Tumors of the head and neck lectures on oncology. From brain tissue. Types of head and neck tumors

Description:

A heterogeneous group emanating from the oral cavity, pharynx, upper respiratory tract And thyroid gland.
Majority malignant diseases head and neck are represented by squamous cell carcinoma, undifferentiated carcinoma and lymphoepitheliomas of the nasopharyngeal zone.
Malignancies of the head and neck account for approximately 3-5% of all cancers. High prevalence is observed among men over 50 years of age.

Causes of head and neck cancer:

RHS has not been studied enough.
Predisposing factors for the development of HNS are considered:

smoking
alcohol abuse
ionizing radiation
family history
Mongoloid race
prolonged contact with asbestos

Classification:

Histological classification:

1. Squamous cell carcinoma (90%)

3. Tumors salivary glands:

a. adenocarcinoma

b. adenoid cystic cancer

c. mucoepidermoid carcinoma

Tumors of the head and neck are predominantly ectodermal - squamous cell carcinomas varying degrees differentiation Low-grade epidermal carcinomas, lymphoepitheliomas, and transitional cell carcinomas are usually located in the nasopharynx, tonsils, lower pharynx, and mobile tongue.
Non-epidermoid tumors account for 10% of head and neck cancers and arise from areas of glandular tissue. In the salivary glands there can be mixed tumors and columnar cell carcinomas (adenocystic), mucoepidermal and acinar cell carcinomas. Adenocarcinomas can occur in the nose, maxillary sinus, or nasopharynx. Lymphomas occur in the nasopharynx, nasal passages and tonsils. Sarcomas arise in maxillary sinuses And lower jaw.
head and neck is classified according to the size and location of the primary tumor, the number and size of metastases to the cervical lymph nodes, and the presence or absence of distant metastases. Staging of HNSCC is carried out according to the TNM system (AJCC and UICC).

Symptoms of head and neck cancer:

Symptoms of head and neck cancer depend on the location of the tumor process. When localized in the oral cavity and pharynx, symptoms may include prolonged sore throat, unilateral enlargement of the tonsil (in adults), ulcerative lesion mucous membranes, neoplasm of the jaw, speech/phonation disorders (dysarthria with tongue cancer, voice changes with cancer of the larynx or nasopharynx), etc. If localized in the nasal cavity, difficulty in nasal breathing, hemorrhagic and purulent discharge from the nasal passages (usually one-sided), persistent one-sided, headaches. When the salivary glands are affected, a palpable tumor is determined in the area of ​​​​the gland’s projection, impaired coordination of the muscles of the face and neck with the involvement of the cranial nerves, pain, etc. The spread of the tumor process can manifest itself in the form of unilateral deafness, often against a background of serous deafness.
These symptoms are often accompanied by symptoms.

Treatment for head and neck cancer:

For treatment the following is prescribed:

Traditional method Treatment of patients with head and neck cancer remains a combined method, including radiation therapy and surgery.  

Induction chemotherapy (before surgery or radiation therapy) for locally advanced tumors achieves remission in more than 80% of cases, reduces the risk of distant metastases, but does not affect the risk of local relapse and survival. With moderate spread, chemoradiotherapy can destroy the tumor and save the larynx.

Adjuvant chemotherapy has greatest effect– for cancer of the larynx and nasopharynx. Cisplatin is the most effective. In addition, carboplatin, fluorouracil, bleomycin, mitomycin, methotrexate, topotecan, vinorelbine, gemcitabine, capecitabine, docetaxel or paclitaxel in monotherapy cause remission in 15-30% of patients, but do not increase disease-free and overall survival.

Adjuvant chemoradiotherapy reduces the risk of local and regional relapse and increases survival for locally advanced cancer of the oral mucosa, larynx and pharynx.

Polychemotherapy is used for metastatic tumors. Increases remission rate than monotherapy, but does not improve survival. Traditionally, two regimens are used: PF (cisplatin and fluorouracil) and PEL (cisplatin, fluorouracil, calcium folinate).

Considering the development of serious side effects combination therapy, it is recommended to carry out treatment aimed at correcting emerging disorders. High efficiency has a modern antiemetic drug - granisetron

In patients with a history of prolonged or febrile neutropenia, filgrastim is prescribed.

The term “tumors of the head and neck” describes malignant neoplasms of various histological structures, localized on the mucous membrane of the lips, in the oral cavity, pharynx, larynx and cervical esophagus, nasal cavity and paranasal sinuses, salivary glands. IN general concept“Tumors of the head and neck” do not include tumors of the central nervous system, neoplasms of the eye, primary tumors of the lymphatic system, tumors of the nervous and endocrine systems, which can also develop in this anatomical region. Tumors of the scalp (melanoma, cancer) are discussed in the relevant sections.

