HeadandNeckCancer

SkyeHChengM.D.

Whatisheadandneckcancer?

HeadandNeckCancerisagroupofcancersthat

includestumorsinseveralareasabovethecollarbone.

HeadandNeckCancer

Squamouscellcarcinomaoftheheadandneck(SCCHN)occursin50,000newcases

annuallyintheUS,resultinginover13,000deathseachyear;and

6,000newcasesannuallyinTaiwan,resultinginover3,000deathseachyear.

HeadandNeckCancerhasthreemajorsubdivisions:

•  OralCavityCancer•  PharyngealCancer:NPC,OPCandHPC•  LaryngealCancer•  Salivarycancer•  Sinuscancer•  Earcancer

Oralcavitycancer

•  Lip. •  Anterior two thirds of tongue. •  Buccal mucosa. •  Floor of mouth. •  Lower gingiva. •  Retromolar trigone. •  Upper gingiva. •  Hard palate.

男性10大癌症年齡標準化發生率之五年變化率, 民國90-94年

17.89

15.64

12.88

7.79

4.07

2.26

-0.56

-3.55

-6.72

-16.03

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RiskFactorsforHeadandNeckCancer

TobaccoProducts:•  SmokingTobacco

•  Cigarettes•  Cigars

•  Pipes

•  ChewingTobacco

•  Snuff

EthanolProducts

Chemicals:•  BetelNut•  Asbestos•  Chromium•  Nickel•  Arsenic•  Formaldehyde

OtherFactors:•  IonizingRadiation•  Plummer‐VinsonSyndrome•  Epstein‐BarrVirus•  HumanPapillomaVirus

HeadandNeckCancer

Linktochronicinfection•  HPV•  EpsteinBarrvirus

HumanPapillomavirus(HPV)

•  DNAvirus•  Preferentiallyinfectsquamousepithelialcells

•  >100genotypes•  ≥40genitalHPVtypes

EpidemiologyofHPV

• 80%sexuallyactiveadultsintheUSinfectedwithatleastoneHPVtypebyage501

• Peakprevalenceduringadolescenceandyoungadulthood• Prevalencedeclineswithage• HPV16isthemostcommontype

1.CentersforDiseaseControlandPrevention.Rockville,Md:CDCNationalPreventionInformationNetwork;2004

WarningSignsofHeadandNeckCancer

•  Hoarseness•  Erythroplasia•  Referredotalgia•  Persistentsorethroat•  Epistaxis•  Nasalobstruction

•  Serousotitismedia

•  Neckmass•  Non‐healingulcer•  Dysphagia•  Submucosalmass

Notallcancerspresentwithsymptomsatearlystages!

FactorsDelayingtheDiagnosisofHeadandNeckCancers

•  Patientprocrastinationinseekingmedicalattention

•  Physiciandelayindiagnosis•  Patientremainsasymptomaticforaprolongedperiod

Diagnosis

•  Magnetic resonance imaging offers an advantage over computed tomographic scans in the detection and localization of head and neck tumors and in the distinction of lymph nodes from blood vessels.

Biological groups Proteins

Cytokines/ Chemokines

IL-6, IL-8, TNF-α, IL-12p40, IL-2R, IL-1β, IL-2, IL-4, IL-5, IFN-γ, IL-13, IL-15, IFN-α, IL-1α, IL-7, Fas, FasL, MIP-3α, MIP-3b, MIF, MCP-1, IL-10, IL-17, IL-1Ra, DR5, TNF-RI, TNF-RII, EOTAXIN, MIP-1α, MIP-1β, IP-10, MIG, RANTES

Growth/angiogenic factors

EGF, VEGF, FGF-b, G-CSF, HGF, GM-CSF, ErbB2, EGFR, IGFBP-1

Proteases Kallikrein-8, Kallikrein-10, MMP-2, MMP-3 Cancer Antigens CA-153, CEA, CA 19-9, CA-125, AFP, CA 72-4 Adhesion molecules sE-Selectin, sV-CAM, sICAM Other markers Cytokeratin-19, HCGβ, MPO, tPAI-1, Mesothelin IgY

