Oral cavityOral cavity

The majority of tumors in the The majority of tumors in the oral cavity are s.c.c.oral cavity are s.c.c.

Oral TongueOral Tongue

• Posterior limit=>circumvallate Posterior limit=>circumvallate papillaepapillae

• Tumors of the tongue begin in the Tumors of the tongue begin in the stratified epithelium of the surfacestratified epithelium of the surface

PresentationPresentation

• Ulcerated massUlcerated mass

• Oxophytic massOxophytic mass

• Regional lymphatics=>Submandibular Regional lymphatics=>Submandibular space+Upper cervical lymph nodesspace+Upper cervical lymph nodes

• Lingual n.&Hypoglossal n.Lingual n.&Hypoglossal n.

• Lateral of the tongue and ventral Lateral of the tongue and ventral surfacesurface

Others tumors of tongueOthers tumors of tongue

• LeiomyomasLeiomyomas

• LeiomyosarcmaLeiomyosarcma

• RhabdomyosarcomaRhabdomyosarcoma

• NeurofibromaNeurofibroma

TreatmentTreatment

• Wide local excisionWide local excision

• Carbon dioxide laserCarbon dioxide laser

• Partial glossectomyPartial glossectomy

• Modify radical neck dissectionModify radical neck dissection

• Selective neck dissectionSelective neck dissection

Salivary Gland TumorsSalivary Gland Tumors

• UncommonUncommon

• <2%head&neck neoplasm<2%head&neck neoplasm

• Major salivary Major salivary gland=>Parotid,Submandibular,Sublingland=>Parotid,Submandibular,Sublingualgual

• Minor salivary glands=>throughout Minor salivary glands=>throughout the submucosa of upper aerodigestive the submucosa of upper aerodigestive tract(highest density within the palatetract(highest density within the palate

• 85%of salivary gland neoplasm arise 85%of salivary gland neoplasm arise in the parotidin the parotid

• The majority are benignThe majority are benign

• The most common histology is mixed The most common histology is mixed tumor(pleomorphic adenoma)tumor(pleomorphic adenoma)

• 50% of tumors of 50% of tumors of submandibular&sublingual are submandibular&sublingual are malignantmalignant

MetastasisMetastasis

• HistologyHistology

• Primary sitePrimary site

• Stage of the tumorStage of the tumor

Metastasis toMetastasis to::

• Parotid=>intra-and periglanular Parotid=>intra-and periglanular node&upper jugular nodesnode&upper jugular nodes

• Submandibular=>prevascular facial Submandibular=>prevascular facial L.N.&submental L.N.&upper and mid-L.N.&submental L.N.&upper and mid-jugularL.N.jugularL.N.

Risk of metastasisRisk of metastasis

• High gradeHigh grade

• Perineural invasionPerineural invasion

• Extraglandular spreadExtraglandular spread

• Advanced ageAdvanced age

Diagnosis evaluationDiagnosis evaluation

• MRIMRI

• FNA(70-80%)FNA(70-80%)

• EpithelialEpithelial

• NonepithelialNonepithelial

• MetastaticMetastatic

Benign epithelial tumorsBenign epithelial tumors

• Pleomorphic adenoma (80%)Pleomorphic adenoma (80%)

• Monomorphic adenomaMonomorphic adenoma

• warthin`s tumorwarthin`s tumor

• OncocytomaOncocytoma

• sebaceoussebaceous

Nonepithelial lesionsNonepithelial lesions

• HemangiomaHemangioma

• Neural sheath tumorsNeural sheath tumors

• lipomalipoma

TreatmentTreatment of benign of benign neoplasnneoplasn

• Surgical excision of affected gland Surgical excision of affected gland (superficial parotiectomy)(superficial parotiectomy)

Malignant epithelial tumorsMalignant epithelial tumors• Low grade to high gradeLow grade to high grade

• The most common malignant The most common malignant epithelial of s.g. is mucoepidermoid epithelial of s.g. is mucoepidermoid ca.ca.

• Adenoid cystic ca.(1.neural invasion Adenoid cystic ca.(1.neural invasion 2.22.2ndnd most common 3.high incidence most common 3.high incidence of distal metastasis 4.the most of distal metastasis 4.the most common malignancy for minor s.g.common malignancy for minor s.g.

