P&P Chapter 29 Notes:
Head and Neck Cancers:
HPV is associated with cancers of the oropharynx
Most common site of mets is to the lungs
-then mediastinal lymph nodes, liver, brain, and bones
Distant mets occurs more often with cancers of the nasopharynx and hypopharynx
Previous RT and RND patients more commonly have atypical mets
High-grade parotid tumors often effect the facial nerves and cause paralysis
-TOC^ surgery and RT
Cancerization: the higher risk of formation of a second primary tumor (SPT) in the same field of
previous treatment
-head and neck patients 20% recurrence
65% survival rate for cancers of the oral cavity and pharynx
-constant rise 0.7% each year (last 10-year average)
-twice as common in men than women
-HPV-related cancers (better prognosis) in white men and women rising incidence in
oropharynx
SEER presented 5-year survival rates:
-oral cavity and pharynx=64.8%
-larynx=60.9%
Most common sites of head and neck cancers:
-oral cavity
-pharynx
-paranasal sinuses
-larynx
-thyroid gland
-salivary glands
Etiologic risk factors:
1) Tobacco and alcohol use (mainly oral cavity, oropharynx, hypopharynx, larynx cancers)
2) UV exposure
3) Viral infection
4) Environmental exposures
Smoking cigarettes increases risk of head and neck cancers by 6
Pipe and cigar smoking results in extensive intraoral keratosis (rough scaly patch on skin)
Unfiltered cigarettes cause lip carcinoma
Certain cancers like oropharyngeal cancers (closer to the esophagus) are caused by the pooling of
saliva containing carcinogens (from tobacco use)
Alcohol consumption alone is a risk for the formation of pharyngeal and laryngeal tumors
-damages mucosa making it more permeable to contaminants
Smoking and alcohol combination is the most important risk factor to head and neck cancers
Smokeless tobacco users often form lesions of oral leukoplakia
-they also develop gingival recession, hyperkeratosis (thickening of skin), and staining
, Lip cancer often arises from UV light exposure (31% of patients have outdoor occupations)
Occupation hazards:
-nickel refining
-furniture and woodworking
-steel and textile work
Nasopharyngeal cancers associated with dust fumes and formaldehyde
-synthetic wood
-binding agents *adenocarcinoma of the nasal cavity and ethmoid sinus
-glue
Radiation exposure especially in children is associated with thyroid and salivary gland tumors
EBV associated with NPC
HSV-1 may cause herpetic stomatitis and recurrent herpes labialis (cold sores)
-remains latent in trigeminal or other sensory ganglion for a lifetime
-reactivation occurs to produce recurrent lesions or shed asymptomatically in the saliva
HPV linked to head and neck carcinogenesis (found in oral and laryngeal papilloma’s and
carcinomas and leukoplakia lesions)
Hypopharyngeal cancer risk factors:
-vitamins A and E deficiency
-fried and processed foods
-alcohol
Post-cricoid cancers associated with iron deficient anemia
Marijuana is a risk factor due to the increased tar and hydrocarbons
Chronic denture irradiation and patients with poor oral hygiene, jagged teeth or fillings may
promote neoplastic activity
Squamous cell cancer (SCC) of the head and neck genetically requires 8-11 mutations or 4-7
DNA mutations for the development of salivary gland malignancies
The deeper the cancer (from lips to the hypopharynx) the worse prognosis
Advanced stage characteristics:
-fixed lymph nodes
-fixed lesion
- cranial nerve involvement
Staging based on involvement of subsites
Nasal cavity openings into nasopharynx provide a route of natural spread
Tonsils: bands of lymphoid tissue that protect against airway infection and form a barrier
between the respiratory tubes (naso) and digestive tubes (oro and hypo)
C1: inferior nasopharynx
C2-3: oropharynx
C3: epiglottis
C4: true vocal cords
Salivary gland tumors can cause paralysis, facial nerve pain, and restriction of neck muscles
blood supply
Cranial nerve involvement can lead to the location of the primary tumor
