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INTRODUCTION

Epidemiology

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Epidemiology
Incidence:

Estimated new cases for 2019 in the United States

Tongue: 17,060 (male, 12,550; female, 4510)

Mouth: 14,310 (male, 8430; female, 5880)

Pharynx; 17,870 (male, 14,450; female, 3420)

Other oral cavity: 3760 (male, 2710; female, 1050)

Larynx: 12,410, (male, 9860; female, 2550)

Deaths:

Estimated deaths in 2019 in the United States

Tongue: 3020 (male, 2220; female, 800)

Mouth: 2740 (male, 1800; female, 940)

Pharynx: 3450 (male, 2660; female, 790)

Other oral: 1650 (male, 1290; female, 360)

Larynx: 3760 (male, 3010; female, 750)

Median age:

Oral cavity and pharynx 63 years

Tongue 63 years

Larynx 65 years

Male to female ratio: 2.76:1

Siegel R et al. CA Cancer J Clin 2019;69:7–34

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov [accessed October 2019]

Pathology

  1. Squamous carcinomas (90%)

  2. Lymphomas

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

  4. Sarcomas

  5. Melanomas

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

  7. PET (CT) in locally advanced disease

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, panorex, 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

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

Clinical Regional Lymph Node (N) Definitions for Cancers of the Oral Cavity, Major Salivary Glands, Paranasal Sinuses, Nasal Cavity, Oropharynx (p16[–]), Hypopharynx, and Larynx
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 and ENE(–)
N2 Metastasis in a single ipsilateral lymph node, larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(–), or in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(–), or in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(–)
N2a Metastasis in a single ipsilateral lymph node, larger than 3 cm but not larger than 6 cm in greatest dimension and ...

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