Head and Neck Cancers Clinical PresentationHead and Neck Cancers James P. Neifeld, MD VCU School of...
Transcript of Head and Neck Cancers Clinical PresentationHead and Neck Cancers James P. Neifeld, MD VCU School of...
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Head and Neck Cancers
James P. Neifeld, MDVCU School of Medicine
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Background
The oral cavity is the most accessible area to inspection, but the most neglected in the physical examination.
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Head and Neck Cancers
SkinMucosaSalivary glandsBoneSoft tissues
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Clinical Presentation
Sore mouthSore throatLump in the throatDifficulty swallowingHoarsenessDifficulty breathingLump in the neck
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History
Symptom(s)– duration
SmokingDrinkingFamily history
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Physical examination
InspectionPalpationIndirect laryngoscopy– fiberoptic laryngscopy
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Preoperative EvaluationHistoryPhysical– Indirect laryngoscopy– Pelvic and rectal exam
Chest x-rayPanendoscopy and biopsyCT (±)MR (±)PET (±)
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Management Involves a TeamSurgeonRadiation OncologistPlastic SurgeonMedical OncologistDentistOral SurgeonProsthodonistSpeech Therapist
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Management of Head and Neck Tumors
Objectives are to:1. Control the tumor2. Provide cosmetic and functional
rehabilitation
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Risk of Oral Cancer According to Presence or Absence of Smoking and Alcohol Consumption
5.711.23YES
1.531.00NO
YESNO
Smoking
Alcohol
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New Cancers and Deaths
40012007002400Other600110024004700Tongue600140020006300Pharynx
800110044004800Oral Cavity
800300024007100LarynxFMFM
DeathsNew CancersSite
ACS, 2003 50
Treatment
SurgeryRadiationChemotherapySurgery + radiationSurgery + radiation + chemotherapyRadiation + chemotherapyOther
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Survival rate of patients with head and neck cancer
182045Pharynx
10558095Larynx
10407090Oral
265680Tongue
T4T3T2T1site
% survival
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Relative Survival Rates (5 year) (%)
3070Larynx2040Pharynx
3060Floor of Mouth
2050Tongue
3055Nose, nasal cavities
5590LipRegionalLocalized
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Oro-pharyngeal Cancer
5% of all malignancies90% are epidermoidcancer60% will develop neck node metastasisTreatment:– stage I – II: surgery or
radiation– stage III – IV: surgery
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Trends in Cancer Survival: Relative 5-year Survival rate (%)
565353Oral cavity
646766Larynx
1992-19981983-19851974-1976site
ACS, 2003
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Conclusion
Early diagnosisCaused by tobacco / alcoholHigh incidence of second primariesTreat aggressivelySTOP SMOKING
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Future Outlook
Earlier diagnosisImproved imagingCombined modality treatmentSTOP SMOKING