Due to the diversity of tumor locations and the tissues from which they originate, the biology of tumor growth, pathways of metastasis, tumor boundaries, and signs and symptoms of the disease vary dramatically. One of the common features of the clinical course of most malignant tumors of the head and neck is high risk development of locoregional relapses (up to 80%) and new tumors, which are observed in at least 20% of patients. Some time after treatment is completed, the risk of developing a second tumor may even exceed the risk of a recurrence of the first. Distant metastases most often develop as the disease progresses and are usually localized in the lungs, bones, and liver. In close proximity to death, distant metastases are clinically detected in 10-30% of patients.

9. General principles of treatment.

Treatment depends on factors related to the characteristics of the tumor and the general condition of the patient. The main goals of therapy are cure of the tumor, preservation or restoration of the functions of the oral cavity, and reduction of treatment complications. A successful treatment outcome usually requires a multidisciplinary approach. Chemotherapy and radiation treatment should be well organized and supervised by chemotherapists and radiologists who have knowledge of the characteristics of treatment and complications in this patient population.

The patient's ability to tolerate the optimal treatment program is an important factor in the decision to undergo it.

The choice of treatment strategy is mainly made between surgical treatment, radiation therapy and combined methods.

The surgical method is acceptable only for the treatment of stage I tumors that can be radically removed with a good functional outcome. In other cases, cancer Stages I-II treated with radiation and in combination. Patients with advanced cancer always require combination treatment. An integral part of the treatment of these patients are extended resections with reconstructive operations. The use of neoadjuvant chemotherapy in a number of locations or simultaneous chemotherapy and radiation treatment makes it possible to increase the number of organ-preserving interventions and transfer some initially unresectable tumors to a resectable state.

10. Principles of radiation treatment. Requirements for initial information about the patient before starting treatment:

a clear clinical description of the tumor and regional lymph nodes (location, size of the tumor and each clinically affected node, number of lymph nodes);

morphological verification of the tumor process;

objective confirmation of clinical information using ultrasound and CT (if necessary).

10.1. Position of the patient during irradiation.

On the back, the head tilts (forward or backward) to the extent that provides maximum exclusion spinal cord from the area of ​​the planned irradiation volume. It is important to use immobilization systems (masks, head holders) and orthogonal laser beams to reproduce the chosen position.

10.2. General pre-radiation preparation.

In all patients with head and neck tumors subject to radiation therapy, the oral cavity must be sanitized. If it is necessary to remove teeth in the area of ​​the irradiation volume, wound healing must occur before the start of irradiation.

10.3. Planning the volume of irradiation.

The planned volume of exposure includes:

anatomical area with a macroscopically detectable tumor;

an additional supply of tissue (at least 1 cm) to take into account the subclinical spread of the tumor process, the patient’s movement and possible errors in reproducing the patient’s position during irradiation;

in the presence of a tracheostomy, the tracheostomy itself is included in the irradiation volume - in patients with tumors of the laryngopharynx, all parts of the larynx, if the tumor of the larynx has spread to the subglottic region; in patients with oropharyngeal tumors infiltrating the preepiglottic space, as well as in patients receiving postoperative radiation due to the presence of tumor cells at the edges of tissue cutting.

10.4. Equipment.

Special pre-radiation preparation is mandatory, including when using any fields and blocks, and is carried out using CT and simulators, X-ray simulators and computer planning systems.

A planning system based on CT data ensures adequate dose distribution. If it is not possible to directly use CT data for planning radiation therapy using three-dimensional planning systems, the planned volume in accordance with CT data should be outlined, if possible, on 3 slices. Irradiation is carried out with a photon beam at gamma-therapeutic units 60Co (1.25 MV) or at a linear accelerator (4–8 MV), as well as with an electron beam (6–15 MeV). The use of photon radiation above 6 MeV without compensators should be avoided in patients with metastatically affected lymph nodes or with a small volume of soft tissue on the patient’s thin neck.

Experts include the term “head and neck cancer” in the group of biologically similar cancers. These types of cancer appear more often from the upper part digestive tract. These include diseases such as:

Acute and chronic periodontitis - treatment and symptoms

periodontal diseases listed in the 1999 classification Signs and symptoms of periodontitis On early stages chronic periodontitis. evidence of connection revealed chronic periodontitis with squamous cell carcinoma of the head and neck. “Patients with periodontitis are more likely to get sick.

• Lip cancer;
• Nasal cavity cancer and oral cavity cancer;
• Paranasal sinus cancer;
• Laryngeal cancer and pharynx cancer.

Approximately 90% are HNSCC or squamous cell carcinoma. It develops from the epithelium (mucous membranes) of the above areas.

