anatomy, diagnosis, and work-up of head and neck cancers...anatomy, diagnosis, and work-up of head...

Anatomy, diagnosis, and work-up of head

and neck cancers

Pr. Christian Simon

Service d’Oto-Rhino-Laryngologie

CHUV, UNIL

2

DISCLOSURE:

- PFIZER: TRIAL STEERING COMMITTEE- MERCK: CONSULTANT

Diagnostic measures

Pan-endoscopy:

1) Histopathology: >90% squamous cell carcinoma

2) Extension of the primary tumor

3) Presence of secondary tumors

Pan-endoscopy

Rigid oesophagoscopy

Video removed for online publication

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

Histological types and symptoms of oral cavity cancers

• Squamous cell carcinomas

• Adenocarcinomas

• Lymphomas

– T-cell lymphomas

– Non-Hodgkin Lymphomas

• Kaposi’s sarcoma

• Dysphagia

• Pain

• Odynophagia

• Fetor

• Otalgia

• Trismus

• Adenopathy

High likelihood

Low likelihood

Cummings 2005

Work-up for oral cavity cancers

Presentation: Oral cavity cancer

Reconstruction of a tongue

Cancers of the pharynx

Anatomy: Pharynx

Exposure of the parapharyngealspace

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Hypopharynx and piriform sinus

Nasopharyngeal Cancer

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

- Algeria

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 2016

Symptoms: Nasopharynx cancer

• Neck mass

• Blood in saliva

• Deafness

• Epistaxis

• Nasal obstruction

• Tinnitus

• Cranial nerve palsy

High likelihood

Low likelihood

Cummings 2005

Presentation and work-up

Oropharyngeal Cancer

Histological types and symptoms 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 tumors

• Neck mass

• Dysphagia

• Odynophagia

• Otalgia

• Oral bleeding

High likelihood

Low likelihood

Cummings 2005

Work-up for oropharyngealcarcinomas

History of present illness• 55 year old female

patient

• Sore throat and dysphagia since 4,5 weeks mainly on the left side, does not respond to antibiotics

• Smoking history of 40 package years

• Drinks one bottle of wine a day since 10-15 years

Panendoscopy: Reveals a 4,5 cm lesion in the left tonsillar region, histology is consistent with squamous

cell carcioma

The tonsillar region belongs to the oropharynx

Imaging: Reveals a tonsillar tumor on the left side

Imaging: Reveals bilateral lymph node metastasis

Cases55 year old female patient with a tonsillar cancer

36 year old female patient with a base-of-tongue cancer

History of present illness

• 36 year old female patient

• Sore throat and dysphagia since 5 weeks mainly on the left side, does not respond to antibiotics

• Never smoked, occasional alcohol

This patient has an HPV+ tumor

Panendoscopy: Reveals a 3 cm lesion in the left base-of-tongue, histology is consistent with

squamous cell carcioma

Imaging: Reveals a left base-of-tongue cancer …

Hypopharyngeal cancer

Histologies and symptoms: Hypopharynx cancer

• Dysphagia

• Neck mass

• Sore throat

• Hoarseness

• Otalgia

• Shortness of breath

• Hemoptysis

High likelihood

Low likelihood

Hoffmann et al. Laryngoscope 1997

• 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 and work-up: Hypopharynx

Laryngeal cancer

Laryngeal anatomy

Histologies and symptoms: Laryngeal cancer

• Hoarseness

• Dysphagia

• Neck mass

• Sore throat

• Otalgia

• Stridor

• Adenopathy

High likelihood

Low likelihood

Cummings 2005

• 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