Dr. Szekanecz Éva Head and Neck Cancer Eva Szekanecz M.D., Ph.D

CANCERS OF THE HEAD AND NECK MAY ARISE FROM ANY OF THE LINING MEMBRANES OF THE UPPER AERODIGESTIVE TRACT MAY ARISE FROM ANY OF THE LINING MEMBRANES OF THE UPPER AERODIGESTIVE TRACT ~2% of all malignancies ~2% of all malignancies number of cases grow continously in certain ages and population number of cases grow continously in certain ages and population mortality increases mortality increases diagnosed in more advanced stages ( bad QoL) diagnosed in more advanced stages ( bad QoL) not ‘enough’ therapeutic modalities not ‘enough’ therapeutic modalities male dominancy 3:1 (?) male dominancy 3:1 (?)

ETIOLOGY SPIRITS SPIRITS SMOKING („pack year of tobacco smoking”) SMOKING („pack year of tobacco smoking”) poor social standing poor social standing spicy / hot food spicy / hot food oral higiene (stomatological status) oral higiene (stomatological status) viruses (EBV) viruses (EBV) activity (wood, tobacco) activity (wood, tobacco) age and sex age and sex

PROGNOSTIC FACTORS smoking habits and alcohol smoking habits and alcohol ( and other continued exposure of carcinogens) sex and age sex and age localisation and histologic type localisation and histologic type extent of the mucosal lesion extent of the mucosal lesion importance of TNM factors importance of TNM factors histologic grade (cellular differentiation) histologic grade (cellular differentiation) averall health parameters of the patient (performance status, comorbidity) averall health parameters of the patient (performance status, comorbidity)

LOCALISATION 1. oral cavity 1. oral cavity 2. pharynx 2. pharynx 3. larynx 3. larynx

LOCALISATION salivary glands nasal cavity and paranasal sinuses external and middle ear 6. unknown primary (8. thyroid gland)

HISTOLOGY CARCINOMA (more than 90%) CARCINOMA (more than 90%) basalioma basalioma lymphoepithelioma lymphoepithelioma lymphomas lymphomas metastatic tumors metastatic tumors melanoma melanoma sarcoma sarcoma

SYMPTOMS functional and aesthetic disorders according to location: breathing, swallowing, vocalisation, haemoptysis functional and aesthetic disorders according to location: breathing, swallowing, vocalisation, haemoptysis pain pain weight loss weight loss metastatic sites metastatic sites - regional: cervical lymph nodes - distant: lungs, liver, mediastinal lymph nodes, (skeletal bones)

CLINICAL STAGING anamnestic findings anamnestic findings performance status performance status physical examination physical examination blood tests blood tests imaging techniques imaging techniques x -ray, ultrasonography, CT, MRI biopsies biopsies bone scans bone scans PET scan PET scan

TREATMENT COMBINED ONCOTHERAPY COMBINED ONCOTHERAPY always INDIVIDUAL treatment planning always INDIVIDUAL treatment planning organ preserving variations in earlier stages, less in advanced stages organ preserving variations in earlier stages, less in advanced stages ↕ablasticity! organ preserving, function sparing methods with good QoL and aesthetic results aim: organ preserving, function sparing methods with good QoL and aesthetic results

11 COMBINATION ONKOTHERAPY ! Chemo Chemo - palliative -neoadjuvant -adjuvant Irradiation Irradiation - palliative -definitive -preoperative -postoperative

CHEMOTHERAPY 1st cytotoxic attempts 30 years ago… (MTX?) 1st cytotoxic attempts 30 years ago… (MTX?) i.v. administration i.v. administration PLATINUM / DDP, CBP / 5, FLUOROURACIL TAXANES EGFR INHIBITORS

TARGETED THERAPY BIOLOGICAL TREATMENT BIOLOGICAL TREATMENT Cetuximab – Cetuximab – Under the age of 70 ys Under the age of 70 ys

IRRADIATION (osteoradionecrosis…) -definitive -preoperative -postoperative -pallative EXTERNAL BEAM RT BRACHYTHERAPY

SURGERY (laser, cryo) excision with directly closing suture excision with closing flap techniques T1-2N0M0 : T1-2N0M0 : T3-4N+: T3-4N+: PARTIAL ~ RADICAL ~ NECK DISSECTION NECK DISSECTION (FND, RND, etc.) palliative surgery, tracheotomy

SURVIVAL OS doesn’t increase despite the developement of oncotherapy↑ locoregionally advanced tumors are diagnosed in most of the cases the patients has less tolerability to more radical and/or combined treatment modalities the patients has less tolerability to more radical and/or combined treatment modalities less than 50% of patients are suitable for combined RT+ chemo less than 50% of patients are suitable for combined RT+ chemo

FOLLOW UP 1st yearevery 2 months 1st yearevery 2 months 2nd yearevery 3 months 2nd yearevery 3 months 3rd-5th year every 6 months 3rd-5th year every 6 months over 5 ysas it necessary or once a year over 5 ysas it necessary or once a year

ORAL CAVITY, PHARYNX AND LARYNX rapid infiltration because of the lack of barriers in the soft tissues rapid infiltration because of the lack of barriers in the soft tissues ~90% differenciated squamous cell carcinoma ~90% differenciated squamous cell carcinoma lymphatic metast. soon ( rich lymphatic network) - lymphatic metast. soon ( rich lymphatic network) - no specific symptoms (pain, bleeding,weight loss), no specific symptoms (pain, bleeding,weight loss),

MAJOR SALIVARY GLANDS 80% parotid tumours /facial nerve!/ 80% parotid tumours /facial nerve!/ - from those 20% malignant : pain, asymetric face movement, problems of salivation, xerostomy, fixed tumor, facial nerve palsy symptoms: pain, asymetric face movement, problems of salivation, xerostomy, fixed tumor, facial nerve palsy recurrence can occur even over 5 years !!! recurrence can occur even over 5 years !!!

SINONASAL TUMORS rare tumors, most - originated from the maxillary sinus rare tumors, most - originated from the maxillary sinus in the 7th decade (never under 40 ys) in the 7th decade (never under 40 ys) : facial asymmetry, pain, smelling disfunction symptoms: facial asymmetry, pain, smelling disfunction poor prognosis (bone arrosion, mutilating surgery) poor prognosis (bone arrosion, mutilating surgery)

EXTERNAL AND MIDDLE EAR rare, painful tumors (1st: pinna, 2 nd: external tube) mostly: basaliomas, melanomas and carcinomas symptoms: pain, bleeding, hearing disorder, tinnitus, otorrhea

TUMORS OF UNKNOWN PRIMARY signs of the metastasis point to the primary localisation signs of the metastasis point to the primary localisation histological heterogenity histological heterogenity poor prognosis (survival:3-5 months) poor prognosis (survival:3-5 months) CLINICAL INVESTIGATION HAS TO BE COMPLETED BEFORE ANY TREATMENT! CLINICAL INVESTIGATION HAS TO BE COMPLETED BEFORE ANY TREATMENT!