Neck Masses, Head & Neck Cancers PDF Spring 2025

NECK MASSES; HEAD & NECK CANCERS Miranda LaCroix, PA-C Spring 2025 Objectives 1. Determine the risk factors for head and neck masses and cancers. 2. Summarize the most common types of head and neck masses and cancers. 3. Evaluate the presenting symptoms and physical findings of he...

NECK MASSES; HEAD & NECK CANCERS Miranda LaCroix, PA-C Spring 2025 Objectives 1. Determine the risk factors for head and neck masses and cancers. 2. Summarize the most common types of head and neck masses and cancers. 3. Evaluate the presenting symptoms and physical findings of head and neck masses and cancers. 4. Establish treatment guidelines for head and neck masses and cancers.  ◦ Can arise in the oral cavity, pharynx, larynx, nasal cavity, paranasal ѕinsеѕ, and salivary glands. Head & Neck ◦ Most common histology: squamous cell carcinoma Masses/Cancer ◦ Also common: nasopharyngeal carcinoma, mucosal melanoma Head & Neck Cancers Risk Factors Epidemiology ◦ Tobacco use ◦ Worldwide: approx 900,000 cases and ◦ Alcohol consumption >400,000 deaths annually ◦ United States: 71,000 cases and 16,000 deaths ◦ Human papillomavirus (HPV) annually infection ◦ Males affected >> females (2-4x) ◦ Oropharyngeal CA ◦ Incidence of laryngeal cancer (but not ◦ Epstein-Barr virus (EBV) infection oral cavity or pharyngeal) approx 50% ◦ Nasopharyngeal CA higher in African American Men Oral (Squamous Cell) Carcinoma o Defined as occurring between vermillion border of lips and junction of hard/soft palates OR posterior 1/3 of tongue o >95% drink and/or smoke o Can also occur from chronic irritation (ill fitting dentures, dental caries, overuse of mouthwash, chewing tobacco) Oropharyngeal Squamous Cell Carcinoma o Cancer of the tonsil, base and posterior one third of the tongue, soft palate, and posterior and lateral pharyngeal walls o HPV (type 16), alcohol, smoking top risk factors  ◦ MCC Squamous cell carcinoma ◦ >95% smoke ◦ Common in true vocal cords (glottis) and supraglottic larynx Laryngeal ◦ Least common subglottic larynx Cancer Salivary Gland Tumors ◦ Most (75-80%) are benign and occur in parotid gland (85%) ◦ MC benign tumors: pleomorphic adenomas ◦ However, can undergo malignant transformation after 15- 20 years ◦ MC malignant tumor: Mucoepidermoid carcinoma ◦ Typically occurs in 20-50s ◦ MC in parotid gland; also submandibular and minor salivary gland of the palate ◦ Fast growing, firm, nodular, can be fixed to adjacent tissue  Thyroid Nodules Most nodules are benign: Hyperplastic colloid goiter Thyroid cyst Thyroiditis Thyroid adenoma Malignant Nodules Papillary thyroid carcinoma Follicular thyroid carcinoma Oncocytic thyroid carcinoma Anaplastic thyroid carcinoma Medullary thyroid carcinoma Radiation-induced thyroid carcinoma Thyroid Cancer Risk Factors History of thyroid irradiation, especially in infancy or childhood Age > 55 years Female sex Family history of thyroid cancer or multiple endocrine neoplasia type 2 A solitary nodule or goiter Dysphagia Dysphonia Increasing size (particularly rapid growth or growth while receiving thyroid suppression treatment) Higher thyroid-stimulating hormone (TSH) levels Vestibular Schwannoma (Acoustic Neuroma) ◦ Schwann cell-derived tumor of 8th CN (vestibular division) ◦ Account for ~7% of all intracranial tumors ◦ As tumor grows, compresses 7 th and 8th CN → unilateral hearing loss, sometimes tinnitus and/or dizziness ◦ Diagnosis based on audiology and confirmed with MRI ◦ Treatment ◦ Small/nongrowing: observation with serial MRI ◦ Large/growing: stereotactic radiation, microsurgery  Otalgia. Neck mass. Hoarseness or voice change. Nasal congestion or epistaxis. Clinical Odynophagia or dysphagia. Presentation Hemoptysis or blood in saliva. Mouth or skin ulcerations. Unilateral tonsil enlargement. Palpable lesions in the salivary glands, especially when they are asymptomatic. Solitary masses in the thyroid or a change in a pre-existing goiter.  Oral cavity Mouth pain or nonhealing mouth ulcers, loosening of teeth, ill-fitting dentures, dysphagia, odynophagia, weight loss, bleeding, or referred οtаlgia Nasopharynx Hearing loss (associated with serous otitis media), tinnitus, nasal obstruction, and pain Most frequent presenting complaint: neck mass due to regional lymph node mеtаstaѕis, which occurs in nearly 90 percent of patients Clinical Oropharyngeal Dysphagia, pain (odynophagia, οtаlgia), obstructive sleep apnea or snoring, bleeding, or a neck mass Features by Laryngeal Tumor Site Persistent hoarseness may be the initial complaint in glottic cancers; later symptoms may include dysphagia, referred otаlgiа, chronic cough, hemoptysis, and stridor. Supraglottic cancers are often discovered later and may present with airway obstruction or palpable metastatic lymph nodes. Primary subglottic tumors are rare. Affected patients typically present with stridor or complaints of dyspnea on exertion. Nasal Cavity & Sinus Nasal obstruction and epistaxis Salivary Gland Swelling or a mass form at the tumor location Head & Neck Cancer Evaluation Head & Neck Cancer ◦ TNM (Tumor, Node, Metastases) Staging Staging ◦ Staging varies by primary tumor site  30-40% of patients with head & neck SCC present with early-stage disease (stage I or II) and typically treated with primary surgery or definitive radiation therapy* 5 year survival rate 70-90% if present early stage *Oral cavity cancers best treated with surgery rather than radiation Head & Neck *Advanced SCC associated with high risk local recurrence and distant metastases and requires combined approach (surgery, Cancer radiation, and/or chemotherapy) Treatment Follow-up necessary to monitor for recurrence or secondary primary tumors Smoking/alcohol cessation highly encouraged  HEAD & NECK CANCER TREATMENT