Video about cancer

It often happens that this type cancer spreads to the cervical lymph nodes. In many cases this is the first manifestation of the disease. Sometimes even the only thing that complicates the diagnosis.

• The prevalence of this type of cancer is largely associated with the following risk factors:
• Environmental factors;
• Lifestyle (especially bad habits. such as smoking, drinking alcohol or using drugs);
• Certain strains that are sexually transmitted (for example, papilloma).

Head and neck cancer is considered a curable disease. The main thing is to detect it in time. Treatment is usually done with chemotherapy. Radiation therapy is also considered very effective. Some patients require surgery. In 2009 alone, the number of patients in America increased significantly and almost reached thirty-six thousand people.

Classification of head and neck cancer

In most cases, neoplasms in the neck and head turn out to be squamous cell carcinoma, arising from the mucous surfaces of this anatomical region. This includes tumors oral cavity and nasal cavity, oropharynx, nasopharynx, larynx, as well as tumors in paranasal sinuses nose

Squamous cell carcinoma is general illness the entire oral cavity ( inner part lips, floor of mouth, tongue, hard palate, gums). The occurrence of this type of cancer is largely associated with tobacco use. It’s not even smoking that has the greatest impact, but chewing tobacco. Alcohol abuse also has a negative effect. Quite often, surgical methods are used to cure oral cancer.

Surgeries for oral cancer may include the following:

• Resection upper jaw. They can do it with or without orbital exenteration.
• Resection of the lower jaw. In this case, the lower jaw is either completely or partially removed.
• Resection of the tongue. Either its complete or partial removal.
• Case-fascial excision of cervical lymph nodes.
• Operation according to the Mohs method.
• Combination, for example simultaneous resection of the tongue and larynx.

Defects caused by surgery are most often hidden by using skin grafts, wearing a prosthesis, or using another part of the body.

Nasopharyngeal cancer appears in the nasopharynx area, that is, in the place where Eustachian tube, which goes to the top of the throat and nasal cavity. In some cases, nasopharyngeal tumors may resemble HNSCC, but nasopharyngeal cancer will still exist in biology, epidemiology, and clinical behavior, in treatment - a separate disease.

Oropharyngeal squamous cell carcinoma, or OSC, occurs in the oropharynx. This is the middle part of the throat. It includes the root of the tongue, soft palate, and tonsils. Squamous cell carcinoma of the tonsils is significantly more dependent on the human papillomavirus than any other type of head and neck cancer.

The area of ​​the laryngopharynx includes the anterior wall, which is formed from the root of the tongue. By the time the diagnosis is made, the tumor in the hypopharynx may be at an advanced stage. Usually the most unfavorable diagnoses are presented for pharyngeal tumors. Due to the well-developed lymphatic network around the larynx area, there is a tendency to early onset metastasis.

Laryngeal cancer begins to develop in the “voice box.” This is what the larynx is often called. The tumor also appears on the most vocal cords, and on fabric. which is located both above and below them. This type of cancer is largely associated with smoking.

Treatment is mainly carried out surgical methods. They can consist of either a partial laryngectomy or a complete one. That is, the larynx will be either completely or partially removed. In the case when the larynx is completely removed, the patient needs to undergo a tracheotomy. That is, he will need to learn to speak again. This is achieved through speech therapy and intensive training. Electronic devices may also be used.

Tracheal cancer is considered quite rare malignant neoplasm. Biologically, it is very similar to head and neck cancer, and may sometimes be classified as such.

Moreover, almost all tumors of the salivary glands will differ from carcinoma of the neck and head in their etiology, in clinical manifestations, in the treatment used, etc.

There are other unusual tumors that occur in the head and neck. These include mucoepidermoid carcinomas, teratomas, adenocarcinomas, and adenoid cystic carcinomas. Sometimes even lymphomas and melanomas arising from the upper respiratory-esophageal tract can appear.

Signs and symptoms of head and neck cancer

Most often, throat cancer makes itself felt with symptoms that at first glance look very harmless. These include sore throat, hoarseness, the appearance of lymph nodes on outside neck.

With throat cancer, such symptoms become chronic. A lump or inflammation may appear on the neck or throat. It will not go away or heal. It is likely that swallowing will be difficult and painful. Speech difficulties may also occur. May begin to appear constant pain in the ear. Other, more serious but less common symptoms may occur, including partial facial numbness and muscle paralysis.

