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Margarita Mega Pertiwi (UPN)

Willy Tenjaya (UKRIDA)

What is head and neck cancer?


Head and Neck
Cancer is a
group of
cancers that
includes tumors
in several areas
above the
collar bone.

Head and Neck Cancer has three


major subdivisions:
1.Oral Cancer
2.Laryngeal Cancer
3.Nasopharyngeal Cancer

Head and Neck Cancer


Squamous cell carcinoma of the
head and neck (SCCHN) occurs in
50,000 new cases annually in the
US, resulting in over 13,000 deaths
each year

Risk Factors for Head and Neck Cancer


Tobacco Products:

Smoking Tobacco
Cigarettes
Cigars
Pipes
Chewing Tobacco

Chemicals:
Asbestos
Chromium
Nickel
Arsenic
Formaldehyde

Other Factors:
Ionizing Radiation

Snuff

Plummer-Vinson Syndrome

Ethanol Products

Epstein-Barr Virus
Human Papilloma Virus

Possible Occupational Risks


for Head and Neck Cancer

*Wood working
*Leather manufacturing
*Nickel refining
*Textile industry
*Radium dial painting

Warning Signs of Head and Neck


Cancer
Hoarseness

Serous otitis media

Erythroplasia

Neck mass

Referred otalgia
Persistent sore throat

Epistaxis
Nasal obstruction

Non-healing ulcer
Dysphagia

Submucosal mass

Not all cancers present with


symptoms at early stages!

Factors Delaying the Diagnosis of


Head and Neck Cancers

Patient procrastination in seeking


medical attention

Physician delay in diagnosis


Patient remains asymptomatic for a
prolonged period

70
60
50
40

Caucasian
African-American

30
20
10
0
Localized

Regional

Distant

Stage at Diagnosis

Research in Head and Neck Cancer


Biomarkers at UPCI
Concentrations of 60 cytokines, growth
factors, and tumor antigens were measured
in the sera of 116 SCCHN patients prior to
treatment (active disease group), 103
patients who were successfully treated (no
evidence of disease, NED, group), and 117
smoker controls without evidence of
cancer.

*Find it, usually late


-over 80% of tumors are late stage

*Surgery (cut it out)


*Radiation (burn it)
*Chemotherapy (selective poisoning)
*Combine the above

The Key to Curing Cancer


Stop all smoking (causes more cancer
deaths than any other factor)
Ignore cancers due to:
Low level exposures
Multifactorial genetic predisposition
Stochastic phenomena

*Prevention
definition of more subtle genetic and environmental risk
factors

*Targeted Therapy
- Molecular and otherwise

*Screening
Molecular Screening for early disease
Genetic screening for inherited cancer
susceptibility

Conventional screening for non-genetic risk factors


o Pap smear, colonoscopy, etc

The purpose of this study is to present the

experience treating patients with squamous cell


carcinoma (SCC) from an unknown head and

neck primary site and to determine whether a


policy

change

eliminating

the

larynx

and

hypopharynx from the radiotherapy (RT) portals


has impacted outcome.

179 patients received definitive RT with or without a

neck dissection for SCC from an unknown head and neck


primary site. RT was delivered to the ipsilateral neck
alone or both sides of the neck and, usually, the

potential mucosal primary sites. The median mucosal


dose was 5670 cGy. The median neck dose was 6500 cGy.
109 patients (61%) received a planned neck dissection.

*Mucosal control at 5 years was 92%. The

mucosal control rate in patients with RT


limited to the nasopharynx and oropharynx
was 100%.

*The 5-year neck-control rates were as follows:


*N1,94%;
*N2a, 98%;
*N2b, 86%;
*N2c, 86%;
*N3, 57%; and overall, 81%.

The 5-year cause-specific survival rates


were as follows:

*N1, 94%;
*N2a, 88%;
*N2b, 82%;
*N2c, 71%;
*N3, 48%; and overall, 73%.

The 5-year overall survival rates were as


follows:

*N1, 50%;
*N2a, 70%;
*N2b, 59%;
*N2c, 45%;
*N3, 34%; and overall, 52%.

Eleven patients (7%) developed


severe complications

RT alone or combined with neck dissection


results in a high probability of cure with a
low

risk

of

severe

complications.

Eliminating the larynx and hypopharynx


from the RT portals did not compromise
outcome and likely reduces treatment
toxicity.