Primary Care Otolaryngology

Chapter 16

Head and Neck Cancer

Diagnosis and management of head and neck cancer is a broad topic. In this chapter we will provide background information about the disease, informa- tion on diagnosis and management, and a few case studies. These will help you understand how to integrate information and treatment modalities to affect a successful, modern approach to head and neck cancer. Head and neck cancer primarily refers to carcinomas of the larynx; naso-, oro-, and hypopharynges; paranasal sinuses; salivary glands; and oral cav- ity. Historically, the majority of these cancers occurred in patients with a history of smoking and alcohol use, and were squamous cell carcinomas of the upper aerodigestive tract. While this is still true, the incidence of oropharyngeal cancers is increasing, primarily due to HPV-mediated can- cers. Almost all (95%) head and neck cancer is squamous cell carcinoma. The cancer originates from the cuboidal cells along the basement membrane

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of the mucosa. Under the microscope, the cancerous cells appear flat, so the cancer is called squamous (from the Latin squama , “a scale or platelike structure”) cell carci- noma. Figure 16.1 is a common presentation of a head and neck cancer. An adult patient with a persistent lump in the neck is very likely to have a malignant process, with its origins in the upper aerodigestive tract. A single course of antibiotics is warranted, but preparation should be made for imme- diate consultation with an otolaryngolo- gist–head and neck surgeon, as there is a high likelihood that this represents a neo- plasm.

Figure 16.1. Neck mass in an adult patient with squamous cell carcinoma of the hypo- pharynx who presented to the primary care physician with a large, firm neck mass. Needle aspiration confirmed the diagnosis of squamous cell carcinoma.

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