Head neck malignancy

On every Wednesday The department of Otolaryngology & Head neck surgery of Sylhet MAG Osmani Medical College Does Case presentation session by Students and doctors.
this was done by the 5th year medical students (52nd MBBS,F batch 2013-14 session)

1. Welcome to clinical presentation

2. - Department of Otolaryngology and Head Neck Surgery SYLHET MAG OSMANI MEDICAL COLLEGE & HOSPITAL

3. Our today’s topic Head & neck malignancies

4. Presented on behalf of F batch (52 nd batch ) by Taufiq Hasan Shourav Md Ajgar Hossain Tanjina Yeasmin Eva Sazia Sultana Sumi

5. Anatomy of the neck

6. What is neck ? The neck is the external aspect of part of the body that connect the head and trunk .

7. Extension of neck It is limited above by the lower border of the body of mandible, a line extending from the angle of mandible to the mastoid process, superior nuchal line and external occipital protuberance .

8. Its lower limit is formed from before backwards by the suprasternal notch of manubrium sterni, upper surface of the clavicle, acromian process of the scapula and a line extending horizontally from the latter to the 7 th cervical spine.

9. Boundaries of the neck-

10. Superficial structures of the neck includes- The skin Superficial fascia with platysma muscle Superficial veins and nerves Investing layer of deep cervical fascia

11. Deep structures of the neck Glands- Thyroid gland,parathyroid glands,major salivary glands Viscera- cervical part of the oesophagus & trachea. Nerves- last four cranial nerves.

12. Continued… Blood vessels- Carotid sheaths & its contents. Lymphatics-Lymphatics of head and neck. Muscles- Strap muscles.

13. Transverse section of neck

14. The Triangles of Neck The neck is subdivided into two large triangles by sternocleidomastoid muscle. The triangles are- Anterior triangle & Posterior triangle.

15. The use of the divisions described as the triangles of the neck permit the effective communication of the location of palpable masses located in the neck between healthcare professionals

16. Anterior triangle

17. Posterior triangle Reference-Grays anatomy

18. Neck nodes

19. There are approximately 150 lymph nodes in the neck region. The main function of lymph node is to produce lymphocytes which are the important component of immune system .

20. Classification of lymph nodes according to levels- Level-1 : Submental (1A) Submandibular (1B) Level-2 : Upper jugular Level-3 : Mid jugular Level-4 : Lower jugular Level-5 : Posterior cervical

21. Continued… Level-6 : Prelaryngeal Pretracheal Paratracheal Level-7 : Nodes of upper mediastinum.

22. Levels of Lymph Nodes

23. Level-1 1A- Submental nodes : Lies in the submental triangle between right & left bellies of digastric muscles and the hyoid bone. 1B- Submandibular nodes : Lies between anterior & posterior bellies of digastric muscle and the lower border of the body of mandible.

24. Level-2 Located along the upper third of jugular vein between the skull base above and the level of lower border of hyoid bone (or bifurcation of carotid artery) below.

25. Level-3 They are located along the middle third of jugular vein from the level of hyoid bone above and the level of lower border of cricoid cartilage (or where omohyoid muscle crosses the jugular vein) below.

26. Level-4 They are located along the lower third of jugular vein; from lower border of cricoid cartilage to the clavicle.

27. Level-5 They are located in the posterior triangle; between posterior border of sternocleidomastoid anteriorly, anterior border of trapezius posteriorly & the clavicle below.

28. Level-6 Located between the medial borders of sternocleidomastoid muscles (or carotid sheaths) on each side, hyoid bone above & suprasternal notch below.

29. Level-7 Located below the suprasternal notch and include nodes of upper mediastinum.

30. Throat Throat is the visceral part of the neck. Which includes- 1. Larynx 2. Pharynx 3. Cervical part of trachea & oesophagus.

31. Hemisection of head-neck region

32. Larynx Larynx is situated in the midline of the neck at meeting of the digestive and respiratory passages. It lies in front of the laryngopharynx from the level of the 3 rd to 6 th cervical vertebrae.

33. Parts of larynx 1. Supraglottic 2. Glottic 3. Subglottic.

34. Pharynx The pharynx is a musculofascial half cylinder that links the oral and nasal cavities in the head to the larynx and oesophagus in the neck.

35. Extension It extends from the base of the skull to the level of the 6 th cervical vertebrae at the lower border of cricoid cartilage.

36. Parts of pharynx 1. Nasopharynx 2. Oropharynx 3. Hypopharynx.

37. Name of Head & Neck Malignancies Epithelial origin Squamous cell carcinoma Basal cell carcinoma

38. Neuroectodermal origin Olfactory neuroblastoma Malignant melanoma Neuroendocrine cancer Merkel’s cancer.

39. Mesenchymal origin Lymphoma Angiosarcoma Osteosarcoma Chondrosarcoma

40. Continued… Nerve sheath tumor Leiomyosarcoma Rhabdomyosarcoma Liposarcoma Fibrosarcoma

41. Salivary gland tumors Mucoepidermoid carcinoma Adenocarcinoma Lymphoma Sarcoma

42. Thyroid Malignancy 1. Papillary carcinoma (>85%) 2. Follicular carcinoma (5-15%) 3. Medullary carcinoma (5%) 4. Anaplastic carcinoma. (<5%)

43. Aetiology of Head & Neck Cancer Betel nut Tobacco- Cigarettes ,Smokeless tobacco, Marijuana 3) Alcohol 4)dental factors 5) occupational exposure 6)Infection-HPV, HIV,HSV,EBV

44. Continued… 6)Nutritional factors 7)inflammatory- Gastro-esophageal reflux disease. -Precancer( Leukoplakia & Erythroplakia) 8)Genetic & immunologic predisposition

45. Prevention Screening Reducing Risk Factors Chemoprevention

46. Some common head and neck cancer symptoms include- A lump in the nose, neck or throat A persistent sore throat Trouble swallowing (dysphagia) Unexplained weight loss

47. Continued.. Frequent coughing Change in voice or hoarseness Otalgia or trouble hearing Headache.

48. “ Measure Twice , Cut Once”

49. Assessment History Examination of the primary sites Examination of the neck Fine Needle Aspiration Cytology (FNAC) General Examination

50. Continued… Radiology Computed tomography Magnetic Resonance Positron Emission Tomography Endoscopy Pathology

51. Grading based on differentiation Grade Histopathological grading GX Grade of differentiation can not be assessed G1 Well differentiated G2 Moderately differentiated G3 Poorly differentiated G4 Undifferentiated

52. Staging Staging is the process of subdivision of cases of cancer into groups in which the behavior may be similar.

53. Benefits of staging An aid to planning therapy. Indication of prognosis. Comparison of results of treatment. Facilitate exchange of information between treatment centres .

54. TNM system T- means size of primary tumour N-means involvement of lymph nodes M-means metastasis present or not

55. “ A picture is worth a thousand words ” -attributed by Frederick R Barnard

56. Imaging Imaging is routinely required at the time of presentation for diagnostic and staging purposes.

57. Imaging includes- Plain films Contrast studies (Fluoroscopy) Ultrasound Computed tomography

58. Continued… Magnetic resonance imaging Magnetic resonance angiography Nuclear medicine Positron emission tomography

59. Ultrasound of neck CT Scan of Neck

60. PET scan MRI of neck

61. “ We recognize only what we see, we see only what we know”

62. Pathological evaluation FNAC Biopsy FNAB

63. Treatment of head neck malignancies Surgery Radiotherapy Chemotherapy Combined treatment 5. Supportive treatment.

64. THANK YOU