03. Head and Neck Cancers
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Transcript of 03. Head and Neck Cancers
Head & Neck Cancers
Prof. Igor Y. Galaychuk, MDChief, Department of Oncology
and RadiologyTernopil State Medical University
Epidemiology. In Ukraine every year:
Lip cancer >2000 pts. Cancer of oral cavity
4500 pts. Larynx cancer 3000 pts.
Thyroid cancer >2000 pts.
Died: Lip cancer 400 pts.
52% within year 38% within year
400 pts.
Oral cavity and pharynx: 28,260 – New Cases; 7230 – DeathsTongue: 7320 1700
Larynx: 10,270 3830
USA2004
25.6%23.2%37.3%
Etiology and risk factors
Tobacco Alcohol Insolation Work factors (out of doors) Viruses (EBV, Herpes 1, Papilloma
viruses) Diet (Vit. А, -carotene, -токоферол)
Cancer of the vermilion surface
TNM Classification of Lip & Oral Cavity Cancers
Тis – carcinoma in situ T1 – tumour less than 2 cm T2 – 2-4 cm in greatest dimension T3 – > 4 cm T4 – tumour invades bone, muscle,
skin N0, N1 <3 cm, N2= 3-6 cm, N3 >6
cm M0, М1
Lower Lip Cancer, Т4N0M0
Precancerous lesions:
Leukoplakia (<5% transformation) Erythroplakia (40%) Hyperkeratosis Papilloma
Hyperkeratosis of lip
Hyperkeratosis: triangle lip biopsy and vermilionectomy
Lower Lip Cancer, T2N0M0
Rectangular resection of lip with reconstruction
Treatment modalities for Lip Cancers:
Surgery: rectangular resection (Т1-Т4), vermilionectomy (Тis), crio (Тis)
X-ray therapy (Тis, N1-2) Gamma-ray therapy (Т3-Т4) Chemotherapy (при ІІІ-ІV ст.): 5-FU,
Cisplatin regional lymph node dissection (N1-
3)
Tongue Cancer
Localization: lateral borders – 60%,radix – 20-27%, tip – 3%, dorsal surface – 7%.
Clinical presentation: nodular tumor, ulcer tumor, inflammatory type
Precancerous lesions: leukoplakia, papilloma, ulcers, fissure, glossitis
Papilloma of Tongue
Tongue cancer: hemiresection
Cancer of Tongue: 5-year survival
І st. – 80% ІІ st. – 60% ІІІ-ІV st. – 15-35% Lymph node metastases decrease
survival on 50%.
Cancer of Oral Cavity – Floor of Mouth
Regression of cancer after gamma-ray therapy
Lymphatic drainage
Levels of lymphatic drainage
Submandibular lymph node dissection
Neck lymph node Mts
Superficial neck lymph node dissection
Extensive lymph node dissection (Crile oper.)
Thyroid cancer
Thyroid cancer: etiology and risk factors
Irradiation (papillary CA), Iodine deficiency (follicular CA) Goiter (anaplastic CA) Multiple endocrine neoplasia MEN-
2A, MEN-2B (medullary CA)
Histology of Thyroid Cancers
Papillary carcinoma (50%) – from А-cells
Follicular CA (30%) – from А-cells Hurthle cell carcinoma – from В-cells
Medullary carcinoma (5-10%) – С-cells
Anaplastic (undifferentiated) CA (5%)
Diagnostics:
USD – 7,5 МГц Scintigraphy: J-131 (“cold” node), Tc-99m (“hot” node) FNA Biopsy Laryngoscopy CТ, MRI Calcitonin in plasma (Medullary
cancer)
TNM Classification (2002)
Т1 < 2 cm T2 2-4 cm T3 > 4 cm T4 t-r invades soft tissues of neck,
larynx, trachea, oesophagus, rec.laryng. nerve.
N0, N1a, N1b (bilateral lymph.nodes) M0, M1
Thyroid carcinomas: staging
Thyroid CA (papillary-follicular), <45 yr.Stage І : T any N any M0Stage ІІ: T any N any M1
Thyr.CA (papil./follic.+medullary) > 45 yr.:
Stage: І, ІІ, ІІІ, ІV
Thyr.CA anaplastic – all cancers are IV st.
Thyroid Cancer, T4 st.
After thyroidectomy
Laryngeal cancer.Anatomy of Larynx
Direct laryngoscopy:normal (1); fibroma (2)
12
Polyp of vocal cord
Laryngeal carcinoma (1), (2)
1 2
TNM Classification of Laryngeal Carcinoma (glottis part)
Т1 – t-r limited to vocal cords with normal mobility
Т2 – t-r extends to supraglottis or subglottis with impaired v/cord mobility
Т3 - t-r limited to larynx with vocal cord fixation Т4 - t-r invades through the thyroid cartilage or
soft tissues of neck
N1 л/в <3 cm, N2 3-6 cm, N3 >6 cm. M0, M1
Partial resection of larynx
Laryngeal carcinoma with neck infiltration
Larynx (surgical specimen)
RL
Tracheostomy after laryngectomy
Rehabilitation: voice prosthesis
Дякую за увагу! Thanks!