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Keywords: Head and neck carcinoma, oral cancer, salivary gland cancer, cancer of Nasal cavity and paranasal
sinus, larynx cancer and throat cancer.
1. Introduction
Head and neck cancer is characterized by diverse group and neck cancers but this category of head and neck
of malignant tumors that can develop in or all-around cancer is comparatively infrequent[8]. According to
the throat, mouth, nose and sinuses [1, 2]. Head and report of AIHW 2014, head and neck cancers are
neck cancer may collectively termed as malignant classified into 5 different cancer groups (Oral cavity,
tumors of diverse range that can arise mainly from the Salivary glands, Pharynx, Nasal cavity and paranasal
surface layers of upper aerodigestive tract (UADT). sinus, Larynx).This classification is dependent on the
Upper aerodigestive tract is comprised of mouth, site in which these cancers begin (see figure 1)[9, 10].
larynx, pharynx and nasopharynx [3, 4]. Squamous cell According to the International Classification
carcinomas encompasses over 90% of all head and neck of Diseases (ICD-10), 5 head and neck cancer groups
cancer because of the involvement of mucus linings of are further categorized in to 18 different cancer sites.
UADT[5, 6]. Squamous cell carcinoma is characterized Sometime, Cancer of ill defined sites (in the lip, oral
by malignant neoplasm of squamous epithelium with cavity and pharynx) is included in 6th group of head and
marked differentiation and predisposition to primitive neck cancer (see table 1)[11, 12] So, it is common that
and widespread lymph nodal metastases [7]. Cancer of at a time, patient may experience multiple type of
different types of salivary glands can also begin in head cancers in the various regions of head and neck.
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5 head and 18 different head and neck cancer sites ICD-10 ICD-9
neck cancer code code
groups
Oral cavity 1. Malignant neoplasm of lip C00 140
2. Malignant neoplasm of base of tongue C01 141.0
3. Malignant neoplasm of other and unspecified parts of tongue C02 141.1-141.9
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Worldwide, HNSCC is 6th most frequent diagnosed elderly people. It has been revealed from recent studies
cancer [13, 14]and its proportion is much higher in that this group of head and neck cancer is also reported
males as compared to females with ratio of 2:1[15, 16]. in children with alarming number[29-31].Squamous
In Australia, from 1982 to 2009, number of cell carcinoma of oral cavity (OSCC) accounts for 80-
newly diagnosed cases of HNSCC and number of 90% of all HNCs[32]and is accountable for nearly
deaths due to head and neck cancer rose from 2,475 to 130,000 deaths every year[11]. In unurbanized
3,896 and 752 to 944 respectively[17]. For countries, oral squamous cell carcinoma occupies 3rd
nasopharyngeal cancer, maximum rate of incidence has rank among other frequent diagnosed cancers [33].
been reported in south-eastern Asia[18, 19]. In Canada Globally, it is 8th most commonly occurring malignancy
head and neck cancers account for 5% of all cancers among males and 14th in females[34-36]. In Pakistan, it
and from which 85% represents squamous cell ranks 2nd most common malignancy among other
carcinoma of oral cavity[20-22]. From recent studies, it cancers in both genders[18, 37].In Karachi, highest
has been reported that squamous cell carcinoma of oral incidence rate has been recorded for OSCC followed by
cavity is most common in the mainland china, India and Jamshoro, Multan and Peshawar[38, 39]. From the
Taiwan [15]. According to the cancer registry report of previous studies, age standardized rates has been
Shaukat Khanum Memorial Hospital and research estimated for oral cancer (table 2) [40].
centre, head and neck cancer is 2nd most common
malignant tumor in Pakistan [23]. Table 2: ASR rate for both males and females
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Table 3: Symptoms associated with different types of head and neck cancer
Table 4: Distribution of primary malignant sites of head and neck cancer 2013
Male 6 43 38 35 23 5 34 23 14 62
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70 62
60
50 43
38 35
40 33 34
30 22 22 23 22 23
17 14
20 10
5 6 7 Female
10 2 5 4
0 Male
It has been demonstrated from the annual cancer registry report of SKMCH that after breast cancer, Head and
neck is 2nd most commonly diagnosed cancer in Pakistan. From the year 1994-3013, total estimated cases of head
and neck cancer in adults were 3531,with distribution of 1336, 2195 in females and males respectively(table
5)[84].