Head and Neck Cancers:
HPV is associated with cancers of the oropharynx
Most common site of mets is to the lungs
-then mediastinal lymph nodes, liver, brain, and bones
Distant mets occurs more often with cancers of the nasopharynx and hypopharynx
Previous RT and RND patients more commonly have atypical mets
High-grade parotid tumors often effect the facial nerves and cause paralysis
-TOC^ surgery and RT
Cancerization: the higher risk of formation of a second primary tumor (SPT) in the same field of
previous treatment
-head and neck patients 20% recurrence
65% survival rate for cancers of the oral cavity and pharynx
-constant rise 0.7% each year (last 10-year average)
-twice as common in men than women
-HPV-related cancers (better prognosis) in white men and women rising incidence in
oropharynx
SEER presented 5-year survival rates:
-oral cavity and pharynx=64.8%
-larynx=60.9%
Most common sites of head and neck cancers:
-oral cavity
-pharynx
-paranasal sinuses
-larynx
-thyroid gland
-salivary glands
Etiologic risk factors:
1) Tobacco and alcohol use (mainly oral cavity, oropharynx, hypopharynx, larynx cancers)
2) UV exposure
3) Viral infection
4) Environmental exposures
Smoking cigarettes increases risk of head and neck cancers by 6
Pipe and cigar smoking results in extensive intraoral keratosis (rough scaly patch on skin)
Unfiltered cigarettes cause lip carcinoma
Certain cancers like oropharyngeal cancers (closer to the esophagus) are caused by the pooling of
saliva containing carcinogens (from tobacco use)
Alcohol consumption alone is a risk for the formation of pharyngeal and laryngeal tumors
-damages mucosa making it more permeable to contaminants
Smoking and alcohol combination is the most important risk factor to head and neck cancers
Smokeless tobacco users often form lesions of oral leukoplakia
-they also develop gingival recession, hyperkeratosis (thickening of skin), and staining
, Lip cancer often arises from UV light exposure (31% of patients have outdoor occupations)
Occupation hazards:
-nickel refining
-furniture and woodworking
-steel and textile work
Nasopharyngeal cancers associated with dust fumes and formaldehyde
-synthetic wood
-binding agents *adenocarcinoma of the nasal cavity and ethmoid sinus
-glue
Radiation exposure especially in children is associated with thyroid and salivary gland tumors
EBV associated with NPC
HSV-1 may cause herpetic stomatitis and recurrent herpes labialis (cold sores)
-remains latent in trigeminal or other sensory ganglion for a lifetime
-reactivation occurs to produce recurrent lesions or shed asymptomatically in the saliva
HPV linked to head and neck carcinogenesis (found in oral and laryngeal papilloma’s and
carcinomas and leukoplakia lesions)
Hypopharyngeal cancer risk factors:
-vitamins A and E deficiency
-fried and processed foods
-alcohol
Post-cricoid cancers associated with iron deficient anemia
Marijuana is a risk factor due to the increased tar and hydrocarbons
Chronic denture irradiation and patients with poor oral hygiene, jagged teeth or fillings may
promote neoplastic activity
Squamous cell cancer (SCC) of the head and neck genetically requires 8-11 mutations or 4-7
DNA mutations for the development of salivary gland malignancies
The deeper the cancer (from lips to the hypopharynx) the worse prognosis
Advanced stage characteristics:
-fixed lymph nodes
-fixed lesion
- cranial nerve involvement
Staging based on involvement of subsites
Nasal cavity openings into nasopharynx provide a route of natural spread
Tonsils: bands of lymphoid tissue that protect against airway infection and form a barrier
between the respiratory tubes (naso) and digestive tubes (oro and hypo)
C1: inferior nasopharynx
C2-3: oropharynx
C3: epiglottis
C4: true vocal cords
Salivary gland tumors can cause paralysis, facial nerve pain, and restriction of neck muscles
blood supply
Cranial nerve involvement can lead to the location of the primary tumor
