Babatunde .A.

Bamigboye
MBBS Lagos, FWACS.
HEAD & NECK TUMOURS
The story of MCP Olumo

 Born into a polygamy

 Worked in father’s farm while schooling
 Dad smoked ‘kataba’ or ‘colitas’, he was
eventually exposed.
 Dropped out of school
 Became a conductor, continued smoking
 Good at calling passengers
MCP Olumo

 16years later………
 Lost his voice, took paraga to cure it
 Breathing Became noisy and progressively
too
 Couldn’t sleep one day. breathless
 Rushed into LUTH
 HEAD & NECK TUMOURS

 Region described from the cranium to the base of the

neck.
- excludes tumours of the intracranial contents
and tumours of the globe and orbit
epidemiology

 Constitutes 3-5% of all cancers

 Approx 500,000 cases diagnosed annually
 Approx. 300,000 deaths worldwide
 Male : Female approx 2:1
Global Statistics 2020
 Total reported 19,292,789
 deaths 9,958,133
 Thyroid 586,202 3.03%

 Lip/oral cavity - 377,713 1.96%

 Larynx 184,615 0.96%
 Nasopharynx 133,354 0.69%
 Oropharynx 98,412 0.51%
 Hypopharynx 84,254 0.44%
 Salivary glands 53, 583 0.28%
H&N Regions
Tumour origins

*Ears and associated structures

*Nose and paranasal sinuses
*Larynx/Hypopharynx
*Oropharynx/ Nasopharynx
*Oral cavity, lips and mandible
*Parapharyngeal spaces
* Salivary glands
*The thyroid glands
* Lymph node & associated structures
 Can be
- benign, intermediate or malignant
- Epithelial and non-epithelial tumours.

Generally –
 Benign: *Papillomas
*Adenomas
*Chondromas
*Neuromas
*Fibroma/angiofibromas
*mixed
 Malignant: * Squamous cell carcinoma
*Lymphoma
*Adenocarcinoma/Adenocystic Ca.
*Papillary/Medullary/Follicular Ca.
*Melanomas
*Basal Cell Carcinoma
*Neuroblastoma

 Intermediate: *Inverted papilloma

*Ameloblastoma
* Chemodectomas
 Manifestations
- Dependent on the site affected
- Lymph node enlargement
- Pain in affected areas
- Signs of metastasis
INVESTIGATIONS

 Radiology
Xrays
CT Scan
MRI
Endoscopies
Laryngoscopy/Hypopharyngoscopy
Nasoendoscopy/Sinoscopy
Sialendoscopy
Investigation (contd)

 Blood Film/FBC, ESR

 Tissue biopsy
 Serology
 FNAC
 Treatment
- Surgery – Excision in Benign
- Surgery +
Chemotherapy +
Radiotherapy
- Radiotherapy alone
- Chemo Radiotherapy
Larynx

 ‘Voice box’
 Comprises- supraglottic, glottic and
subglottic sites
 Epidemiology- approxly 2-3/100,000
individuals, Males: female ratio : 1-7:1
 Risk Factors – smoking , alcohol, pre-
cancerous lesion- laryngeal papilloma,
previous irradiation, long standing reflux
laryngitis
Diagnosis= hx, exam + inv

 Hoarseness- progressive and unremitting

 Noisy/difficulty in breathing/stridor.
 Airway obstruction
 Aspiration
 Video Laryngoscopy - Vocal/supraglottic
lesion
 CT/MRI – extent of tumour + nodal met.
 Biopsy carried out commonly under G.A
Classification- T N M

 T1 – tumour limited to the VC, may involve

ant. or post. Commissure with normal
mobility
 T2- Tumour extends to supraglottic or
subglottic with impaired VC mobility
 T3-Tumor limited to the larynx with VC
fixation
 T4a- Tumor beyond the larynx.
 T4b- encases carotid, invades mediastinum
Nodal classification

 N1- ipsilateral node <3cm

 N2a- ipsilateral node >3 but </=6cm
 N2b-multiple ipsilat. Nodes none >6cm
 N2c- contralateral node/bilateral nodes none
>6cm
 N3- Any node>6cm
Treatment

 Initial tracheostomy for pt with airway

obstruction.
 Surgery – Laryngectomy-total or partial,
Partial- Vertical or Horizontal
Total- complete removal with a permanent
tracheostomy, +/-speaking valve/voice
prosthesis.
 +/-Neck Dissection where there is nodal
metastasis.
Treatment Contd.