Biomarkersrelatedtoheadandneckcancer

2010AJCCstagingsystem

Tis Carcinoma in situ

T1 Tumor 2 cm or less in greatest dimension

T2 Tumor>2cmbutnotmorethan4cmingreatestdimension

T3 Tumormorethan4cmingreatestdimension

T4a Moderatelyadvancedlocaldisease.(lip)Tumorinvadesthroughcorticalbone,inferioralveolarnerve,floorofmouth,orskinofface,i.e.,chinornose(oralcavity)Tumorinvadesadjacentstructuresonly(e.g.,throughcorticalbone,[mandibleormaxilla]intodeep[extrinsic]muscleoftongue[genioglossus,hyoglossus,palatoglossus,andstyloglossus],maxillarysinus,skinofface)

T4b Veryadvancedlocaldisease.Tumorinvadesmasticatorspace,pterygoidplates,orskullbaseand/orencasesinternalcarotidarteryNote:Superficialerosionaloneofbone/toothsocketbygingivalprimaryisnotsufficienttoclassifyatumorasT4.

N0 No regional lymph node metastasis

N1 Metastasisinasingleipsilaterallymphnode,3cmorlessingreatestdimension

N2

N2a Metastasis in single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension

N2b Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension

N2c Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension

N3 Metastasisinalymphnodemorethan6cmingreatestdimension

Treatmentoption

•  Early cancers (stage I and stage II) of the lip, floor of mouth, and retromolar trigone are highly curable by surgery or radiation therapy.

•  Most patients with stage III or stage IV tumors are candidates for treatment by a combination of surgery, radiation therapy, and/or chemotherapy, and/or target therapy

部位別 全癌症 肝 肺 結直腸 口腔 胃 攝護腺 膀胱 食道 鼻咽 皮膚

觀察存活率

一年 62.08 47.05 34.81 78.74 75.61 56.24 89.57 84.37 37.68 87.06 90.61

二年 49.30 34.45 18.58 66.82 60.35 42.90 79.80 75.47 20.24 75.97 83.35

三年 42.46 26.66 13.01 58.43 53.71 36.41 71.63 69.20 14.92 68.11 77.97

四年 37.91 21.67 10.06 52.29 49.27 32.16 65.54 64.16 12.16 62.74 73.33

五年 34.46 18.14 8.21 47.62 45.66 29.31 59.44 59.24 10.74 57.61 69.07

相對存活率

一年 64.00 48.19 36.24 81.50 76.57 58.61 94.29 87.84 38.56 88.05 94.11

二年 52.28 36.10 20.01 71.49 61.85 46.36 88.53 81.70 21.17 77.64 89.99

三年 46.37 28.59 14.50 64.67 55.74 40.79 83.93 77.92 15.96 70.33 87.59

四年 42.68 23.81 11.62 60.00 51.81 37.42 81.32 75.31 13.33 65.50 85.74

五年 40.04 20.41 9.85 56.71 48.68 35.47 78.25 72.64 12.08 60.81 84.11

Five‐YearSurvivalRateforOralCavityandPharynxCancer

Stage at Diagnosis

指標類型 測量指標 治遼-1 口腔癌病人手術後病理紀錄原發腫瘤手術邊界（margin

status）的比率。 治遼-21 口腔癌病人手術後病理紀錄淋巴結膜（ECS）侵犯情形

的比率。 治遼-3 淋巴結有清除的口腔癌病人，有陽性淋巴結所在部位

描述的比率。 治遼-4 口腔癌病人放射治遼時，有做電腦斷層定位的比率。

治遼-52 口腔癌病人做放射治遼前2個月曾做牙科會診的比率。

治遼-6 手術後6 週內開始放射治遼的比率。

治遼-73 手術後接受放射線治遼的病人有以下兩種情形之一 （ECS, LVI），同時接受化學治遼的比率。

治遼-8 手術後30 天內的死亡的比率。

追蹤-1A 治遼後第1年，回診至少4 次的比率。

追蹤-1B 治遼後第2年，回診至少4 次的比率。

追蹤-2 治遼後第3-5年，每年回診至少2 次的比率。

Oral cancer 核心測量指標 �TCDB資料庫可提供有四項

•  病人手術後病理記錄原發腫瘤手術邊界的比率

•  病人手術後6週內開始放射治療的比率

•  病人手術後接受放射線治療且手術邊緣為陽性的病人，同時接受化學治療的比率

•  病人手術後30天內死亡的比率

“Genesloadthegun.Lifestylepullsthetrigger”

Dr.ElliotJoslin

LifestyleFactors

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