Download - 03. Head and Neck Cancers
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Head & Neck Cancers
Prof. Igor Y. Galaychuk, MDChief, Department of Oncology
and RadiologyTernopil State Medical University
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Epidemiology. In Ukraine every year:
Lip cancer >2000 pts. Cancer of oral cavity
4500 pts. Larynx cancer 3000 pts.
Thyroid cancer >2000 pts.
Died: Lip cancer 400 pts.
52% within year 38% within year
400 pts.
Oral cavity and pharynx: 28,260 – New Cases; 7230 – DeathsTongue: 7320 1700
Larynx: 10,270 3830
USA2004
25.6%23.2%37.3%
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Etiology and risk factors
Tobacco Alcohol Insolation Work factors (out of doors) Viruses (EBV, Herpes 1, Papilloma
viruses) Diet (Vit. А, -carotene, -токоферол)
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Cancer of the vermilion surface
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TNM Classification of Lip & Oral Cavity Cancers
Тis – carcinoma in situ T1 – tumour less than 2 cm T2 – 2-4 cm in greatest dimension T3 – > 4 cm T4 – tumour invades bone, muscle,
skin N0, N1 <3 cm, N2= 3-6 cm, N3 >6
cm M0, М1
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Lower Lip Cancer, Т4N0M0
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Precancerous lesions:
Leukoplakia (<5% transformation) Erythroplakia (40%) Hyperkeratosis Papilloma
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Hyperkeratosis of lip
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Hyperkeratosis: triangle lip biopsy and vermilionectomy
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Lower Lip Cancer, T2N0M0
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Rectangular resection of lip with reconstruction
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Treatment modalities for Lip Cancers:
Surgery: rectangular resection (Т1-Т4), vermilionectomy (Тis), crio (Тis)
X-ray therapy (Тis, N1-2) Gamma-ray therapy (Т3-Т4) Chemotherapy (при ІІІ-ІV ст.): 5-FU,
Cisplatin regional lymph node dissection (N1-
3)
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Tongue Cancer
Localization: lateral borders – 60%,radix – 20-27%, tip – 3%, dorsal surface – 7%.
Clinical presentation: nodular tumor, ulcer tumor, inflammatory type
Precancerous lesions: leukoplakia, papilloma, ulcers, fissure, glossitis
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Papilloma of Tongue
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Tongue cancer: hemiresection
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Cancer of Tongue: 5-year survival
І st. – 80% ІІ st. – 60% ІІІ-ІV st. – 15-35% Lymph node metastases decrease
survival on 50%.
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Cancer of Oral Cavity – Floor of Mouth
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Regression of cancer after gamma-ray therapy
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Lymphatic drainage
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Levels of lymphatic drainage
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Submandibular lymph node dissection
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Neck lymph node Mts
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Superficial neck lymph node dissection
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Extensive lymph node dissection (Crile oper.)
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Thyroid cancer
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Thyroid cancer: etiology and risk factors
Irradiation (papillary CA), Iodine deficiency (follicular CA) Goiter (anaplastic CA) Multiple endocrine neoplasia MEN-
2A, MEN-2B (medullary CA)
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Histology of Thyroid Cancers
Papillary carcinoma (50%) – from А-cells
Follicular CA (30%) – from А-cells Hurthle cell carcinoma – from В-cells
Medullary carcinoma (5-10%) – С-cells
Anaplastic (undifferentiated) CA (5%)
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Diagnostics:
USD – 7,5 МГц Scintigraphy: J-131 (“cold” node), Tc-99m (“hot” node) FNA Biopsy Laryngoscopy CТ, MRI Calcitonin in plasma (Medullary
cancer)
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TNM Classification (2002)
Т1 < 2 cm T2 2-4 cm T3 > 4 cm T4 t-r invades soft tissues of neck,
larynx, trachea, oesophagus, rec.laryng. nerve.
N0, N1a, N1b (bilateral lymph.nodes) M0, M1
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Thyroid carcinomas: staging
Thyroid CA (papillary-follicular), <45 yr.Stage І : T any N any M0Stage ІІ: T any N any M1
Thyr.CA (papil./follic.+medullary) > 45 yr.:
Stage: І, ІІ, ІІІ, ІV
Thyr.CA anaplastic – all cancers are IV st.
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Thyroid Cancer, T4 st.
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After thyroidectomy
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Laryngeal cancer.Anatomy of Larynx
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Direct laryngoscopy:normal (1); fibroma (2)
12
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Polyp of vocal cord
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Laryngeal carcinoma (1), (2)
1 2
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TNM Classification of Laryngeal Carcinoma (glottis part)
Т1 – t-r limited to vocal cords with normal mobility
Т2 – t-r extends to supraglottis or subglottis with impaired v/cord mobility
Т3 - t-r limited to larynx with vocal cord fixation Т4 - t-r invades through the thyroid cartilage or
soft tissues of neck
N1 л/в <3 cm, N2 3-6 cm, N3 >6 cm. M0, M1
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Partial resection of larynx
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Laryngeal carcinoma with neck infiltration
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Larynx (surgical specimen)
RL
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Tracheostomy after laryngectomy
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Rehabilitation: voice prosthesis
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Дякую за увагу! Thanks!