Here's more detailed list symptoms:

• Swelling of the neck;
• Neck pain;
• The appearance of bleeding from the mouth;
• Constant accumulations in the sinuses (especially pronounced with nasopharyngeal cancer);
• The emergence of persistent unpleasant odor from the oral cavity;
• Inflammation of the tongue;
• The appearance of a painless ulcer or numerous wounds in the mouth that also do not heal;
• White, red or dark spots in the oral cavity that do not disappear;
• Pain in the ear;
• unusual bleeding in the mouth or numbness;
• The appearance of a tumor on the lip, gum or oral cavity;
• Enlarged lymph nodes;
• Inarticulate speech (in cases where the cancer has already affected the tongue);
• Hoarse voice that persists for more than 1.5 months;
• Sore throat that persists for more than 1.5 months;
• Having difficulty swallowing food;
• Diet changes or weight loss.

Causes

What are the reasons for such dangerous disease. Tobacco and alcohol are considered the most important risk factors. In the United States alone, they have caused many cases of cancer. Such trends are also typical for other countries.

It is believed that when exposed to tobacco and alcohol together, there is a significantly greater likelihood of developing neck and head cancer. Oddly enough, smokeless tobacco is also the etiological causative agent of pharyngeal cancers. Cigar smoking is also an important risk factor for the occurrence and development of cancer.

The risk factors are not limited to these. There are also human environmental factors. Among them, a special place occupies professional activity. People involved in areas where they come into contact with carcinogens are particularly affected. The most dangerous areas are:

• Textile fiber processing;
• Nickel purification;
• Woodworking.

One ongoing study found that smoking marijuana was in no way associated with the occurrence of squamous cell carcinoma. Another study generally confirmed that marijuana is a protective factor, and its use, on the contrary, prevents the occurrence of of this disease.

At the same time, experts still note that smokers have a chance of developing neck and head cancer that is approximately five to twenty-five times greater than those who do not smoke at all. Only twenty-five years after a person quits smoking, his risk of cancer is equal to that of a “non-smoker.”

Both tobacco and alcohol are widespread throughout the world. Cancer prevention may be closely linked to efforts to reduce smoking and regular alcohol consumption.

Dietary factors may also contribute in part to cancer. Current research shows that excessive consumption of raw and processed meats and meat products– increases the likelihood of head and neck cancer. At the same time, when eating vegetables (both raw and cooked), this likelihood decreases.

It is worth noting that taking vitamin E cannot prevent the development of leukoplakia (the appearance of white plaques on the mucous membrane, which are considered a precursor to cancer in smokers). One study even showed that beta-carotene in combination with vitamin E, on the contrary, can cause a deterioration in the condition of patients who smoke, with an early stage of the disease, and who regularly take vitamins.

Eating this nut also increases the likelihood of squamous cell carcinoma.

Human papillomavirus (HPV)

Recent research confirms that some head and neck cancers are caused by viruses. HPV sometimes causes HNSCC. Most often, cancer occurs after HPV16. About 15-25% of all cases of HNSCC also contain HPV in their DNA. The percentage largely depends on the specific location of the tumor. Most often, HPV manifests itself together with oropharyngeal cancer, which causes high level distribution in the tonsils. There, HPV DNA is found in almost half of all recorded cases (45-67%). In the laryngopharynx this is 13-25%, in the oral cavity 12-18%, and least of all in the larynx - 3-7%.

However, many experts believe that even with 50% of tonsil cancer cases HPV infection, only half of them are caused by HPV. In other cases, the main cause is still alcohol and tobacco. In other cases, the role of HPV is still unknown. Cancer caused by HPV will be associated with oral sex.

Also associated with nasopharyngeal cancer Epstein-Barr virus, which is denoted as EBV. Nasopharyngeal cancer is endemic. It appears more often in Asian and Mediterranean countries. There, the level of EBV antibodies is measured, after which the risk group can be identified. Sometimes nasopharyngeal cancer is associated with frequent use salted fish. because the level of nitrites in it is often very high.

Gastroesophageal reflux disease

Presence acid reflux(GERD) or pharyngolaryngeal reflux may be an important factor. In case of acid reflux, acid gastric juice enters the esophagus and damages the lining of the esophagus, making it more susceptible to throat cancer.

Hematopoietic stem cell transplantation (HSCT)

Patients after HSCT are at higher risk of developing squamous cell carcinoma of the neck. After HSCT, oral cancer may have more aggressive behavior with worse prognosis compared to oral cancer in patients who did not undergo HSCT. This occurs due to continuous lifelong immune suppression and chronic oral graft-versus-host disease.

Other Possible Causes

There are many factors that can put a person at higher risk for throat cancer. The first, of course, refers to smoking and chewing tobacco (as well as other substances such as paan or gutkha). Poor nutrition, leading to vitamin deficiency; excessive alcohol consumption; weakened immune system; prolonged exposure to paint fumes or wood dust; frequent exposure to asbestos dust; impact chemical substances during oil refining, as well as old age (over 55 years) - all this can be a reason. Additionally, another risk factor is the appearance of white patches in the mouth, called leukoplakia. In about a third of cases, they eventually turn into cancer.