• Malignant mixed tumor (high grade)Malignant mixed tumor (high grade)

TreatmentTreatment

• Surgical excisionSurgical excision

• Postoperative radiation therapyPostoperative radiation therapy

Indication for radiation Indication for radiation therapytherapy

• Extraglandular diseaseExtraglandular disease

• Perineural invasionPerineural invasion

• Direct invasion of regional structuresDirect invasion of regional structures

• Regional metastasisRegional metastasis

• High grade histologyHigh grade histology

Hypopharynx & cervical Hypopharynx & cervical esophagusesophagus

• S.C.C. (advanced stage)S.C.C. (advanced stage)

Clinical findingsClinical findings

• Neck massNeck mass• Muffled or hoarse voiceMuffled or hoarse voice• Referred otalgiaReferred otalgia• Dysphagia (common symptom-solid Dysphagia (common symptom-solid

to liquid)to liquid)• Weight lossWeight loss• Vocal cord paresis or paralysis (direct Vocal cord paresis or paralysis (direct

invasion of larynx)invasion of larynx)• Airway compromiseAirway compromise

Work upWork up

• Flexible fiberoptic laryngoscopy Flexible fiberoptic laryngoscopy (extent of tumor)(extent of tumor)

• Barium swallowBarium swallow

• CT,MRICT,MRI

L.N. metastasisL.N. metastasis

• Bilateral metastatic adenopathy in Bilateral metastatic adenopathy in the paratracheal chain is commonthe paratracheal chain is common

• ¾ of patients have L.N. metastasis at ¾ of patients have L.N. metastasis at the time of diagnosisthe time of diagnosis

Poor prognosisPoor prognosis

TreatmentTreatment

• Definitive radiation therapy for Definitive radiation therapy for smaller T1 –T2 tumorssmaller T1 –T2 tumors

• Surgery + postoperative radiation for Surgery + postoperative radiation for advanced tumorsadvanced tumors

Cervical esophagusCervical esophagus

• SurgerySurgery

• Chemotherapy + external beam Chemotherapy + external beam radiotherapyradiotherapy

• 5-years survival rate < 20%5-years survival rate < 20%

LarynxLarynx

• SmokingSmoking

• Prolonged hoarse voiceProlonged hoarse voice

AnatomyAnatomy

• SupraglotticSupraglottic

• GlotticGlottic

• SubglotticSubglottic

Tumors of LarynxTumors of Larynx

• S.C.C.S.C.C.

• Neuroendocrine originNeuroendocrine origin

• Squamous papillomaSquamous papilloma

• Granular cell T.Granular cell T.

• Tumor of salivary originTumor of salivary origin

Tumors of laryngeal Tumors of laryngeal frameworkframework

• Synovial sarcomaSynovial sarcoma

• ChondromaChondroma

• ChondrosarcomaChondrosarcoma

Symptoms of Supraglottic TSymptoms of Supraglottic T..

• Chronic sore throatChronic sore throat

• Dysphonia(Hot potato voice)Dysphonia(Hot potato voice)

• Neck mass(L.N. metastasis)Neck mass(L.N. metastasis)

• Vocal cord fixationVocal cord fixation

• Muffled voiceMuffled voice

• Reffered otalgiaReffered otalgia

• OdynophagiaOdynophagia

• Airway compromise(bulky T.)Airway compromise(bulky T.)

Symptoms of glottic TSymptoms of glottic T..

• HoarsnessHoarsness

• Airway Obstruction(late)Airway Obstruction(late)

Symptoms of subglottic TSymptoms of subglottic T..

• RareRare

• Laryngeal paralysis (unilateral)Laryngeal paralysis (unilateral)

• StridorStridor

• painpain

Vascular lesionVascular lesion

• HemangiomaHemangioma

• Vascular malformationVascular malformation

HemangiomaHemangioma

• Infancy & childhoodInfancy & childhood• 30% present at birth30% present at birth• ProliferateProliferate• 40% resolve completely40% resolve completely• Surgery =>1.for those that have not Surgery =>1.for those that have not

significantly involuted by 3-4 years of significantly involuted by 3-4 years of age 2.severe functional problem age 2.severe functional problem (periorbital) 3.cosmetic problem (periorbital) 3.cosmetic problem (nasal tip) (nasal tip)

• Laser (4-6 weeks)Laser (4-6 weeks)

• Systemic steroidSystemic steroid

EvaluationEvaluation

• CTCT

• MRIMRI

• Fiberoptic endoscopyFiberoptic endoscopy

• Direct laryngoscopy (general Direct laryngoscopy (general anesthesia)anesthesia)

• EsophagoscopyEsophagoscopy

• bronchoscopybronchoscopy

TreatmentTreatment

• Small involvement: Small involvement: 1.laser ablation 1.laser ablation 2.conservative surgery 2.conservative surgery

• Advance: Advance: 1.partial laryngectomy 1.partial laryngectomy 2.total laryngectomy 2.total laryngectomy

• radiotherapyradiotherapy