common tumours of the head and neck - jeeve kanagalingam tumours... · oral cavity tumours largely...
TRANSCRIPT
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Common tumours of
the head and neck Jeeve Kanagalingam
MA, FRCS (ORL-HNS), FAMS
Assistant Professor
Lee Kong Chian School of Medicine
Consultant ENT / Head & Neck Surgeon
Tan Tock Seng Hospital
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Head and Neck Cancer
Global Burden
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Head and Neck Cancer
Personal Burden
Dysfunction
Death Pain
Deformity Poverty
Social Isolation
Malnutrition
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Aetiology
Smoking
Alcohol
Betel nut
Viruses
Epstein-Barr (EBV)
Human papilloma (HPV)
Hard wood
Other chemicals Video
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Tumour types
Most common tumour type is squamous cell carcinoma
In the nasopharynx, undifferentiated carcinoma is the commonest sub-type and most radiosensitive
Salivary gland tumours are the most varied
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Tumour subsites
(Relevant to CMF surgery)
Oral cavity tumours
Tumours of the upper jaw (sinus and anterior
skullbase)
Skin cancers
Oropharyngeal cancer
Temporal bone (ear) cancer
Nasopharyngeal cancer
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Oral cavity tumours
Largely SCC
Smoking, Spirits, Betel
Nut, Sharp Teeth,
Syphilis and (Spices)
Highly debilitating –
affects speech and
swallowing
Aggressive
Increasing in young non-
smokers and non-
drinkers
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Oral cavity tumours
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Tumours of the upper jaw
(Sinus and anterior skullbase)
Ohngren’s Line
Present late as symptoms
are few
Carcinogens implicated
e.g. hardwood -
adenocarcinoma
5 year survival - - 63%,
local control rate - 57%
Histology matters:
Adenocarcinoma (78%),
SCC (60%), SNUC(40%)
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Tumours of the upper jaw
(Sinus and anterior skullbase)
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Skin cancers
May be indolent (BCC)
or aggressive
(Melanoma)
Tendency to recur
Bony erosion and
perineural spread pose
surgical challenges
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Skin cancers
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Skin cancers
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Skin cancers
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Oropharyngeal cancer
Better chemoradiation
has reduced the cases
treated primarily by
surgery
Transoral robotic surgery
(TORS) may potentially
reverse this trend
At present, surgery is
often for salvage
HPV+ve tumours are
highly radiosensitive
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HPV in Sweden
Incidence of tonsil cancer from 1970 to 2002 has increased 2.8-fold (2.6 in men and 3.5 in women)
During the same period, a significant increase in the proportion of HPV-positive tonsillar cancer cases was observed
Hammarstedt L, et al. Int J Cancer. 2006 Dec 1;119(11):2620-3
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HPV in Sweden
Formed in 1970
People need love, 1972
Take a Chance on Me, 1977
Gimme! Gimme! Gimme! (A
Man After Midnight),1979
Lay All Your Love on Me,
1981
One of us (has HPV), 1981
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Oropharyngeal cancer
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Temporal bone (ear) cancer
Usually SCC
Secondary to a
chronically discharging
ear
Skin cancer arising from
the pinna
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Temporal bone (ear) cancer
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Nasopharyngeal cancer
Endemic in Southeast Asia
Genetic, viral and dietary aetiology
Symptoms: Neck mass - 56%; Blood stained sputum - 35.6%; Deafness - 26.3%; Nose bleed - 22 %; Double vision- 8%
RT for early stage and ChemoRT for late stage
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Paradigms in head and neck cancer
Multidisciplinary care and multi-modality
therapy
Diagnostics: findings best unfound
Elective treatment
Evidence-based medicine and Osler’s dictum
Beyond survival: QOL
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QOL: Beyond survival
Peter Rhys-Evans: “John, I think we should take
you to theatre and tie off the bleeding point”
John Diamond (scribbles): “What’s the bleeding point…”
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Thank you