A head and neck squamous cell carcinoma model to study and ...
Head and Neck Squamous Cell Carinoma
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HEAD AND NECK SQUAMOUS CELL
CARINOMAUneke Edwards
MD5
#1607
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TABLE OF CONTENTS Introduction Classification Etiology Signs and Symptoms Clinical features Diagnosing Treatment Prognosis References
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INTRODUCTION: WHAT IS IT?
Squamous cell carcinomas (SCC) are cancers that arise from outer layer of skin and mucosa
Head and neck squamous cell carcinomas (HNSCC) affects oral cavity, oropharynx, nasal cavity, paranasal sinuses, larynx and hypopharynx
Sixth most cancer worldwide (affects men in 50’s and 60’s)
Accounts for 90% of all Head and neck cancers
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INTRODUCTION: WHAT IS IT?
Affects men more than women
The major cause is tobacco smoking (75% cases)
Has a good prognosis, if caught early usually treatable.
Accounts for 90% of all Head and neck cancers
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CLASSIFICATION HNSCC can present in the oral cavity,
oropharynx, larynx, nasal cavity, nasopharynx hypopharynx, paranasal sinuses and trachea. According to WHO, HNSCC can be categorized in these different types:
Conventional Verrucous Basaloid Papillary
Spindle cell Acantholytic Adenosquamous Cuniculatum (oral mucosa
only)
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CLASSIFICATION contd…
HNSCC often develops from preexisting dysplastic lesions and these lesions can also be classified as:
Mild, moderate, severe (carcinoma in situ)
Well, moderate or poorly differentiated
Keratinizing or Non-keratinizing
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ETIOLOGY Tobacco Smoking and Excess alcohol intake
The most common cause of HNSCC is associated with tobacco smoking. About 75% of cases are due to smoking. This is especially associated with oropharyngeal type of HNSCC
Human papillomavirus (HPV)
Particularly, HPV16 is a cause of HNSCC in about 15-25% of cases. They do this by the expression of viral oncoproteins (E6,E7) and by other mechanisms such as disruption of tumor suppressor genes. HPV associated HNSCC affects oropharynx, hypopharynx and oral cavity.
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ETIOLOGY contd…
Radiation Exposure
Epstein-Barr Virus (EBV)
Highly associated with Nasopharyngeal cancer
Occupational Exposure
Exposure to wood dust, asbestos, synthetic fibers,
metal dust, formaldehyde can increase risk of
nasopharyngeal, laryngeal and sinus cancer
Leukoplakia
White patches on the mucosa of tongue have
increased risk of becoming cancerous
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SIGNS AND SYMPTOMS
Neck Mass
Neck pain
Dysphagia
Mouth ulcers(painless)
Sore throat
Hoarse Voice
Enlarged lymph nodes
Lump on lips, mouth or gums
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SIGNS AND SYMPTOMS Oral cavity: A white or red patch on the gums,
the tongue, or the lining of the mouth; a swelling of the jaw ; unusual bleeding or pain in the mouth; referred pain to ear, dysphagia. It includes inner lip, tongue, floor of mouth, gingiva and hard palate
Pharynx: Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing, hoarseness, hemoptysis.
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SIGNS AND SYMPTOMS
Larynx: Pain when swallowing or ear pain.
Paranasal sinuses and nasal cavity: Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; epistaxis; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; rhinorrhea, paresthesia
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DIAGNOSING The doctor evaluates a person’s medical
history, performs a physical examination, and orders diagnostic tests such as needle biopsy head and neck computed tomography (CT) scan or magnetic resonance imaging (MRI)
If the diagnoses is cancer, doctors discuss the severity and whether metastasis has occurred and discuss optimal treatment whether surgery, medicine or radiation is required
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TREATMENT Radiation Therapy
The most common form of treatment. There are different forms of radiation therapy, including 3D conformal radiation therapy, intensity-modulated radiation therapy, and brachytherapy, which are commonly used in the treatments of cancers of the head and neck
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TREATMENT Chemotherapy
Docetaxel-based chemotherapy has shown a very good response in locally advanced head and neck cancer. Taxotere is the only taxane approved by US FDA for Head and neck cancer, in combination with cisplatin and fluorouracil for the induction treatment of patients with inoperable
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TREATMENT contd…
Surgery
In selected cases of localized recurrence, surgery (if operable) or re-irradiation can be considered.
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PROGNOSIS If caught in early stages, HNSCC has a
very good prognosis, up to 50%.
Has a 5 year survival rate
If the cancer metastasize to lung and lymph node, prognosis becomes less than 50% and can be fatal
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Clinical Case 1 A 61yr old man has had progressive hoarseness
over the past 8 months. he has smoked 2 packs of cigarettes for 40yrs. cervical LN are palpable. Laryngoscopy shows 1cm ulcerated mass involving the true vocal cord. histologic tissue from the mass is most likely to show??
a - adenocarcinomab - lymphoepitheliomac - papillomad - polype- squamous cell carcinoma
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REFERENCES http://ghr.nlm.nih.gov/condition/head-and-
neck-squamous-cell-carcinoma http://www.esmo.org/Guidelines/Head-and-
Neck-Cancers/Squamous-Cell-Carcinoma-of-the-Head-and-Neck
Robin’s Pathology textbook 2014 http://www.cancer.gov/types/head-and-
neck/head-neck-fact-sheet#q1 http://www.nature.com/nature/journal/
v517/n7536/full/nature14129.html Google Images
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THANK YOU!