicious
neck node
• US guided FNAC – overall accuracy comparable to neck CT – better detect
malignancy in radiologically –ve but clinically suspicious LNs
• Biopsy:
• For definitive histopathological confirmation, which may be direct or USG/CT
guided
51. Imaging studies (CT, MRI, PET/CT):
• Important for assessing:
• Degree of local infiltration/ extent
of primary lesion
• Involvement of regional lymph nodes Tumour staging
• Presence of distant metastases
or second primary tumours
• Assessment of operability
• Radiotherapy treatment planning
• Imaging is done with contrast, unless contraindicated.
• To achieve complete evaluation of the primary and any nodal disease, CT or
MRI of the neck should image the anatomy from the skull base to the
thoracic inlet (nape of neck).
52. CT
• Compared to MRI
• Better spatial resolution
• Better at evaluating bone (cortical) invasion
• Faster to perform
• Upstaging of HNC that have deeper local
invasion/infiltration into adjacent structures
• Dual energy/ multispectral CT have increased
specificity at evaluation of cartilage invasion (70% to
96%) with no compromise in sensitivity (86% vs 86%)
• Both CT and MRI are complementary to clinical
examination for staging of neck LNs, based on
• Size criteria (>10mm)
• Appearance (presence of central necrosis)
53. MRI:
• Provides superior soft tissue definition over CT Scan and tends to be better
at detecting bone marrow and cartilage invasion
• MRI is preferred over CT for the following conditions:
• Oral cavity cancer, like CA Tongue or if there is a need to evaluate the extent of bone
marrow invasion or in patients with extensive dental amalgam that may obscure the
anatomy on CT
• Nasopharyngeal cancer, to assess skull base invasion and cranial nerve involvement
• Sinonasal cancer, to evaluate skull base or intracranial or orbital invasion, and to
differentiate tumor from obstructed sinuses
• Any head and neck cancer with cranial nerve symptoms or if radiographic perineural
tumor spread is a possibility
• But, overall, in most studies, CT outperforms MRI in detection of nodal
metastasis with a sensitivity of MRI as low as 57-67% (as well as in terms of
logistic issues of long waiting and and cost too)
54. PET/CT:
• As sensitive & specific as CT and MRI in detecting primary tumours of HNC
but superior to both in detecting regional nodal metastasis, distant
metastasis and 2nd primary tumours, thereby improving TNM staging of
primary tumors (and subsequent management)
• Especially useful in pts. presenting with cervical LAD with unknown primary
(sensitivity of 97%). Actually, if imaging fails to reveal an obvious primary,
PET/CT should be ordered before EUA, biopsies, and tonsillectomy, to help
identify potential primary sites before any intervention occurs.
• Sensitivity is lower for pts. with clinically negative neck nodes, due to
inability to detect nodal metastasis <5mm in size.
• Beneficial for restaging of HNC after chemoradiation. –ve findings may
accurately determine early disease response, making further surgical
intervention unnecessary.
55. NCCN FOLLOW-UP RECOMMENDATIONS for HNC 2021
(based on risk of relapse, second primaries, treatment sequelae, and toxicities)
- H&P exam (including a complete head and neck exam; and mirror and fiberoptic
examination):
• Year 1, every 1–3 mo
• Year 2, every 2–6 mo
• Years 3–5, every 4–8 mo
• >5 years, every 12 mo
- Thyroid-stimulating hormone (TSH) every 6–12 mths if neck irradiated.
- Dental evaluation for oral cavity and sites exposed to significant intraoral radiation
treatment.
- Consider EBV DNA monitoring for nasopharyngeal cancer
- Supportive care and rehabilitation:
• Speech/hearing and swallowing evaluation and rehabilitation as clinically indicated.
• Nutritional evaluation and rehabilitation as clinically indicated until nutritional status is
stabilized.
• Smoking cessation and alcohol counselling as clinically indicated.
56. - Imaging (baseline):
- Short term (<6mths f/u)
- Obtain CT and/or MRI within 3–4 months after definitive treatment for patients with locoregionally
advanced disease or with altered anatomy causing challenging physical exam assessment, in order to
establish a new baseline for future comparisons.
- The optimal timing of PET scans after radiation treatment appears to be at the 3- to 6-month
window. A negative PET at this time point predicts improved overall survival at 2 years. Early FDG
PET/CT scans before 12 weeks are associated with significant false-positive rates and should be
avoided in the absence of signs of recurrence or progression.
- In a study involving patients receiving definitive RT-based treatment with N2–N3 nodal disease, FDG
PET/CT surveillance approach led to fewer neck dissections and considerable cost savings compared
to a routine approach of planned post-treatment neck dissection.
- Long term (≥6mths to 5yrs f/u)
- CT, MRI, and PET/CT all have unique advantages and disadvantages when used as surveillance
imaging. There is evidence that FDG PET/CT may be the most sensitive of these modalities. A 12-
month PET has been shown to reveal recurrent or second primary cancers in approximately 10% of
treated patients; a 24-month FDG PET/CT imaging revealed these findings in approximately 5% of
treated cases. Most cases of asymptomatic FDG PET/CT lesion localization occur at distant sites.
Whether earlier detection leads to improved disease-specific survival is not established.
- If an FDG PET/CT at 3 months post-treatment is negative, there are no data to support substantial
benefit for further routine imaging in an asymptomatic patient with negative exam.
57. Prognostic Discussion
• Age and tumour staging are considered the most important prognostic
factors for overall survival.
• Recurrence and second primary tumours are influenced negatively by
high alcohol consumption and cigarette smoking.
• Clinical characteristics remain the best known prognostic factors in
HNC.
• A major effort in HNC prevention and modification of patients'
behaviour could lead to early diagnosis and reduction of recurrence
and second primary tumours.
• This topic will be further explored in the next class on HNC.