Diagnosis of head and neck cancer

When a diagnosis is carried out, the patient tells the doctor about his health. In this way, one or more symptoms of the disease can be identified. Most often in oncology clinic Patients undergo a biopsy of the affected area. This procedure is important in determining whether a tumor is malignant or benign. The histopathological information obtained is then discussed at a multidisciplinary meeting between several specialists. Most often this is an oncologist-surgeon. medical oncologist and radiation oncologist. Only then can the optimal strategic treatment plan be determined.

Cancerous tumors that occur in the throat are in most cases classified according to their cellular structure and histology. Their specific location in the mouth and neck is also considered. This is due to the fact that location greatly influences prognosis, since some cancers are more aggressive, others less so. The stage of the cancer is also an important factor.

Squamous epithelial cells are the surface cells of most of the body. The skin and mucous membranes are considered squamous epithelium. This type of cancer is the most common. It accounts for 90% of all types of throat cancer. Most often, this type of cancer occurs in men who are over forty and have a long history of smoking combined with alcohol abuse.

Adenocarcinoma is a cancer of columnar epithelium. It is most common in the lower part of the esophagus. Although it is most common in Barrett's esophagus, it can still appear elsewhere. Adenocarcinoma is a product of Barrett's esophagus.

Preventing head and neck cancer

The most effective form Prevention is the avoidance of all the risk factors that we have already listed. In addition, regular dental examinations may reveal precancerous lesions.

If cancer was diagnosed at an early stage, then the probability of curing it is very high. It is believed that HPV vaccines may reduce the risk of HPV-induced head and neck tumors.

Treatment for head and neck cancer

Due to the fact that diagnosis has been improved, as well as local treatment, such as targeted therapy, and the quality of life and survival of patients with head and neck tumors have improved since 1992.

After a histological examination is carried out, which determines the extent of the tumor, a further treatment, which is completely consistent with the specific type of cancer, and also depends on many other factors (among them general state patient, accompanying illnesses, possible problems with health. social and material factors, patient nutrition, tumor location, etc.). Of course, in order to plan treatment, it is necessary A complex approach which will include participation various specialists(radiation and medical oncologist, surgeon).

In developing a therapeutic conclusion, some generalizations can be very useful, although variations will remain numerous and varied. In most cases, the mainstay of treatment will be surgery and radiotherapy.

In the case where only primary cancers are detected small size that do not form regional metastases use therapeutic radiotherapy or surgical excision. But this is only suitable for stages I and II of the disease. If the primary tumors are more extensive and regional metastases have already begun to appear (that is, the disease has progressed to stages III-IV), a planned combined method can be used. It consists of complete surgical excision and preoperative and postoperative radiotherapy. More recently, due to the fact that the indicators were considered unsatisfactory, the emphasis was shifted to the use different modes chemotherapy.

All patients who have head and neck cancer are usually divided into several clinical groups:

• Patients with local diseases;
• Patients with regional or local diseases;
• Patients with recurrent metastatic disease.

The results of treatment, as well as the tolerability of aggressive treatment methods, are largely influenced by concomitant diseases. Especially those associated with alcohol and tobacco abuse.

There are quite a few different methods and procedures that are used in treatment. To a large extent, the type of treatment will be determined by the extent of the cancer and its location. Patients themselves decide whether or not to agree to a particular treatment method. For example, not everyone agrees to undergo radiation therapy in cases where it will prolong life by only a few months. This is due to the fact that it has quite significant side effects. Others, on the contrary, fight for extra time and agree to it.

Such a method of treatment as surgery in this type cancer used quite often. Most often used complete removal cancerous tumor. This is most difficult to do when laryngeal cancer is detected, because after this the patient will not be able to speak.

During surgery, several lymph nodes are often resected (i.e. removed). This is necessary in order to prevent further distribution tumors.

CO2 laser surgery is a slightly different form of treatment. With the help of transoral laser microsurgery, surgeons can remove tumors from the larynx without even making external incisions. It can also be used to gain access to those tumors that cannot be reached with robotic surgery. Thanks to a microscope, the surgeon can clearly see the edges of the tumor, which reduces the likelihood of removing or damaging healthy tissue. This method reduces speech and swallowing functions less than others after surgery.

This type of therapy is considered the most common in the treatment of throat cancer. Eat different shapes radiation therapy. These include brachytherapy, 3D conformal therapy and intensity-modulated radiation therapy. It is the latter option, together with the use of high-energy photons, that is most often used to treat patients with head and neck cancer in Europe and the USA.

Chemotherapy is practically not used for throat cancer. But here it becomes necessary so that harsh conditions for metastases can be created. This is necessary to prevent their spread throughout the body.

