Title: Head and neck cancers
1- Head and neck cancers
- Recognising the early signs and symptoms of
cancer - Mr C. Chan, Consultant HN Surgeon (OMFS), LD
- Dr K. Goodchild, Consultant Clinical Oncologist
NSSG Lead, MVCC - Mr P. Kothari, Consultant HN Surgeon (ENT), LD
2Incidence rates for 20 commonest cancers in
UK2010
3Common Head Neck Cancers
- Oral cancers oral cavity, oropharynx,
hypopharynx (ICD-10 C00-06,C09-C10, C12-14) - Larynx (ICD-10 C32)
- Thyroid (ICD-10 C73)
- Others major salivary glands (C07, C08),
nasopharynx (C11), accessory sinus (C31), nasal
cavity middle ear (C30)
4Topics to be covered
- Incidence
- Risk factors
- Prevention and screening
- Mortality
5Oral Cancers Lip, tongue, mouth, oropharynx,
hypopharynx
- How common?
- 15th most common cancer UK (2009) 2 all new
cases - 6236 new cases in 2009 gt17 people per day
- Higher incidence in Scotland and North of England
CRUK
6Oral Cancers
Oral Cancer (C00-C06,C09-C10,C12-C14) 2007-2009
Average Number of New Cases Per Year and
Age-Specific Incidence Rates per 100,000
Population, UK
- Prepared by Cancer Research UK
- Original data sources
- Office for National Statistics. Cancer
Statistics Registrations Series MB1.
http//www.statistics.gov.uk/statbase/Product.asp?
vlnk8843. - Welsh Cancer Intelligence and Surveillance Unit.
http//www.wcisu.wales.nhs.uk. - Information Services Division Scotland. Cancer
Information Programme. www.isdscotland.org/cancer.
- N. Ireland Cancer Registry. www.qub.ac.uk/nicr.
7Oral Cancers
- Trends over time
- Incidence rates in UK ? by gt ¼ in last decade
CRUK
8Oral Cancers
Profile of Head and Neck Cancers in England
Incidence, Mortality and Survival . OCIU January
2010
9Oral Cancers
Profile of Head and Neck Cancers in England
Incidence, Mortality and Survival . OCIU January
2010
10Oral Cancers
11Laryngeal cancer (ICD10 32)
- How common?
- 2300 diagnosed in 2009 (UK) 6 people daily
- 5 times more common in men than women
- Men incidence rates rose until 1990, then
fallen - Women stable past 40 years
- Rare under age 40, majority diagnosed 60 or older
12Laryngeal cancer
Larynx (C32) 2006-2008
Average Number of New Cases Per Year and
Age-Specific Incidence Rates per 100,000
Population, UK
- Prepared by Cancer Research UK
- Original data sources
- Office for National Statistics. Cancer
Statistics Registrations Series MB1.
http//www.statistics.gov.uk/statbase/Product.asp?
vlnk8843. - Welsh Cancer Intelligence and Surveillance Unit.
http//www.wcisu.wales.nhs.uk. - Information Services Division Scotland. Cancer
Information Programme. www.isdscotland.org/cancer.
- N. Ireland Cancer Registry. www.qub.ac.uk/nicr.
13Laryngeal cancer
European Age-Standardised Incidence Rates per
100,000 Population, by Sex, Great Britain
14Laryngeal cancer
Profile of Head and Neck Cancers in England
Incidence, Mortality and Survival . OCIU January
2010
15Laryngeal cancer
- The incidence has fallen by 20 in the study
period, but levelled off in the last five years - ? smoking habit
- There is a falling trend from North to South East
16Thyroid cancer (ICD10 C73)
- How common?
- 2350 diagnosed in 2009 (UK) 6 per day
- More common in women than men
- ½ cases diagnosed age under 50
- Incidence rates in women gt 2x past 40 years
- 5 per 100,000 women
17Thyroid cancer
Average Number of New Cases Per Year and
Age-Specific Incidence Rates per 100,000
Population, UK
- Prepared by Cancer Research UK
- Original data sources
- Office for National Statistics. Cancer
Statistics Registrations Series MB1.
http//www.statistics.gov.uk/statbase/Product.asp?
vlnk8843. - Welsh Cancer Intelligence and Surveillance Unit.
http//www.wcisu.wales.nhs.uk. - Information Services Division Scotland. Cancer
Information Programme. www.isdscotland.org/cancer.
- N. Ireland Cancer Registry. www.qub.ac.uk/nicr.
