Essential Cases in Head and Neck Oncology

13 Which of the following statements is correct with regards to the primary site of a minor salivary gland cancer?Tumors of the sinonasal tract have a poorer outcome.The most common site in the oral cavity is the floor of the mouth.Tumors of the oropharynx tend to be mucoepidermoid cancer.Tumors arising from the oropharynx have superior outcome to those of the oral cavity.Answer: a. Of all of the subsites, tumors arising from the sinonasal tract tend to have poorer outcomes. This is because they present with a more advanced local stage (T3, T4) and are more likely to have positive margin resection. Within the oral cavity, the most common subsite is the hard palate. In the trachea, the most common pathology is adenoid cystic cancer. Patients with tumors in the oropharynx have similar outcomes to those with oral cavity cancers.

1 de Visscher, J.G., Botke, G., Schakenraad, J.A., and van der Waal, I. (1999). A comparison of results after radiotherapy and surgery for stage I squamous cell carcinoma of the lower lip. Head Neck 21: 526–530. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10449668.

1 Amin, M.B., Edge, S., Greene, F. et al. (2017). AJCC Cancer Staging Mannual, vol. 8. Chicago IL: American Joint Committee on Cancer, Springer.

2 Barttelbort, S.W. and Ariyan, S. (1993). Mandible preservation with oral cavity carcinoma: rim mandibulectomy versus sagittal mandibulectomy. Am. J. Surg. 166 (4): 411–415. https://doi.org/10.1016/s0002‐9610(05)80344‐7. PMID: 8214304.

3 Bernier, J., Ozsahin, M., Lefebvre, J.L. et al. (2004). Postoperative ioncomitant chemotherapy for locally advanced head and neck cancer. New Engl. J. Med. 350 (19): 1945–1952.

4 Bernier, J., Cooper, J.S., Pajak, T.F. et al. (2005). Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27 (10): 843–850. https://doi.org/10.1002/hed.20279.

5 Brown, J.S., Lowe, D., Kalavrezos, N. et al. (2002). Patterns of invasion and routes of tumor entry into the mandible by oral squamous cell carcinoma. Head Neck 24 (4): 370–383.

6 Cooper, J.S., Pajak, T.F., Forastiere, A.A. et al. (2004). Postoperative concurrent radiotherapy and chemotherapy for high risk squamous cell carcinoma of the head and neck. New Engl. J. Med. 350 (19): 1937.

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8 Ferris, R.L., Blumenschein, G. Jr., Fayette, J. et al. (2016). Nivolumab for recurrent squamous‐cell carcinoma of the head and neck. N. Engl. J. Med. 375 (19): 1856–1867. https://doi.org/10.1056/NEJMoa1602252.

9 Futran, N.D. and Mendez, E. (2006). Developments in reconstruction of midface and maxilla. Lancet Oncol. 7: 249–258.

10 Givi, B., Eskander, A., Awad, M.I. et al. (2015). Impact of elective neck dissection on the outcome of oral squamous cell carcinomas arising in the maxillary alveolus and hard palate. Head Neck 38 (Suppl 1): E1688–E1694. https://doi.org/10.1002/hed.24302.

11 Hanasono, M.M. (2014). Reconstructive surgery for head and neck cancer patients. Adv. Med. 2014: 795483.

12 Huang, S.H., Hwang, D., Lockwood, G. et al. (2009). Predictive value of tumor thickness for cervical lymph‐node involvement in squamous cell carcinoma of the oral cavity: a meta‐analysis of reported studies. Cancer 115 (7): 1489–1497. https://doi.org/10.1002/cncr.24161.

13 Linz, C., Müller‐Richter, U.D.A., Buck, A.K. et al. (2015). Performance of cone beam computed tomography in comparison to conventional imaging techniques for the detection of bone invasion in oral cancer. Int. J. Oral Maxillofac. Surg. 44 (1): 8–15.

14 McCombe, D., MacGill, K., Ainslie, J. et al. (2000). Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979‐88. Aust. N. Z. J. Surg. 70: 358–361. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10830600.

15 Pfister DG, Spencer S, Adelstein D, et al (2018). NCCN Clinical Practice Guidelines in Oncology, Head and Neck Cancers, (version 2, 2018). Available at: https://www.kankertht‐kepalaleher.info/wp‐content/uploads/2019/02/NCCN‐Clinical‐Practice‐Guidelines‐in‐Oncology‐2018.pdf.

16 Okay, D.J., Genden, E., Buchbinder, D., and Urken, M. (2001). Prosthodontic guidelines for surgical reconstruction of the maxilla: a classification system of defects. J. Prosthet. Dent. 86 (4): 352–363.

17 Poeschl, P.W., Seemann, R., Czembirek, C. et al. (2012). Impact of elective neck dissection on regional recurrence and survival in cN0 staged oral maxillary squamous cell carcinoma. Oral Oncol. 48: 173–178.

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19 Sollamo, E.M., Ilmonen, S.K., Virolainen, M.S., and Suominen, S.H. (2016). Sentinel lymph node biopsy in cN0 squamous cell carcinoma of the lip: a retrospective study. Head Neck 38 (Suppl. 1): E1375–E1380. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26514547.

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21 de Visscher, J.G., van den Elsaker, K., Grond, A.J. et al. (1998). Surgical treatment of squamous cell carcinoma of the lower lip: evaluation of long‐term results and prognostic factors – a retrospective analysis of 184 patients. J. Oral Maxillofac. Surg. 56: 814–820. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9663570.

Liana Puscas

Raymond Chai

A 62‐year‐old Caucasian male is seen in the office with a 2‐month history of a palpable left neck mass.

Question: What additional questions would you want to ask?

Is it painful? Patient denies.

Is it tender to the touch? Patient denies.

Is it growing? Patient denies.

Any trouble swallowing? Patient denies.

Any voice changes? Patient denies.

Any throat pain? Patient denies.

Any ear pain? Patient denies. Base of tongue/tonsil tumors may produce referred ear pain.

Any skin changes over the mass? No. Erythema or induration could indicate extranodal extension of a malignancy or an infectious etiology (e.g., scrofula).

Has he received any treatment for this? Yes. He has undergone two rounds of antibiotic therapy and steroids without decrease in the size of the mass.

Hypercholesterolemia, hypertension.

Appendectomy and tonsillectomy as a child.

Atorvastatin, lisinopril.

No known drug allergies.

Tobacco use? Patient denies.

Alcohol use? The patient has a glass of wine with dinner on a regular basis.

Well‐developed male in no distress. Voice strong.

Skin: no suspicious lesions.

Oral cavity examination shows teeth in good condition. No lesions seen or palpated.

Oropharynx: tonsils surgically absent; no lesions palpated in the base of tongue but exam limited due to gag reflex.