Head and Neck Flashcards
Most common histology
squamous cell (alternate etiology suggest salivary or thyroid origin)
Incidence of new diagnosis,
Sex,
Age
3%,
M>F (3:1),
>60 (except HPV: 40-60)
Enviornmental Risk Factors
- Alcohol or Tobacco (if combine 100 fold increase)
- EBV (nasopharyngeal: endemic in southern China and Hong Kong)
- HPV (70% oropharyngeal)
Premalignant Lesions
Leukoplakia: fixed white patches
Erythroplakia: red patches; often with epithelial dysplasia
Key Molecular Abnormalities
p53 (poor prognosis, usually w/ Alcohol & Tobacco)
p16 inactivation
EGFR overexpression
CCND1 over expression
HPV: E6, E7 viral protein: inhibits tumor suppressors ie. p53, Rb
EBV: LMP1 protein
Big Picture:
multimodality approach allows for cure even in locally advanced
In addition to cure we strive for:
organ preservation
Treatment baskets:
- Early Stage (stage I-II; not high risk): single modality: surgery or RT
- Locally Advanced (stage III-IVB): surgery with adjuvant radiation +/- chemo or definitive chemoradiation
- Metastatic: combination chemo (ECOG1)
What are high risk features in early stage that warrant adjuvant therapy?
- extracapsular extension
- vascular embolism
- perineural invasion
When is adjuvant radiation + chemo preferred?
> 2 positive nodes
+ surgical margins (consider re-surgery first)
+ extracapsular extension
When is definitive chemoradiation preferred?
nonsurgical disease (Adelstein JCO 2003) larynx preservation (Forastiere NEJM 2003)
What are 6 primary sites of origin for SCC of Head and Neck?
Oral Cavity Oropharynx Nasal Cavity Nasopharynx Hypophaynx Larynx
Components of oral cavity?
lips, alveolar ridge, hard palate, buccal mucosa, anterior 2/3 tongue, floor of mouth, retromolar trigone (7)
Components of Oropharynx?
palatine tonsils, posterior 1/3 of tongue, vallecula, lingual tonsil, midportion of posterior pharyngeal wall, interior surface of soft palate, uvula (7)
Components of Nasal Cavity?
Nasal septum, mucosa of nasal cavity; superior, middle and inferior turbinates (3)
