Dr. Szekanecz ÉvaHead and Neck CancerHead and Neck Cancer
Eva Szekanecz M.D., Ph.D.2014.
CANCERS OF THE HEAD AND NECKCANCERS OF THE HEAD AND NECK
MAY ARISE FROM ANY OF THE LINING MAY ARISE FROM ANY OF THE LINING MEMBRANES OF THE UPPER MEMBRANES OF THE UPPER AERODIGESTIVE TRACTAERODIGESTIVE TRACT
~2% of all malignancies~2% of all malignancies number of cases grow continously in certain ages number of cases grow continously in certain ages
and populationand population mortality increasesmortality increases diagnosed in more diagnosed in more advanced stages advanced stages ( bad QoL) ( bad QoL) not ‘enough’ therapeutic modalitiesnot ‘enough’ therapeutic modalities male dominancy 3:1 (?)male dominancy 3:1 (?)
ETIOLOGYETIOLOGY
SPIRITSSPIRITSSMOKING SMOKING („pack year of tobacco smoking”)(„pack year of tobacco smoking”)
poor social standingpoor social standingspicy / hot foodspicy / hot foodoral higiene (stomatological status)oral higiene (stomatological status)viruses (EBV)viruses (EBV)activity (wood, tobacco)activity (wood, tobacco)ageage and sexand sex
PROGNOSTIC FACTORSPROGNOSTIC FACTORS
smoking habits and alcohol smoking habits and alcohol ( and other continued exposure of carcinogens)( and other continued exposure of carcinogens)
sex and agesex and age localisationlocalisation and histologic type and histologic type extent extent of the mucosal lesionof the mucosal lesion importance of importance of TNMTNM factors factors histologic grade (cellular differentiation)histologic grade (cellular differentiation) averall health parameters of the patient averall health parameters of the patient
(performance status, comorbidity)(performance status, comorbidity)
LOCALISATIONLOCALISATION
1. oral cavity1. oral cavity
2. pharynx2. pharynx
3. larynx3. larynx
LOCALISATION 2.LOCALISATION 2.
4.4. salivary glandssalivary glands
nasal cavity and paranasal sinuses nasal cavity and paranasal sinuses
external and middle earexternal and middle ear
6.6. unknown primaryunknown primary
(8. thyroid gland)(8. thyroid gland)
HISTOLOGYHISTOLOGY
CARCINOMACARCINOMA (more than 90%) (more than 90%)
basaliomabasalioma lymphoepitheliomalymphoepithelioma lymphomaslymphomas metastatic tumorsmetastatic tumors melanomamelanoma sarcomasarcoma
SYMPTOMSSYMPTOMS
functional and aesthetic disorders according functional and aesthetic disorders according to location:to location: breathing, swallowing, breathing, swallowing, vocalisation, haemoptysisvocalisation, haemoptysis
painpain weight lossweight loss metastatic sitesmetastatic sites
- regional: cervical lymph nodes- regional: cervical lymph nodes- distant: lungs, liver, mediastinal lymph - distant: lungs, liver, mediastinal lymph
nodes, (skeletal bones)nodes, (skeletal bones)
CLINICAL STAGINGCLINICAL STAGING anamnestic findingsanamnestic findings performance status performance status physical examination physical examination blood tests blood tests imaging techniquesimaging techniques
x -ray, ultrasonography, CT, MRIx -ray, ultrasonography, CT, MRI biopsiesbiopsies bone scansbone scans PET scanPET scan
TREATMENTTREATMENT
COMBINED ONCOTHERAPY COMBINED ONCOTHERAPY always always INDIVIDUAL treatment planningINDIVIDUAL treatment planning organ preserving variations in earlier stages, organ preserving variations in earlier stages,
less in advanced stages less in advanced stages
↕↕ablasticity!ablasticity!
aim: organ preserving, function sparing methods organ preserving, function sparing methods with good QoL and aesthetic resultswith good QoL and aesthetic results
1111
COMBINATION ONKOTHERAPY !COMBINATION ONKOTHERAPY !