 Radiation
 use of Ionizing radiation in the treatment.
 Could be primary , adjuvant, or palliative.
 Primary in early stages 1&2
 Adjuvant (post surgery) in stages 3 -4a
 Palliative in 4b &c
Chemotherapy

 Use of anti-neoplastic agents in treatment

 Often used as adjuvant treatment alongside
radiation therapy.
 Also used for palliative treatment in
advanced/inoperable cases
 Examples – cisplatin, carboplatin commonly
used.
Current trends

 Multidisciplinary approach via a Tumor Board.

 No single modality for treatment
 Minimum of 2 combination of modalities
 Targeted treatment in cases of over
expression of EGFR
Prognosis

 In early stages nearly 100% 5year survival rate

 Late stages 30-45% 5 year survival.
Nasopharyngeal tumour

 Occur within the nasopharyngeal space

 Often from the fossa of Rossenmuller
 Closely related to the eustachian tube and
parapharyngeal space
 Anteriorly with the nasal cavity
 Superiorly base of skull (basi-sphenoid)
 Supero-laterally the orbit
 Inferiorly the oropharynx
epidemiology

 Occurs 1/100,000 per population

 Most prevalent among the chinese and and
people of asian descent,
 Higher among the north africans within the
subregion
 Higher among chinese/asian americans
Risk Factors

 Male gender
 Ingestion of salted ungutted meals and other
nitrosamine containing diets
 Family hx of NPC
 Ebstein Barr Virus infection
 Genetic factors
 Tobacco, Alcohol
 Exposure to wood dust
Diagnosis- hx, exam

 Nasal obstruction
 Epistaxis
 Conductive hearing loss
 Cervical lymphadenopathy
 Proptosis/diplopia/headache
 Nasoendoscopy &
 Biopsy of nasopharyngeal mass for
Histopathology
Staging TNM

 Tis - carcinoma in –situ

 T1- tumor confined to the nasopharynx, or
extends to nasal cavity/oropharynx, No PPS
 T2- extends to PPS, media or lateral
pterygoid or prevertebral muscles
 T3-Infiltrate bony struc. skull base, cervical
vertebra, paranasal sinuses
 T4- intracranial ext. cranial nerves
involvement,orbit, parotid gland
Nodal Staging

 N1- unilateral cervical nodal metastasis

and/or uni- or bilateral retropharyngeal nodes
none greater than 6cm above the lower
border of cricoid cartilage
 N2- Bilat cervical nodal metastasis, 6cm or
less above the lower border of cricoid
cartilage.
 N3- uni/bilat cervical nodal metastasis>6cm
and below the border of cricoid cartilge
Treatment

 External beam irradiation

 + Chemotherapy
 Monoclonal antibody therapy
 Surgery is indicated in the following
circumstances
1. Tracheostomy in oropharyngeal extension
2. Excision of residual tumour
3. Neck dissection in persistent nodal disease
Prognosis

 Approaches 90% 5 years survival rate in early

stages
 Poor in advanced cases especially where
there is intracranial and cranial nerves
involvement
Oropharyngeal tumor

 Area bounded by
 1. Anterior faucial pillars and the base of the
tongue
 2. The tonsil/tonsillar fossae
 3. Oropharyngeal surface of the soft palate
and the oropharyngeal isthmus
 4. Communicates inferiorly with the larynx
and hypopharynx
Risks

