Anatomy of Head of Neck Cancer

Transcription

1 Anatomy of Head of Neck Cancer J. Robert Newman, MD The ENT Center of Central GA H&N Cancer Overview Most categories of cancer are represented in the H&N Squamous cell carcinoma most common mucosal cancer of the H&N Thyroid, parotid, ear different Squamous Cell Carcinoma Mucosal (not skin cancer) 3% of new cancer diagnoses 63,000 people each year Avg age at diagnosis is 50 Risk factors Smoking Synergistic effect Alcohol abuse HPV Cancer.net. types/head and neck cancer/statistics 1

2 Squamous Cell Carcinoma (HPV ) Average age around 50 Heavy tobacco**/alcohol abuse Larynx, hypopharynx, oral cavity Worse prognosis Field cancerization Survival stats based on this disease Rates began declining in the 1980 s Sturgis EM, Ang KK. The epidemic of HPV associated oropharyngeal cancer is here: is it time to change our treatment paradigms? J Natl Compr Canc Netw 2011; 9:665. Squamous Cell Carcinoma (HPV +) Human Papilloma Virus DNA virus HPV genotype 16 (also 18, 31, 33) Most common STD in the US Cervical, condyloma acuminatum, anal, vaginal cancers More prevalent in oral cavity of men (10%) vs. women (3%) 1 Vaccination decreases presence of virus in the oral cavity 2 1. Gillison ML, Broutian T, Pickard RK, et al. Prevalence of oral HPV infection in the United States, JAMA 2012; 307: Gillison ML, Broutian T, Graubard B, et al. Impact of HPV vaccination on oral HPV infections among young adults in the US (abstract 6003) American Society of Clinical Oncology annual meeting. Squamous Cell Carcinoma (HPV +) Almost exclusively oropharyngeal cancers Diagnosis using P16 marker Men >> Women Lack traditional risk factors (Tob/EtOH) Younger onset (30 50 yrs old) Present with lower T, higher N stage Still better prognosis (Stg I = IVA) Different staging system O'Sullivan B, Huang SH, Su J, et al. Development and validation of a staging system for HPV related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON S): a multicentre cohort study. Lancet Oncol 2016; 17:440. 2

3 Oral Cavity Anatomy Vermillion border Post hard palate Ant tonsillar pillar www. Humananatomylibrary.com Circumvallate papilla Oral Cavity Staging T1 <2 cm T2 2 4 cm T3 >4 cm T4a invades bone, inf alveolar n. FOM, skin T4b masticator sp Pterygoids, carotid www. Humananatomylibrary.com 3

4 Hypopharynx Anatomy Pyriform sinus Posterior & Lateral walls Post cricoid Hypopharynx Staging T1 <2 cm T2 2 4 cm T3 >4 cm or TVC fixation T4a moderately adv T4b very adv disease Laryngeal Anatomy Tip of the epiglottis to the cricoid supraglottis glottis subglottis 4

5 Laryngeal Anatomy Supraglottic larynx epiglottis arytenoid false vocal fold Laryngeal Anatomy Glottic larynx Glottis (true vocal cords) Laryngeal Anatomy Subglottic larynx Inf glottis to cricoid 5

6 Laryngeal Cancer Staging (supraglottis) T1 T2 T Stage One subsite, TVC mobility wnl Invades adj subsite, larynx, etc T3 Vocal cord fixation, invades post criocoid/paraglottic/ Preepiglottic spaces T4a Invades beyond larynx T4b Invades prevertebral sp, encases carotid, mediastinal involvement Laryngeal Cancer Staging (glottis) T1a T1b T2 T Stage One TVC, TVC mobility wnl Both vocal cords Into supraglottis, subglottis Or TVC impairment T3 TVC fixation, paraglottic inv T4a Invades thyroid cartilage, tissues outside larynx T4b Invades prevertebral sp, encases carotid, mediastinal involvement Laryngeal Cancer Staging (subglottis) T Stage T1 Subglottis only T2 Extends into TVC T3 Extends into TVC With fixation T4a Invades thyroid cartilage, tissues outside larynx T4b Invades prevertebral sp, encases carotid, mediastinal involvement 6

7 Oropharynx Anatomy Soft palate Ant tonsillar pillars Vallecula Includes tonsils, soft palate and tongue base Oropharynx Staging T1 <2 cm T2 2 4 cm T3 >4 cm T4a invades larynx, deep tongue muscles, med pterygoid, hard palate or mandible *Predominately HPV + disease T4b invades lateral pterygoid, nasopharynx, skull base or carotid Neck Anatomy 7

8 Neck Anatomy Cervical Lymph Nodes 8

9 Neck Staging N0 no evidence of disease N1 single node, <= 3cm N2a single node 3 6 cm N2b multiple nodes, <6 cm N2c bilateral or contralateral node <6cm N3 >6 cm Questions? 9

10 Center for advanced parotid surgery glands/ 10