Anatomy, diagnosis, and work-up of head and neck cancers - CHUV, UNIL Pr. Christian Simon Service d'Oto-Rhino-Laryngologie - OncologyPRO
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Anatomy, diagnosis,
and work-up of head
and neck cancers
Pr. Christian Simon
Service d’Oto-Rhino-Laryngologie
CHUV, UNIL
DISCLOSURE:
- PFIZER: TRIAL STEERING COMMITTEE
- MERCK: CONSULTANT
2
Diagnostic measures Pan-endoscopy: 1) Histopathology: >90% squamous cell carcinoma 2) Extension of the primary tumor 3) Presence of secondary tumors
Pan-endoscopy
Risk of secondary primaries
Gan et al. Cancer 2013
Imaging CT, MRI, US, PET 1) Extension of the disease 2) Lymph node metastases 3) Distant metastases: Lung, liver, bone
Oral cavity cancers
Anatomy of the oral cavity: General
Anatomy of the oral cavity: Blood
supply
Symptoms: Oral cavity cancer
• Dysphagia
High likelihood
• Pain
• Odynophagia
• Fetor
• Otalgia
• Trismus
• Adenopathy
Low likelihood
Cummings 2005Histological types of oral cavity
cancers
• Squamous cell carcinomas
• Adenocarcinomas
• Lymphomas
– T-cell lymphomas
– Non-Hodgkin Lymphomas
• Kaposi’s sarcomaPresentation: Oral cavity cancer
Work-up for oral cavity cancers
Cancers of the pharynx
Anatomy: Pharynx
Exposure of the parapharyngeal
spaceHypopharynx and piriforme sinus
Nasopharyngeal Cancer
Histology types and etiology of
nasopharyngeal cancers
• Histological subtypes:
– Keratinising (associated
with HPV)
– Non-keratinising
(differentiated or
undifferentiated;
associated with EBV)
– Basaloid (no association
known)
Chua et al. Lancet 2016Symptoms: Nasopharynx cancer
• Neck mass
High likelihood
• Blood in saliva
• Deafness
• Epistaxis
• Nasal obstruction
• Tinnitus
• Cranial nerve palsy
Low likelihood
Cummings 2005Presentation
Work-up for nasopharyngeal
carcinomasOropharyngeal Cancer
Histological types of oropharyngeal
malignancies
• Malignant epithelial tumors
– Squamous cell carcinoma
– Lympho-epithelial carcinoma
• Salivary gland tumors
– Salivary gland carcinomas
• Adenoid cystic carcinoma etc.
• Myoepithelial carcinoma
• Soft tissue tumors
• Hemato-lymphoid tumors
• Mucosal malignant melanoma
• Secondary tumorsSymptoms: Oropharynx cancer
High likelihood
• Neck mass
• Dysphagia
• Odynophagia
• Otalgia
• Oral bleeding
Low likelihood
Cummings 2005Presentation
Work-up for oropharyngeal
carcinomasHypopharyngeal cancer
Symptoms: Hypopharynx cancer
• Dysphagia
High likelihood
• Neck mass
• Sore throat
• Hoarseness
• Otalgia
• Shortness of breath
• Hemoptysis
Low likelihood
Hoffmann et al. Laryngoscope 1997Histological types of
hypopharyngeal malignancies
• Squamous cell carcinomas
• Lympho-epithelial carcinomas
• Lymphomas
– T-cell lymphomas
– Non-Hodgkin Lymphomas
• Adenocarcinomas
• Soft tissue tumors
• Secondary tumors (i.e. thyroid cancer by direct
infiltration)Presentation: Hypopharynx
Work-up for hypopharyngeal
carcinomasLaryngeal cancer
Laryngeal anatomy
Symptoms: Laryngeal cancer
• Hoarseness
High likelihood
• Dysphagia
• Neck mass
• Sore throat
• Otalgia
• Stridor
• Adenopathy
Low likelihood
Cummings 2005Histological types of laryngeal
malignancies
• Squamous cell carcinomas
• Lympho-epithelial carcinomas
• Malignant salivary gland tumors (i.e. Adenocarcinomas)
• Lymphomas
– T-cell lymphomas
– Non-Hodgkin Lymphomas
• Neuroendocrine tumors
• Soft tissue tumors
• Secondary tumors (i.e. thyroid cancer by direct
infiltration)Presentation: Laryngeal cancer
Work-up for laryngeal carcinomas
Thank you for your attention
Traitement: Radiothérapie +/-
chimiothérapie
40La classification de la maladie par le système TNM aide
à déterminer
1) Le pronostic 2) Le traitement
stade précoce Chirurgie ou
Radiothérapie
Chirurgie et
stade avancé Radiothérapie
ou
