head and neck cancers clinical presentationhead and neck cancers james p. neifeld, md vcu school of...
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Head and Neck Cancers
James P. Neifeld, MDVCU School of Medicine
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Background
The oral cavity is the most accessible area to inspection, but the most neglected in the physical examination.
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Head and Neck Cancers
SkinMucosaSalivary glandsBoneSoft tissues
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Clinical Presentation
Sore mouthSore throatLump in the throatDifficulty swallowingHoarsenessDifficulty breathingLump in the neck
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History
Symptom(s)– duration
SmokingDrinkingFamily history
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Physical examination
InspectionPalpationIndirect laryngoscopy– fiberoptic laryngscopy
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Preoperative EvaluationHistoryPhysical– Indirect laryngoscopy– Pelvic and rectal exam
Chest x-rayPanendoscopy and biopsyCT (±)MR (±)PET (±)
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Management Involves a TeamSurgeonRadiation OncologistPlastic SurgeonMedical OncologistDentistOral SurgeonProsthodonistSpeech Therapist
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Management of Head and Neck Tumors
Objectives are to:1. Control the tumor2. Provide cosmetic and functional
rehabilitation
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Risk of Oral Cancer According to Presence or Absence of Smoking and Alcohol Consumption
5.711.23YES
1.531.00NO
YESNO
Smoking
Alcohol
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New Cancers and Deaths
40012007002400Other600110024004700Tongue600140020006300Pharynx
800110044004800Oral Cavity
800300024007100LarynxFMFM
DeathsNew CancersSite
ACS, 2003 50
Treatment
SurgeryRadiationChemotherapySurgery + radiationSurgery + radiation + chemotherapyRadiation + chemotherapyOther
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Survival rate of patients with head and neck cancer
182045Pharynx
10558095Larynx
10407090Oral
265680Tongue
T4T3T2T1site
% survival
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Relative Survival Rates (5 year) (%)
3070Larynx2040Pharynx
3060Floor of Mouth
2050Tongue
3055Nose, nasal cavities
5590LipRegionalLocalized
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Oro-pharyngeal Cancer
5% of all malignancies90% are epidermoidcancer60% will develop neck node metastasisTreatment:– stage I – II: surgery or
radiation– stage III – IV: surgery
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Trends in Cancer Survival: Relative 5-year Survival rate (%)
565353Oral cavity
646766Larynx
1992-19981983-19851974-1976site
ACS, 2003
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Conclusion
Early diagnosisCaused by tobacco / alcoholHigh incidence of second primariesTreat aggressivelySTOP SMOKING
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Future Outlook
Earlier diagnosisImproved imagingCombined modality treatmentSTOP SMOKING