18Thyroid cancer
European Age-Standardised Incidence Rates per
100,000 Population, by Sex, Great Britain
19Thyroid cancer
Profile of Head and Neck Cancers in England
Incidence, Mortality and Survival . OCIU January
2010
20Thyroid cancer
- Incidence of thyroid cancer has nearly doubled
- May in part be due to imaging of goitres and
subsequent surgery, leading to an increase in the
number of small papillary carcinomas being
detected
21Risk factors for HNC
22Risk factors oral cancer
- Tobacco
- Dose and duration dependent
- cigarettes, cigars, roll-ups, pipes
- 70 oral and pharyngeal cancers (male) caused
by tobacco Parkin DM. Cancers attributable to
consumption of alcohol in the UK in 2010. Br J
Cancer 2011 105(S2)S14-S18 doi
10.1038/bjc.2011.476 - Smokeless tobacco
- Betel quid (paan)
- others
-
23Risk factors oral cancer
- Alcohol
- major risk factor
- consumption increasing in the UK
- further increase in risk in smokers
- heavy alcohol smoking 35x risk
- total amount more important
- may explain rising mortality in Europe
24Risk factors oral cancer
Relative risk of oral/pharyngeal cancer in males
by alcohol/tobacco consumption using US measures
25Risk factors oral cancer
- Human papillomavirus (HPV-16)
- Strong association with oropharyngeal cancer
- Immunosuppression
- HIV/ AIDS
- organ transplants
-
26Risk factors oral cancer
- Diet and nutrition
- some evidence of risk reduction
- Sun exposure
- lip cancers
27Risk factors oral cancer
- Oral mucosal lesions
- erythroplakia
- leukoplakia
- submucous fibrosis
- lichen planus
- syphilitic glossitis
- Previous cancer diagnosis
28Risk factors laryngeal cancer
- 80 caused by smoking 25 linked to alcohol
- Combined effect 89 of cases
- Risk is proportional to duration and intensity of
smoking - Environmental tobacco smoke (ETS) limited
evidence in causing laryngeal cancer - Diet high in fruit and vegetables ? risk
29Risk factors laryngeal cancer
- Gastro-oesophageal reflux - ? risk 2 3 times
- Immunosuppression HIV/AIDS organ transplant
- HPV-16
- Previous H N cancers
- First degree relative with H N cancers
30Risk factors thyroid cancer
- Women gt men
- Exposure to radiation environmental / medical,
especially in childhood - Family history/ genetics medullary FMTC,
MEN2a, MEN2b FAP - Some benign thyroid conditions thyroiditis,
adenomas, goitre - High BMI
31- Prevention Screening in HNC
32Prevention Screening oral cancer
- Avoid risk factors primary prevention
- smoking cessation 50 ? risk in 3 5 years
- education delay in presentation
- Screening secondary prevention
- no cost-effective population screening tool/
test - opportunistic screening of at risk population
33Prevention screening laryngeal cancer
- Avoid/ eliminate risk factors
- No effective population screening tool
34Prevention screening thyroid cancers
- Avoid/ eliminate risk factors
- Genetic testing family history of medullary
carcinoma
35 36Symptoms Signs oral cancer
- Non-healing/ persistant ulcer over 3 weeks
- solitary
- /- pain
- no obvious cause/ trauma
- Lump/ swelling in mouth gt 3 weeks
- soft tissues mucosal/ submucosal
- exclude dental cause
37(No Transcript)
38Symptoms Signs oral cancer
- Red or red and white patches of the oral mucosa
- Dysphagia, including odynophagia, gt3 weeks ?
- Unilateral nasal obstruction
- Unexplained tooth mobility, not periodontal
disease - Cranial neuropathies V and VII
- (Orbital masses)
39Symptoms Signs oral cancer
- Hoarseness for more than 6 weeks (larynx)
- Persistent neck lump gt3 weeks
- Unilateral persistent sore throat
- Unilateral otalgia with normal otoscopy
40Signs Symptoms laryngeal cancer
- Hoarse voice gt 3 weeks,
- Difficulty in swallowing
- Weight loss, often with other symptoms
- Persistent cough/ SOB
- Neck lump
- Pain/ otalgia
41 42Signs symptoms thyroid cancer
- Solitary thyroid nodule
- Lymph node enlargement in neck
- Rapidly growing goitre
- Pain
- Stridor/ dysphagia
- Hoarseness
43- Anaplastic carcinoma of thyroid
44Mortality Survival
45The 20 Most Common Causes of Cancer Death UK 2010
46Mortality oral cancer
47Mortality oral cancer
- 2000 died of oral cancer in 2010 (UK) around 5
people per day - Despite the rising incidence, mortality remains
essentially static
48Mortality - oropharynx
49Mortality - oropharynx
- A rising trend in mortality
- The increase in mortality is much less than the
rise in incidence - ?more effective combined treatment
- ?better prognosis in HPV group
- Stage at presentation detail incomplete
50Mortality laryngeal cancer
51Mortality laryngeal cancer
- Falling trend in mortality 33 reduction study
period - Reasons are unclear - Stage and treatment
information is needed to explore this further - 760 people died from laryngeal cancer in 2010
52Mortality thyroid cancer
53Mortality thyroid cancer
- Despite the rising incidence, mortality rate has
remained - essentially static
- This may in part be due to an increase in the
number of small papillary carcinomas being
detected which have high cure rates - 350 people died of thyroid cancer 2010
54Survival oral cancer
5 year survival rate 56
Profile of Head and Neck Cancers in England
Incidence, Mortality and Survival . OCIU January
2010
55Survival oral cancer
- Trends in 1- and 5-year relative survival -
significant improvement - 5-year relative survival rate for the most recent
period is 56 - In 2010, 2000 people died from oral cancer
- Survival is related to stage at presentation,
sub-sites, HPV status
56Survival oral cancer
57Survival laryngeal cancer
58Survival laryngeal cancer
- 5-year relative survival rates have remained
unchanged - The absence of any significant new therapies is a
likely factor - 5-year relative survival rate is 65
- ? of men survive for 5 years or more
- There is evidence of improved quality of life
with advances such as surgical voice restoration
59Survival thyroid cancer
60Survival thyroid cancer
- Trends in one and five year relative survival -
an increase of11 - Identifying and treating smaller cancers may be a
factor - The 5-year relative survival rate for the most
recently diagnosed cases is 87 - Survival is better for the younger age 95
under 40 are likely to survive at least 5 years
61Referral pathways
- 2WW proforma
- Indications for referral
- Neck lump clinics
62Referral pathways
63Thyroid Clinics
64HPV Status
- 5 year overall survival 75-80 if HPV positive
vs 45 if HPV negative - Independent of age, TNM stage, smoking
65Incidence rates for 20 commonest cancers in
UK2010
66Head Neck Cancer