Most often, a combination of several means is used for these purposes. Typically these are carboplatin and paclitaxel. Cetuximab is also used to treat throat cancer.

Chemotherapy with docetaxel shows quite good results, especially in locally advanced cancer. To date, Taxotere is the only taxane approved by the US FDA. medicines and food products.

Not always, but quite often, amifostine is administered intravenously during chemotherapy. It helps protect the patient's gums and salivary glands from negative impact radiation on them.

Photodynamic therapy may be quite promising. Especially when it comes to treating mucosal dysplasia, as well as small tumors of the head and neck. Amfinex shows good results at the start of clinical trials for the treatment of advanced head and neck cancer.

Data from the National Cancer Institute show that targeted therapy is a type of treatment that involves the use of drugs and other substances ( monoclonal antibodies), helping to identify and destroy specific cancer cells without harming normal cells.

Drugs such as erlotinib, bevacizumab, and cetuximab are often used in targeted therapy.

To date top scores cetusimab shows exactly. A 2006 study compared radiation therapy and radiation therapy plus cetuximab. The results showed that in the second case it was possible to achieve significantly more, both in overall survival and in local-regional control. However, there was no significant increase in side effects. Chemoradiotherapy is now the gold standard in the treatment of locally advanced forms of cancer. More detailed results from studies with cetusimab are eagerly awaited.

Another study aimed to evaluate the effects of cetuximab used together with standard chemotherapy (cislatin). However, it was compared with the use of cisplatin alone. There were no improvements associated with the drug combination during this study.

However, another study conducted a little later (March 2007) still showed an increase in survival rates. In 2010, experts concluded that combining cetuximab with platinum and fluorouracil - standard scheme treatment.

In March 2007, patients were recruited for clinical trials. A treatment that included bevacizumab and the angiogenesis inhibitor VEGF was then tested.

Erlotinib is an oral EGFR inhibitor that was found in phase II clinical trials. With its help, the development of the disease is delayed. There is not yet sufficient evidence to demonstrate effectiveness of this product. Clinical trials, evaluating the use of erlotinib in metastatic cancer head and neck are recruiting patients as of March 2007.

Forecast

Even though this malignant tumor responds well to treatment, the prognosis is not always optimistic, since in almost half of the cases the disease is detected in advanced forms. Then you definitely cannot count on complete healing.

In locally advanced cases, the likelihood of recovery also decreases, since it directly depends on the regional location of the node and the size of the tumor. Consensus groups of America (AJCC) and Europe (UICC) have created a staging system for squamous cell carcinoma of the head and neck. This system is an attempt at standardization clinical criteria tests for scientific research that aim to determine prognostic categories for a disease. Staging of squamous cell carcinoma of the head and neck should be carried out according to the TNM classification, where T is the size and spread of the tumor, N is the absence or presence of metastases in the lymph nodes, and M is the absence or presence of distant metastases. TNM characteristics combine to form “stages” of cancer from I to IVB.

Even after successfully completing therapy, patients may experience a dramatic impact on their quality of life. Although many advances have been made in the field of rehabilitation and reconstructive surgery, some patients report significant functional deficits.

The Problem of Primary Multiplicity

All the benefits that are provided using the latest methods treatments were significantly undermined by the high percentage of patients who were initially cured of HNSCC but then relapsed into multiple primary malignancies.

Studies of the incidence of primary multiple tumors range from 9.1-23% per 20 years. This is the main threat to survival on long term perspective, even after successful therapy.

Such a high incidence rate can be explained as a consequence of strong exposure to carcinogens, giving rise to the development of a field of carcinization.

Throat cancer also affects other areas, particularly the digestive system. This is because this type of cancer can impair eating and swallowing functions. Difficulties that arise during swallowing can cause choking, which already in the early stages prevents the normal flow of food into the body.

Also, cancer treatment can be harmful not only to the food system, but also to others. Radiation therapy has vomiting and nausea among the side effects. This can cause the body to become deprived of vital fluids, which are especially important during illness.

Because of frequent vomiting There may even be an electrolyte imbalance, which in turn is bad for the heart. In addition, constant vomiting has a bad effect on the balance of stomach acid, as a result of which another blow is dealt to the stomach. digestive system, especially along the membranes of the esophagus and stomach.

With some types of throat cancer, the airways of the nose and mouth may become blocked. This is due to a tumor.

When throat cancer is located in its lower part, the likelihood of it spreading to the lungs increases greatly, which will also become an obstacle to respiratory functions. Smokers are much more likely to have this option because they have a predisposition to lung cancer.

