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Chapter 14

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INTRODUCTION

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Epidemiology

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Epidemiology
Incidence:

Tongue 13,590 (male: 9,720; female: 3,870. Estimated new cases for 2014 in the United States)

Mouth 11,920 (male: 7,150; female: 4,770. Estimated new cases for 2014 in the United States)

Pharynx 14,410 (male:11,550; female: 2,860. Estimated new cases for 2014 in the United States)

Larynx 12,630 (male: 10,000; female: 2,630. Estimated new cases for 2014 in the United States)

Deaths:

Tongue estimated 2,150 in 2014 (male: 1,450; female: 700)

Mouth estimated 2,070 in 2014 (male: 1,130; female: 940)

Pharynx estimated 2,540 in 2013 (male: 1,900; female: 640)

Larynx estimated 3,610 (male: 2,870 female: 740)

Median age:

Oral cavity and pharynx 62 years

Tongue 61 years

Larynx 65 years

Male to female ratio: 2.5:1

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

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Pathology

  1. Squamous carcinomas (90%)

  2. Lymphomas

  3. Salivary gland tumors (adenocarcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma)

  4. Sarcomas

  5. Melanomas

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Work-up

  1. History and physical examination

  2. ENT examination

  3. Laryngoscopy with biopsy of suspicious lesions

  4. CT and/or MRI of the head and neck

  5. X-ray or CT of chest (to rule out metastatic disease or second primary tumor)

  6. Needle biopsy of lymph node not associated with obvious primary tumor

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Organ Site Specific Work-up

  1. Ethmoid sinus: H&P, CT and/or MRI, CXR, pathology review if diagnosis with incomplete excision

  2. Maxillary sinus: H&P, Head and neck CT with contrast ± MRI, CXR, dental/prosthetic consultation as indicated

  3. Salivary glands: H&P, CT/MRI, CXR, pathology review

  4. Lip, oral cavity: H&P, CT/MRI, parorex, biopsy, preanesthesia studies, dental evaluation

  5. Hypopharynx: H&P, biopsy, CXR or chest CT, CT with contrast or MRI of primary and neck, examination under anesthesia with laryngoscopy/esophagoscopy, preanesthesia studies, dental evaluation, multidisciplinary consultation as indicated

  6. Glottic larynx: Same work up as for hypopharynx + CT scan with contrast and thin cuts of the larynx or MRI of primary, speech and swallowing studies

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Staging

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Staging

Primary Tumor (T)

  • Differs for each site

  • For larynx and hypopharynx cancers, vocal cord paralysis indicates at least T3

  • Local invasion of adjacent structures indicates T4

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Staging

Regional Lymph Nodes (N)

NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
N2 Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension, or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
N2a Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
N2b Metastasis in multiple ipsilateral lymph nodes, ...

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