Table 5: Total estimated cases of head and neck cancer in adults, From the year 1994-3013
No.of Oral cavity cancer Cance Throat cancer Cancer of Laryn
patient r of nasal cavity x
s salivar and paranasal
diagno y sinuses
sed glands
Lip Ton Gum Floor and Tonsil Naso- Pyriform Nasal
gue other parts and pharyn sinus & cavity,middle
of mouth orophary x hypopharyn ear and
nx x acc.sinuses
Female 42 501 208 418 186 37 147 279 150 97
Male 116 776 430 673 227 63 423 332 234 861
673
430 423
500 332
227 234
116 63
0
Male
1994-2013
Fig.3: 1994-2003 Data
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500
400
300
200 501 418
100 208 186 279
147 150 97
0 42 37
1994-2013
Tests References
1.Taking medical history of patient [85]
2.Physical examination [86]
3.Complete head and neck exam [87]
i. Indirect pharyngoscopy and laryngoscopy
ii. Direct (flexible) pharyngoscopy and laryngoscopy
iii. Panendoscopy
4.Biopsy [88, 89]
i. Exfoliative cytology
ii. Incisional and excisional biopsies
iii. Endoscopic biopsy
iv. Open (surgical) biopsy
v. Fine needle aspiration (FNA) biopsy
vi. Lab tests of biopsy samples (HPV testing)
5.Imaging tests [90]
i. Chest x-ray
ii. Computed tomography (CT)
iii. Magnetic resonance imaging (MRI)
iv. Positron emission tomography (PET)
6.Barium swallow [91]
7.Other tests (Blood tests ) [92]
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The term TNM (Tumor, node, metastasis) was first staging system uses all the information based on
time described by Pierre Denoix in the decade of clinical perspective gathered from complete physical
1940[61]. It is referred to as anatomic system of examination, radiographic, intraoperative and
staging through which clinician are able to classify pathological findings, and gives detail about the size
the head and neck tumor’s site in a particular way of primary tumor(anatomic extent), regional lymph
that provide assistance in measurement of level of nodal involvement and also distant metastasis as
disease status, diagnosis and management. This . well[93].
Table 7: Staging of head and neck cancer according to the AMERICAN JOINT COMMITTEE ON
CANCER (AJCC) [[94]
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Table 9: General treatment principles of HNC on the basis of clinical stages[[109, 110]
For the SCC of all HN sites excluding nasopharynx For nasopharyngeal cancer
Early SCC (T1-2 N0- Advanced HN tumours (T3-4 Tumor with distant i)Radiotherapy(once or twice
1) or N2-3) metastases a day),
i)Surgery i)Radiotherapy neck i)Chemotherapy
dissection ii)Combined chemo-
ii)radiation ii)palliative radiotherapy radiotherapy either prior to
ii)surgery definitive treatment or as
adjuvant therapy
postoperative radiotherapy
iii)Adjuvant therapy
following definitive therapy.
iii)chemoradiotherapy
combine
Table 10: Possible side effects related to HNC treatment: [25, 111, 112]
Side effects
Radiotherapy Surgery Chemotherapy
Xerostomia,Mucositis, Myelitis, After surgery Patients experience Fatigue, indolence, anemia, hair
osteoradionecrosis, Oropharyngeal problems while eating, breathing, loss, soreness in mouth, nausea,
candidiasis (OPC), Dental caries, and speaking. other risks associated vomiting, diarrhea, memory
Periodontal disease, loss of appetite, with are infections, blood clots, problems, change in taste and
trismus, radiation fibrosis, Stricture wound breakdown. Lose of patient become more susceptible to
and Dysphagia, primary sensation. Dry mouths, permanent infection, stinging sensation due to
hypothyroidism , Ocular Toxicity, change in appearance, stiff neck are nervous break .
Ototoxicity, Temporal lobe necrosis the long lasting effect of surgery.
(TLN), weight and hair loss, white
spots in the mouth due to thick
saliva/less saliva.
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