As with any cancer, metastasis will affect the rest of the body as the disease spreads from one cell to another and from one organ to another. When the disease progresses to Bone marrow, the body begins to produce insufficient red blood cells. It will also affect the functioning of white cells and immune system generally. If this spreads to the circulatory system, then all cells of the body will no longer be supplied with oxygen. Because of this, throat cancer can cause complete chaos in nervous system, which will not be able to properly control the functioning of the body.

Symptoms and side effects

Patients with head and neck cancer may experience the following symptoms as a result of treatment:

• Having problems eating food;
• The appearance of pain associated with metastases;
• Inflammation of the mucous membrane;
• Occurrence of renal toxicity and ototoxicity;
• Constant dry mouth;
• Gastroesophageal reflux;
• Radiation-induced osteonecrosis of the jaw.

Epidemiology

In 2006, 40,490 new cases of the disease occurred in the United States alone. This represents approximately 3% of all species malignant tumors in adults. During the year, 11,170 people died from the disease. If you look at the data taking into account the whole world, it can be noted that only one and a half million people get throat cancer every year. In Europe and the USA, cancer of the pharynx, oral cavity and larynx is more common. While in the Far East and the Mediterranean, nasopharyngeal cancer is more common. Taiwan and Southeast China have very high performance mortality among young men with nasopharyngeal cancer. It is one of the most common causes of death in this category.

• In 2008, there were more than twenty-two thousand new cases of oral cancer in the United States. Among them, 12,250 were laryngeal cancer and 12,410 were pharyngeal cancer.
• 7,400 Americans died from exposure to this type of cancer in 2002.
• More than 70% of throat cancers are at an advanced stage when detected.
• Men are much more likely to receive this diagnosis (89% of cases). And the mortality rate among them is also twice as high.
• Today, African Americans are significantly more likely to suffer from head and neck cancer. Moreover, they have the most early age occurrence of the disease. This category is characterized by relatively low level survivability.
• Oropharyngeal deaths from this disease are strongly influenced by alcohol and tobacco use.
• The likelihood of developing this cancer increases with age, especially after 50. Most patients are between fifty and seventy years of age.

Worldwide, head and neck tumors account for about 10% of malignant tumors. In terms of etiology, clinical picture, and treatment, many types of head and neck tumors are very similar to each other.

For example, 90% of head and neck tumors are squamous cell carcinoma, originating from the mucous membrane of the mouth or pharynx, larynx or lymphoid tissue Waldeyer's rings, in men over 50 years of age.

The first symptoms of head and neck tumors are insignificant. Pain occurs late. Therefore, more than 50% of malignant tumors of the head and neck are detected in late stages, which means that any symptom lasting more than 3 weeks in smokers should be a reason for a thorough examination by a specialist.

For a long time, head and neck tumors remain locally advanced, and therefore an aggressive approach to treatment is warranted.

The prognosis depends on the invasion of surrounding tissues and lymph node involvement. In the absence of involvement of the lymph nodes, regardless of the location and size of the primary tumor, the five-year survival rate is 50%; if the lymph nodes are involved, it decreases to 30%, and if the lymph node capsule grows, up to 20%.

Epidemiology of head and neck tumors

The mucous membranes of the mouth, lips, and upper respiratory tract are exposed to the direct effects of carcinogenic agents that enter the body with inhaled air and food. Tobacco and alcohol are reliable risk factors for the occurrence of tumors in these locations. Each factor can cause a 2-3-fold increase in risk, and when they are combined, the risk increases by more than 15 times. TO etiological factors risk of development include chronic irritation of the mucous membrane various types tobacco: snuff-chewing or placed behind the lip (southern states of America, India, Central Asia). Wood dust leads to sinus cancer in wood industry workers. The connection between the Epstein-Barr virus and lymphomas of the nasopharyngeal zone, HPV and ionizing radiation has been proven - with cancer of the oral mucosa, salivary glands, and thyroid gland.

Precancerous diseases of the head and neck

These include whitish or whitish-gray keratoses, hyperkeratoses and leukoplakias (flat, verrucous), as well as reddish erythroplakias. White plaques on the mucosa may be parakeratosis, acanthosis or dysplasia, carcinoma in situ, which is usually diagnosed after a biopsy. Up to 8% white pathological formations appear to be malignant, although erythroplakia usually raises more suspicion for cancer than leukoplakia.

Examination and diagnosis of head and neck tumors

To fully assess the objective status of a patient with a suspected tumor of the head and neck, the following examination procedure is proposed - examination and palpation (the latter is especially important, since many tumors can be located intramurally and be painless or, conversely, painful in the absence of a primary tumor): skin; lips and oral cavity; pharynx and larynx; nose and nasopharynx; ears; neck and salivary glands.

Any tenderness or induration, enlarged lymph nodes, or ulceration should be considered as manifestations of malignancy of the tumor, unless their likelihood is excluded. 25% lymph nodes, malignant lesion which can be determined histologically, are not palpable during examination.