ChemoChemo-- palliativepalliative-- neoadjuvantneoadjuvant-- adjuvantadjuvant
IrradiationIrradiation-- palliativepalliative-- definitivedefinitive-- preoperativepreoperative-- postoperativepostoperative
CHEMOTHERAPYCHEMOTHERAPY
1st cytotoxic attempts 30 years ago… (MTX?)1st cytotoxic attempts 30 years ago… (MTX?) i.v. administration i.v. administration
PLATINUMPLATINUM / DDP, CBP // DDP, CBP /5, FLUOROURACIL5, FLUOROURACILTAXANESTAXANESEGFR INHIBITORSEGFR INHIBITORS
TARGETED THERAPYTARGETED THERAPY
BIOLOGICAL TREATMENTBIOLOGICAL TREATMENT
Cetuximab Cetuximab – –
Under the age of 70 ysUnder the age of 70 ys
IRRADIATIONIRRADIATION
(osteoradionecrosis…)(osteoradionecrosis…)
-- definitive definitive
-- preoperativepreoperative
-- postoperativepostoperative
-- pallativepallative
EXTERNAL BEAM EXTERNAL BEAM RTRT
BRACHYTHERAPYBRACHYTHERAPY
SURGERYSURGERY
(laser, cryo) excision with directly closing suture excision with closing flap techniques T1-2N0M0 : T1-2N0M0 : T3-4N+:T3-4N+:
PARTIAL ~
RADICAL ~
NECK DISSECTIONNECK DISSECTION (FND, RND, etc.)
palliative surgery, tracheotomy
SURVIVALSURVIVAL
OS doesn’t increase despite OS doesn’t increase despite
the developement of the developement of
oncotherapyoncotherapy
↑↑locoregionally advanced tumors locoregionally advanced tumors
are diagnosed in most of the casesare diagnosed in most of the cases
• the patients has less tolerability to more radical and/or the patients has less tolerability to more radical and/or combined treatment modalitiescombined treatment modalities
• less than 50% of patients are suitable for combined less than 50% of patients are suitable for combined RT+ chemoRT+ chemo
FOLLOW UPFOLLOW UP
1st year1st year every 2 monthsevery 2 months 2nd year2nd year every 3 monthsevery 3 months 3rd-5th year3rd-5th year every 6 monthsevery 6 months over 5 ysover 5 ys as it necessary or once a yearas it necessary or once a year
ORAL CAVITY, PHARYNX AND ORAL CAVITY, PHARYNX AND LARYNXLARYNX
rapid infiltration because of the lack of barriers in the rapid infiltration because of the lack of barriers in the soft tissuessoft tissues
~90% differenciated squamous cell carcinoma~90% differenciated squamous cell carcinoma
lymphatic metast. soon ( rich lymphatic network) -lymphatic metast. soon ( rich lymphatic network) -
no specific symptoms (pain, bleeding,weight loss), no specific symptoms (pain, bleeding,weight loss),
MAJOR SALIVARY GLANDSMAJOR SALIVARY GLANDS 80% parotid tumours /facial nerve!/ 80% parotid tumours /facial nerve!/
- from those 20% malignant - from those 20% malignant
symptoms: pain, asymetric face movement, problems : pain, asymetric face movement, problems of salivation, xerostomy, fixed tumor, facial nerve of salivation, xerostomy, fixed tumor, facial nerve palsypalsy
recurrence can occur even over 5 years !!! recurrence can occur even over 5 years !!!
SINONASAL TUMORSSINONASAL TUMORS rare tumors, most - originated from the maxillary sinus rare tumors, most - originated from the maxillary sinus
in the 7th decade (never under 40 ys) in the 7th decade (never under 40 ys)
symptoms: facial asymmetry, pain, smelling disfunction: facial asymmetry, pain, smelling disfunction
poor prognosis (bone arrosion, mutilating surgery)poor prognosis (bone arrosion, mutilating surgery)
EXTERNAL AND MIDDLE EAREXTERNAL AND MIDDLE EAR
rare, painful tumors (1st: pinna, 2 nd: external tube)
mostly: basaliomas, melanomas and carcinomas
symptoms: pain, bleeding, hearing disorder, tinnitus, otorrhea
TUMORS OF UNKNOWN PRIMARYTUMORS OF UNKNOWN PRIMARY
signs of the metastasis point to the primary signs of the metastasis point to the primary localisationlocalisation
histological heterogenity histological heterogenity
poor prognosis (survival:3-5 months)poor prognosis (survival:3-5 months)
CLINICAL INVESTIGATION HAS TO BE CLINICAL INVESTIGATION HAS TO BE COMPLETED BEFORE ANY TREATMENT!COMPLETED BEFORE ANY TREATMENT!
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