Chapter 19: Head and Neck Cancers

Epidemiology

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