Radio et chimiothérapieHistoire de la maladie • Femme âgée de 55 ans • odynophagie et dysphagie depuis 4,5 semaines, non- répondantes aux antibiotiques • Tabagisme de 40 PA • Consommation quotidienne d’une bouteille de vin depuis 10-15 ans
La panendoscopie montre une tumeur de 4,5 cm dans la région
amygdalienne gauche. L’examen histopathologique
révèle un carcinome épidermoïdeLa région amygdalienne fait partie de
l’oropharynxL’imagerie révèle une tumeur
amygdalienne gaucheL’imagerie révèle des métastases
ganglionnaires bilatéralesTraitement
stade précoce Chirurgie ou
Radiothérapie
Chirurgie et
Radiothérapie
stade avancé ou
Radio et chimiothérapieFemme âgée de 55 ans avec un Femme âgée de 36 ans avec un cancer de l’amygdale gauche cancer de la base de la langue
Histoire de la maladie • Femme âgée de 36 ans • odynophagie et dysphagie depuis 5 semaines, non- répondantes aux antibiotiques • Non-fumeuse, l’alcool à l'occasion • changement fréquent de partenaire
La panendoscopie montre une tumeur de 3 cm à la base de la
langue du côté gauche. L’examen histopathologique
révèle un carcinome épidermoïdeL’imagerie révèle une tumeur de la base de la langue du côté gauche
Treatment
stade précoce Chirurgie ou
Radiothérapie
Chirurgie et
Radiothérapie
stade avancé ou
Radio et chimiothérapieLe traitement local cherche à éviter le traumatisme causé par l’accès chirurgical: La chirurgie robotique au système « DaVinci »
Installation
Le traitement local cherche à éviter le traumatisme
causé par l’accès chirurgical: La chirurgie robotique au
système « DaVinci »The treatment of head and neck
cancer patients comprises …
Diagnostic
Re-education
and follow-up
TreatmentReconstruction of a tongue
Physiology • Swallowing • Speech • Respiration • Immune system
Epidemiology Northern Europe: Finland, Iceland, Norway United Kingdom and Ireland: England, Northern Ireland, Republic of Ireland, Scotland, Wales Central Europe: Austria, Belgium, France, Germany, Switzerland, The Netherlands Eastern Europe: Bulgaria, Czech Republic, Estonia, Latvia, Lithuania, Poland, Slovakia Southern Europe: Croatia, Italy, Malta, Portugal, Slovenia, Spain
Epidemiology
Epidemiology: Countries with high
incidence of nasopharyngeal
cancer
Age standardized incidence rates
(ASIR):
A) For men
B) For women
Countries with highest ASIR:
- China
- Hong Kong
- Singapore
- Malaysia
- AlgeriaEtiology and risk factors of
oropharyngeal carcinomas
• Tobacco: 20 cig./day 3.1 fold increased risk
for OPC, reduction of risk down to 1.2 10 years
after quitting smoking (Ansary et al., 2009)
• Alcohol: 36 fold increased risk for OPC in
heavy drinkers and heavy smokers (Ansary et
al., 2009)
• Ethnicity: Increased risk in African-Americans
in the US (Lambert et al., 2011)Etiology and risk factors of
oropharyngeal carcinomas
• HPV:
– 20-25% HPV-positivity in HNSCC-patients
(D´Souza et al, 2007)
– 40%-80% of OPCs positive for HPV (Miller et al.,
2012)
– Associated mostly with HPV16 (Gillison, 2006)
– Sexually transmitted disease (Gillison, 2006)Epidemiology
of oroparyngeal cancer
• Incidence of
oropharyngeal cancer
(OPC) in the US is
2.2/100.000 in 2009
(SEER 2013)
• Early stage OPC between
16.5% and 26% of all
OPCs (Carvalho 2005)Epidemiology: HPV and
oropharyngeal cancer (US)
• Population level
incidence /100.000 of
HPV positive OPC
increased from 0,8
(1988) to 2,6 (2004)
corresponding to an
increase of 225%
• Incidence of HPV
negative OPC declined
by 50%
Chaturvedi et al. JCO 2011HPV positive oropharyngeal
cancers have a better prognosis
Ang et al. New Engl J Med 2010Etiology of hypopharyngeal cancer
• Alcohol consumption (more important)
• Tobacco
• Plummer-Vinson syndrome (postcricoid
cancer)
Cummings 2005You can also read
