Head and Neck cancer for medical student.ppt

Head and Neck cancer for medical student.ppt

2. What is head and neck
cancer?
Head and Neck
Cancer is a
group of
cancers that
includes
tumors in
several areas
above the
collar bone.

3. Head and Neck Cancer has
three major subdivisions:
•Oral Cancer
•Laryngeal Cancer
•Nasopharyngeal Cancer .

5. Lips, inside lining of the lips & cheeks, the teeth, the gums, the
front 2/3 of the tongue, the floor of the mouth below the
tongue, the bony roof of the mouth (hard palate), & area behind
the wisdom teeth.

6. • Cancer that occurs in the . . .
• Mouth
• Lip
• Tongue
• Floor of the mouth
• Sulcus
• Hard palate
• Tonsils
• 90% squamous cell

7. •Tobacco is the main culprit
–Mainly chewing tobacco
–75% those diagnosed tobacco users
–Cumulative damage

8. •Alcohol 2
nd
largest risk factor
•Alcohol tobacco use

9. •Excessive sun exposure
Lip cancer
•Irritation: Long-term irritation  poorly
fitting dentures

10. •Poor nutrition:
fruits & vegetables <<  risk
•Mouthwash: with a high alcohol content

11. •Immune system suppression
•Age: > 35  risk
•Gender: men 2X > women

12. •X-rays
Cumulative exposure
•Other biological factors
–Fungus
–Viruses HPV 16
•Main agent in ca cervic
•Linked to oral cancer

13. •a sore in the mouth that does
not heal (most common
symptom)
•pain in the mouth that doesn't
go away (also very common)
•a persistent lump or thickening
in the cheek

14. •a persistent white or red patch on
the gums, tongue, tonsil, or lining
of the mouth
•a sore throat or a feeling that
something is caught in the throat
that doesn't go away

15. •Oral sores that last more than 2 weeks
–Found on cheek, tongue, floor of mouth, or lip
•Types of oral cancer sores
Leukoplakia : is a white area
Dysplasia

16. •Lump or mass
•Difficulty swallowing, speaking or chewing
•Numbness in oral or facial region
Erythroplakia : is a slightly raised, red
area that bleeds

17. Site of Oral cavity Cancer
•Tongue (35%)
•Floor of mouth (30%)
•Lower alveolus (15%)
•Buccal mucosa (10%)
•Upper alveolus/hard palate (8%)
•Retromolar (2%)
•Lips(lower 93%, upper 5%, commissure
2%)

18. •Head and neck exam should be a
routine part of medical check-up
•Take a history of alcohol and
tobacco use
•Follow up on suspicious signs

19. •Biopsy
–Normally performed by surgeon
–Lab pathologist determines abnormal stage
•Staging: Panoramic photo, thorax, USG
liver, or CT/MRI/PET Scan

20. UICC/AJCC STAGING SYSTEM FOR ORAL
CANCER 2002
Primary Tumor
(T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor 2 cm or less in greatest dimension
T2 Tumor more than 2 cm but not more than 4 cm in greatest
dimension
T3 Tumor more than 4 cm in greatest dimension
T4a (lip) Tumor invades through cortical bone, inferior alveolar nerve,
floor
of mouth, or skin (chin or nose)
T4a (oral cavity) Tumor invades through cortical bone, into deep /
extrinsic
muscle of tongue (genioglossus, hyoglossus, palatoglossus and
styloglossus), maxillary sinus, or skin of face
T4b (lip and oral cavity) Tumor invades masticator space, pterygoid
plates,
or skull base, or encases internal carotid artery

21. Regional Lymph Nodes
(N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest
dimension
N2 Metastasis in a single ipsilateral lymph node, more than 3 cm but not
more than
6 cm in greatest dimension; or in multiple ipsilateral lymph nodes,
none more
than 6 cm in greatest dimension; or in bilateral or contralateral lymph
nodes,
non more than 6 cm in greatest dimension
N2a Metastasis in single ipsilateral lymph node more than 3 cm but not
more than 6 cm in greatest dimension
N2b Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in
greatest dimension
N2c Metastasis in bilateral or contralateral lymph nodes, none more than 6
cm in greatest dimension
N3 Metastasis in a lymph node more than 6 cm in greatest dimension
Distant Metastasis
(M)
MX Presence of distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis

22. Stage Grouping
Stage 0TisN0M0
Stage IT1N0M0
Stage IIT2N0M0
Stage III T1, T2 N1M0
T3N0, N1 M0
Stage IV A T1, T2, T3N2M0
T4aN0, N1, N2M0
Stage IV B Any TN3M0
T4b Any N M0
Stage IV C Any TAny N M1

23. Treatments
•Multidisciplinary treatment is ideal
•Surgery
–Most common with radiation
–General health of mouth is analyzed and affects
treatment
•Chemotherapy
–Sometimes added to decrease possibility of distant
micro-metastasis
–Loss of taste and smell
•Removal of portion of mandible
–Severe cases
–Facial reconstruction is needed
–Later assistance needed with speech and chewing

24. Cancer of Tongue

28. Cancer Of Cheek after tobacco quid habit

29. Cancer of buccal mucosa after tobacco habit going
extra-orally

30. CANCER STARTING FROM BUCCAL VESTIBULE
FOLLOWING HABIT OF PAN WITH TOBACCO

31. Cancer of labial mucosa after tobacco quid habit

32. Same patient with Cancer Of Gums

33. CANCER OF GUMS FOLLOWING EATING OF GUTKA

34. Alveolar cancer after tobacco quid habit

35. Relapsed cancer in upper jaw in July 04

37. This patient of SMF has so much of limitation in opening of mouth that it is difficult to put
even 2 fingers in the mouth