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Head & Neck Cancers

Head & Neck Cancers. Prof. Igor Y. Galaychuk, MD Chief, Department of Oncology and Radiology Ternopil State Medical University. Lip cancer >2000 pts . Cancer of oral cavity 4500 pts . Larynx cancer 3000 pts . Thyroid cancer >2000 pts. Died : Lip cancer 400 pts . 52% within year

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Head & Neck Cancers

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  1. Head & Neck Cancers Prof. Igor Y. Galaychuk, MD Chief, Department of Oncology and Radiology Ternopil State Medical University

  2. Lip cancer>2000 pts. Cancer of oral cavity4500 pts. Larynx cancer 3000 pts. Thyroid cancer >2000 pts. Died: Lip cancer 400 pts. 52% within year 38% within year 400 pts. Epidemiology. In Ukraine every year: Oral cavity and pharynx: 28,260 – New Cases; 7230 – Deaths Tongue: 73201700 Larynx: 10,2703830 25.6% 23.2% 37.3% USA 2004

  3. Etiology and risk factors • Tobacco • Alcohol • Insolation • Work factors (out of doors) • Viruses (EBV,Herpes 1, Papilloma viruses) • Diet (Vit. А, -carotene, -токоферол)

  4. Cancer of the vermilion surface

  5. TNM Classification of Lip & Oral Cavity Cancers • Тis – carcinomain situ • T1 – tumour less than 2 cm • T2 – 2-4 cm in greatest dimension • T3 – > 4cm • T4 – tumour invades bone, muscle, skin • N0, N1 <3 cm,N2= 3-6 cm, N3 >6 cm • M0, М1

  6. Lower Lip Cancer, Т4N0M0

  7. Precancerous lesions: • Leukoplakia(<5%transformation) • Erythroplakia (40%) • Hyperkeratosis • Papilloma

  8. Hyperkeratosis of lip

  9. Hyperkeratosis: triangle lip biopsy and vermilionectomy

  10. Lower Lip Cancer, T2N0M0

  11. Rectangular resection of lip with reconstruction

  12. Treatment modalities for Lip Cancers: • Surgery: rectangular resection (Т1-Т4), vermilionectomy (Тis), crio (Тis) • X-ray therapy (Тis, N1-2) • Gamma-ray therapy (Т3-Т4) • Chemotherapy (при ІІІ-ІV ст.): 5-FU, Cisplatin • regional lymph node dissection (N1-3)

  13. Tongue Cancer • Localization:lateral borders – 60%, radix – 20-27%, tip – 3%, dorsal surface – 7%. • Clinical presentation: nodular tumor, ulcer tumor, inflammatory type • Precancerous lesions: leukoplakia, papilloma, ulcers, fissure, glossitis

  14. Papilloma of Tongue

  15. Tongue cancer: hemiresection

  16. Cancer of Tongue: 5-year survival • І st. – 80% • ІІ st. – 60% • ІІІ-ІVst. – 15-35% • Lymph node metastases decrease survival on 50%.

  17. Cancer of Oral Cavity – Floor of Mouth

  18. Regression of cancer after gamma-ray therapy

  19. Lymphatic drainage

  20. Levels of lymphatic drainage

  21. Submandibular lymph node dissection

  22. Neck lymph node Mts

  23. Superficial neck lymph node dissection

  24. Extensive lymph node dissection (Crile oper.)

  25. Thyroid cancer

  26. Thyroid cancer: etiology and risk factors • Irradiation (papillary CA), • Iodine deficiency (follicular CA) • Goiter (anaplastic CA) • Multiple endocrine neoplasia MEN-2A, MEN-2B (medullary CA)

  27. Histology of Thyroid Cancers • Papillary carcinoma (50%) – from А-cells • Follicular CA (30%) – from А-cells • Hurthle cell carcinoma – from В-cells • Medullary carcinoma (5-10%) – С-cells • Anaplastic (undifferentiated) CA (5%)

  28. Diagnostics: • USD – 7,5 МГц • Scintigraphy:J-131 (“cold” node), Tc-99m (“hot” node) • FNA Biopsy • Laryngoscopy • CТ, MRI • Calcitonin in plasma (Medullary cancer)

  29. TNM Classification (2002) • Т1 < 2 cm • T2 2-4 cm • T3 > 4 cm • T4t-r invades soft tissues of neck, larynx, trachea, oesophagus, rec.laryng. nerve. • N0, N1a, N1b (bilateral lymph.nodes) • M0, M1

  30. Thyroid carcinomas: staging • Thyroid CA (papillary-follicular), <45yr. Stage І : T any N any M0 Stage ІІ: T any N any M1 • Thyr.CA (papil./follic.+medullary) > 45yr.: Stage: І, ІІ, ІІІ, ІV • Thyr.CAanaplastic – all cancers areIVst.

  31. Thyroid Cancer, T4 st.

  32. After thyroidectomy

  33. Laryngeal cancer.Anatomy of Larynx

  34. Direct laryngoscopy:normal (1); fibroma (2) 1 2

  35. Polyp of vocal cord

  36. Laryngeal carcinoma (1), (2) 1 2

  37. TNMClassification of Laryngeal Carcinoma (glottis part) • Т1 – t-r limited to vocal cords with normal mobility • Т2 – t-r extends to supraglottis or subglottis with impaired v/cord mobility • Т3 - t-r limited to larynx with vocal cord fixation • Т4 - t-r invades through the thyroid cartilage or soft tissues of neck • N1л/в <3 cm, N2 3-6 cm, N3 >6 cm. • M0, M1

  38. Partial resection of larynx

  39. Laryngeal carcinoma with neck infiltration

  40. Larynx (surgical specimen) L R

  41. Tracheostomy after laryngectomy

  42. Rehabilitation: voiceprosthesis

  43. Дякую за увагу! Thanks!

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