Head and neck squamous cell cancer Head and neck squamous cell carcinoma (HNSCC) is relatively common and is strongly related to smoking and alcohol consumption but infection by human papillomavirus has also emerged as a risk factor for HNSCC. The treatment of these tumors is complicated and patients are best served by a multidisciplinary team. The therapy now commonly involves a multidisciplinary approach including surgery, radiation treatment and chemotherapy. Lower stage disease carries a relatively good prognosis. The treatment of metastatic HNSCC remains unsatisfactory and the prognosis of these patients is poor.

Icel Med J 1009; 95: 671-80.

 

 

Figure 1.

CT scans of head and neck squamous cell cancers of various stages. A. T1 tongue cancer (red arrow). B. T3 tongue cancer (red arrow). C. T2 tonsil cancer (red arrow). D. T2 hypopharyngeal cancer(red arrow). E. T2 right true vocal cord cancer (red arrow). F. Cervical lymph node metastasis (red arrow). G. T4a oropharyngeal cancer of the base of tongue (red arrow). H. T4a anterior floor of mouth cancer (red arrow) which has invaded the mandible. I. T4b nasopharyngeal cancer (red arrow) which has wrapped around the internal carotid (blue arrow head). J. T4b oropharyngeal cancer (red arrow) which has wrapped around the internal carotid (blue arrowhead).

 

Figure 2.

Clinical pictures of head and neck squamous cell cancers of various stages (red arrows point to the tumors) . A. T1 cancer of the tongue. B. T2 cancer of the tongue. C. T2 cancer of the tonsil. D. T2 cancer of the hypopharynx. E. T2 cancer of the right vocal cord. F. Cervical lymph node metastasis. G. T4a cancer of the base of the tongue. H. T4a cancer of the floor of the mouth eroding through the mandible. I. T4b cancer of the nasopharynx surrounding the internal carotid artery (blue arrowhead). J. T4b cancer of the oropharynx surrounding the internal carotid artery (blue arrowhead).

 

Figure 3.

68 year-old female, a heavy smoker, admitted with shortness of breath attributed at first to COPD. Found to have a large squamous cell carcinoma of the larynx. PET/CT shows the primary tumor (yellow arrows). There are no positive neck nodes but she has a tracheostomy (green arrow). The PET/CT also shows a tumor in the right lung (red arrow) which originated from a segmental bronchi and was believed to be a second primary. Normal uptake is seen in the in left ventricle of the heart (blue arrow).

 

Figure 4.

60 year old male, heavy smoker, presented with a left sided neck mass. PET/CT shows uptake in lymph nodes on both sides of neck indicating metastatic disease (yellow arrows). It furthermore shows an uptake in the right tonsil (blue arrow) and an uptake in the hypopharynx indicating another primary tumor (red arrow).

 

Figure 5.

Head and neck anatomic subsites

Oral cavity is defined from vermilion border of lips back to anterior tonsillar pillar. Superiorly it reaches the border of soft and hard palate and anterior 2/3 of the tongue is included in the oral cavity. Other subsites of oral cavity are: mobile tongue, floor of mouth, buccal mucosa, lips, hard palate, retromolar trigone and alveolar ridges.

Oropharynx includes the soft palate, tongue base (posterior 1/3 of tongue), tonsils, posterior pharyngeal wall. It´s inferior extent is the vallecula.

Hypopharynx is defined from the vallecula down to the cricoid cartilage and includes the piriform fossae, postcricoid area and posterior wall.

The larynx is divided into three areas: Supraglottis, glottis and subglottis. The supraglottis is further subdivided into epiglottis, aryepiglottic folds, arytenoids and false vocal cords. The glottis goes from the false vocal cords and goes 1 cm down below the true vocal cords. Subglottis is defined from the lower part of glottis down to inferior part of the cricoid cartilage.

Reprinted with permission from: Cancer Management: A Multidisciplinary Approach, 11th edition 2008. Pazdur R, Wagman L, Camphausen K, et al (Editors).

  

Figure 6. 

Cervical lymph node levels.

Reprinted with permission from: Cancer Management: A Multidisciplinary Approach, 11th edition 2008. Pazdur R, Wagman L, Camphausen K, et al (Editors).

 

Table I.

TNM staging of head and neck cancer.

 

Table II.

Incidence, mean age at diagnosis and five year relative survival of Icelandic men and women with squamous cell carcinoma of the head and neck.