Special studies - x-rays heads, necks, chest, thyroid gland - are mandatory in terms of clarifying diagnostics. CT is useful in determining the size and location of the tumor. To evaluate cavities and hollow organs, endoscopic examination with biopsy is used. Morphological verification of a head and neck tumor is a mandatory procedure in the diagnostic process.

Before choosing a treatment method, a complete clinical examination of the patient is carried out. In many cases, health conditions worsen due to the inability or restriction of food intake. Often, to restore nutrition, a gastric tube may need to be inserted through the nose to best prepare the patient for healing. surgical wound and radiation procedures.

Before irradiation of the oral cavity, dental sanitation is required (filling or removal of diseased teeth that cannot be saved), the appointment of sodium fluoride for the prevention of caries, radiation fistulas and osteonecrosis of the lower jaw.

Treatment of head and neck tumors

Surgery and radiotherapy are the most effective and complementary treatments. Their capabilities are well known. Chemotherapy and immunotherapy are mainly used for palliative and adjuvant purposes. The treatment program is developed during a joint consultation different specialists. Ideally, a multidisciplinary consultation should include a dental surgeon, a radiologist and an attending oncologist. The patient is informed about treatment alternatives and risks. The decision regarding preoperative or postoperative radiation is made on an individual basis based on the personal preference and experience of the surgeon.

The choice of treatment depends on: the size of the primary tumor; growth forms (exophytic or infiltrative); bone and muscle involvement; radical possibilities; patient's condition; ability to preserve speech and swallowing; patient's profession; experience as a surgeon and radiotherapist.

Surgical treatment of head and neck tumors

Surgeries are often extensive and include tracheostomy, removal of the primary tumor, unilateral or bilateral lymph node dissection and reconstruction. Despite the large volume of tissue removed, 2/3 of relapses are local rather than distant. Thanks to advances in anesthesiology, the emergence of new reconstructive plastic techniques and maxillofacial prosthetics, it has become possible to reduce the consequences extensive operations. However, “rescue surgery” (removal of large tumors) after full course is very labor-intensive, almost always accompanied by complications, but, nevertheless, provides a three-year survival rate for one out of three patients. Laser surgery gives excellent results for small tumors of the larynx and oral cavity.

Preoperative radiotherapy for head and neck tumors

Its goal is to prevent relapses, reduce disease activity and the risk of dissemination, and transform inoperable tumor to the operating room. Combined treatment head and neck tumors (preoperative radiotherapy + surgery) has disadvantages: during surgery it is difficult to determine the boundaries of the primary tumor; the frequency of postoperative complications increases.

Preoperative radiation therapy is carried out at a dose of 45-50 Gy for 5 weeks followed by (after no more than a month) radical surgery. This method is used for moderate and widespread tumors of the tongue, floor of the mouth, gums, lower part of the pharynx and larynx.

Preoperative radiotherapy can also be administered at a dose of 60-70 Gy over 6-7 weeks to the tumor site with narrowing of the fields after 50 Gy. Radiation is followed by palliative surgery (only the residual primary tumor is removed). This can avoid significant loss of function and cosmetic surgical defect (mutilation) in patients with neglected forms tumors of the retromolar triangle and tonsils with lesions adjacent to them soft palate, root of the tongue or gums. In such cases, more radical surgical interventions lead to a high incidence of postoperative complications.

Postoperative radiation therapy for head and neck tumors

Its goal is to destroy residual tumor components in the surgical field and the area of ​​regional metastasis. Irradiation is carried out no earlier than 4 weeks after surgery. If there is no clinical or microscopic evidence of residual tumor, 55 Gy over 6 weeks is sufficient. If a residual tumor is established or suspected, then higher doses of reduced fields must be applied to suspicious areas.

Chemotherapy for head and neck tumors

Chemotherapy has the theoretical advantage of affecting cancer cells that have spread beyond the regional zone. Both general and regional chemotherapy for head and neck tumors have not shown the required effectiveness in terms of survival. It is used as an adjuvant to surgery or radiation therapy for common forms of tumors. Usually several drugs are used, such as methotrexate, cisplatin, bleomycin.

Follow-up after treatment of head and neck tumors

Clinical observation and periodic examinations are mandatory and are carried out:

• during the first year after treatment - once a month;
• during the second year - once every two months;
• during the third year - once every three months;
• during the fourth and subsequent years - once every six months.

Most recurrences of squamous cell carcinoma occur within the first 12 months, and metastases to regional lymph nodes or distant organs appear within two years after treatment. It should be noted that after a patient has been cured of one tumor of the head and neck, there is a strong tendency for multiple primary tumors of the upper and lower respiratory tract to appear.