 Smoking
 Heavy alcohol use
 HPV 16 infection
 Previous head and neck tumor
 Previous radiation to the head and neck
Diagnosis

 Unremitting sore throat

 Sensation of lump in the throat
 Odynophagia/Dysphagia
 Muffled voice
 Impaired tongue protrusion
 Referred pain in ipsilateral ear
 Trismus
 Weight loss
Diagnosis contd

 Cervical adenopathy
 Blood stained saliva or mucus
 Tonsillar enlargement
 Features of airway obstruction
 Exophytic or infiltrative mass in the
oropharynx
 Biopsy under LA and sometimes GA
Staging Tumour classificatio

 T1- tumour <2cm in greatest dimension

 T2- Tumour >2cm but not >4cm
 T3- Tumour >4cm , extension into the lingual
surface of the epiglottis
 T4- Tumour invades the larynx, extrinsic
muscles of the tongue, medial pterygoid,
mandible
Staging nodal classification

 N1- One or more ipsilateral nodes none >6cm

 N2-Contralateral or bilateral nodes none
>6cm
 N3- Nodes >6cm
Treatment

 Surgery – Oropharyngeal excision

 traditionally, ‘Commando’ procedure –
hemimandibulactomy, glossectomy and
cervical node dissection.
 Followed by composite flap reconstruction
 Limited procedures include:
Ttransmandibular/lateral
pharyngotomy/transcervical approaches for
excision of tumour
 treatment contd

 Post operative Radiotherapy

 Post operative Chemotherapy
 Immunotherapy
 Targeted therapy
prognosis

 Depends on
 Overall health status
 HPV status
 Degree of smoking
 Stage at presentation

HPV associated associated tumours tend to

have higher prognostic rate
Sinonasal tumours

 Tumours of the nose and paranasal sinuses

 Constitutes <1% of all tumours
 Late presentation/diagnosis due to non-
specificity of early symptoms often taken for
usual ‘catarrh’
Risk facrors

 Exposure to hardwood dust

 Softwood dust
 Viral aetiology ??
 Hydrocarbon dyes exposure
 Previous exposure to ionizing radiation
Diagnosis

 Non specific symptoms – nasal discharge,

obstruction, epistaxis
 Tooth ache/loosening in the upper jaw
 Heaviness and pain in the affected side of the
face
 Facial swelling
 Nasal endoscopy + biopsy
treatment

 Surgery- Maxillectomies-removal of part or

whole of the maxilla

 Post operative Radiotherapy

 Adjuvant Chemotherapy
prognosis

 Generally poor with 5year survival less than

30%
 However where treatment is carried out with
tumour still confined to the nose/sinuses, 5-
year survival approaches 60%
Lymphomas

 Considered a systemic disease form the

onset, commonly NHL
 Can occur anywhere within the lymphatic
system of the head and neck including the
nasopharynx and oropharynx
 Presentation is dependent on site of
manifestation.
 Diagnosis include endoscopies and biopsy ,
fine needle aspiration cytology of neck node.
Treatment

 Chemotherapy
Cyclophosphamide
Doxorubicin
Vincristine
Prednisolone

Other forms of adjuvant Rx : Radiotherapy &

Immunotherapy
Salivary Glands

 Parotid
 Submandibular
 Minor Salivary glands.
Present as masses in the affected regions.
Slow /rapidly growing
+/- Cervical Adenopathy
Diagnosis- FNAC/ Excisional Biopsy
Treatment

 Surgery- Total parotidectomy+/- Neck

Dissection,
Submandibulectomy+/- Neck
Dissection
For minor salivary gland
malignancy, wide excision of the mass with
flap reconstruction
Post-op Radiotherapy
Skin

 Malignant Melanomas
 Squamous cell Carcinomas
 Basal Cell Carcinomas
Diagnosis-clinical/biopsy
Rx- Wide Excision, flap reconstruction +/-
radiotherapy