HEAD AND NECK

SQUAMOUS CELL
CARINOMA
Uneke Edwards
MD5
#1607

TABLE OF CONTENTS

Introduction
Classification
Etiology
Signs and Symptoms
Clinical features
Diagnosing
Treatment
Prognosis
References

INTRODUCTION: WHAT IS IT?

Squamous cell carcinomas (SCC) are cancers that

arise from outer layer of skin and mucosa

Head and neck squamous cell carcinomas (HNSCC)

affects oral cavity, oropharynx, nasal cavity, paranasal
sinuses, larynx and hypopharynx

Sixth most cancer worldwide (affects men in 50s and

60s)

Accounts for 90% of all Head and neck cancers

INTRODUCTION: WHAT IS IT?

Affects men more than women

The major cause is tobacco smoking (75% cases)

Has a good prognosis, if caught early usually

treatable.

Accounts for 90% of all Head and neck cancers

CLASSIFICATION

HNSCC can present in the oral cavity,

oropharynx, larynx, nasal cavity, nasopharynx
hypopharynx, paranasal sinuses and trachea.
According to WHO, HNSCC can be categorized
in these different types:
Conventional
Verrucous
Basaloid
Papillary

Spindle cell
Acantholytic
Adenosquamous
Cuniculatum (oral mucosa
only)

CLASSIFICATION

contd

HNSCC often develops from preexisting dysplastic

lesions and these lesions can also be classified as:

Mild, moderate, severe (carcinoma in situ)

Well, moderate or poorly differentiated

Keratinizing or Non-keratinizing

ETIOLOGY
Tobacco Smoking and Excess alcohol intake
The most common cause of HNSCC is associated with
tobacco smoking. About 75% of cases are due to
smoking. This is especially associated with oropharyngeal
type of HNSCC

Human papillomavirus (HPV)

Particularly, HPV16 is a cause of HNSCC in about 1525% of cases. They do this by the expression of viral
oncoproteins (E6,E7) and by other mechanisms such as
disruption of tumor suppressor genes. HPV associated
HNSCC affects oropharynx, hypopharynx and oral cavity.

ETIOLOGY
Radiation

contd

Exposure

Epstein-Barr

Virus (EBV)
Highly associated with Nasopharyngeal cancer

Occupational

Exposure
Exposure to wood dust, asbestos, synthetic fibers,
metal dust, formaldehyde can increase risk of
nasopharyngeal, laryngeal and sinus cancer

Leukoplakia

White patches on the mucosa of tongue have

increased risk of becoming cancerous

SIGNS AND SYMPTOMS

Neck Mass

Sore throat

Neck pain

Hoarse Voice

Dysphagia

Enlarged lymph
nodes

Mouth
ulcers(painless)

Lump on lips,
mouth or gums

SIGNS AND SYMPTOMS

Oral cavity: A white or red patch on the gums, the

tongue, or the lining of the mouth; a swelling of
the jaw ; unusual bleeding or pain in the mouth;
referred pain to ear, dysphagia. It includes inner
lip, tongue, floor of mouth, gingiva and hard palate

Pharynx: Trouble breathing or speaking; pain

when swallowing; pain in the neck or the throat
that does not go away; frequent headaches, pain,
or ringing in the ears; or trouble hearing,
hoarseness, hemoptysis.

SIGNS AND SYMPTOMS

Larynx: Pain when swallowing or ear pain.

Paranasal sinuses and nasal cavity:

Sinuses that are blocked and do not clear;
chronic sinus infections that do not respond to
treatment with antibiotics; epistaxis; frequent
headaches, swelling or other trouble with the
eyes; pain in the upper teeth; rhinorrhea,
paresthesia

DIAGNOSING

The doctor evaluates a persons medical

history, performs a physical examination, and
orders diagnostic tests such as needle biopsy
head and neck computed tomography (CT)
scan or magnetic resonance imaging (MRI)

If the diagnoses is cancer, doctors discuss the

severity and whether metastasis has occurred
and discuss optimal treatment whether
surgery, medicine or radiation is required

TREATMENT
Radiation Therapy
The most common form of treatment.
There are different forms of radiation
therapy, including 3D conformal radiation
therapy, intensity-modulated radiation
therapy, and brachytherapy, which are
commonly used in the treatments of
cancers of the head and neck

TREATMENT
Chemotherapy
Docetaxel-based chemotherapy has shown a
very good response in locally advanced head
and neck cancer. Taxotere is the only taxane
approved by US FDA for Head and neck
cancer, in combination with cisplatin and
fluorouracil for the induction treatment of
patients with inoperable

TREATMENT

contd

Surgery
In selected cases of localized recurrence,
surgery (if operable) or re-irradiation can be
considered.

PROGNOSIS

If caught in early stages, HNSCC has a

very good prognosis, up to 50%.

Has a 5 year survival rate

If the cancer metastasize to lung and

lymph node, prognosis becomes less
than 50% and can be fatal

Clinical Case 1

A 61yr old man has had progressive hoarseness over

the past 8 months. he has smoked 2 packs of
cigarettes for 40yrs. cervical LN are palpable.
Laryngoscopy shows 1cm ulcerated mass involving
the true vocal cord. histologic tissue from the mass is
most likely to show??

a - adenocarcinoma
b - lymphoepithelioma
c - papilloma
d - polyp
e- squamous cell carcinoma

REFERENCES

http://ghr.nlm.nih.gov/condition/head-andneck-squamous-cell-carcinoma
http://www.esmo.org/Guidelines/Head-andNeck-Cancers/Squamous-Cell-Carcinomaof-the-Head-and-Neck
Robins Pathology textbook 2014
http://www.cancer.gov/types/head-andneck/head-neck-fact-sheet#q1
http://www.nature.com/nature/journal/v517/n
7536/full/nature14129.html
Google Images

THANK
YOU!