Head & Neck Oncology - Most accessed articles

Open cervical lymph node biopsy for head and neck cancers: any benefit?

Adeyi Adoga — 2009-04-29T00:00:00Z

Background: Most patients with head and neck cancers in our environment present late and usually first to the general surgeons whose practice is to subject these patients to open cervical lymph node biopsy without a prior examination under anesthesia and endoscopic biopsy from the primary tumor site in order to obtain a histological diagnosis.This paper presents the influence of open cervical lymph node biopsy on the clinical outcome of patients with head and neck cancers in our environment. Methods: This is a ten-year retrospective review of patients with head and neck cancers in the Jos University Teaching Hospital, Jos, Nigeria. Results: Eighty nine patients aged between 23 and 78 years had head and neck cancers with 38/89 (42.7%) patients having cervical lymphadenopathy at presentation and these initially presented to the general surgeons. Twenty six (68.4%) patients had open cervical lymph node biopsy and 12/38 (31.6%) patients had FNAB. Eleven (28.9%) patients presented to the otolaryngology unit 6 months after they presented to the general surgeons and 27 (71.1%) patients beyond 6 months. Nine deaths were recorded. Ten patients were lost to follow-up. Conclusion: All patients with head and neck lymphadenopathy who present to any physician for diagnostic examination should undergo formal ENT staging and FNAB to avoid the problems of tumor spread and the reduction in consequent prognosis.

Establishment and Characterization of a Novel Head and Neck Squamous Cell Carcinoma Cell Line USC-HN1

Daniel Liebertz — 2010-02-22T00:00:00Z

Background: Head and neck squamous cell carcinoma (HNSCC) is an aggressive and lethal malignancy. Publically available cell lines are mostly of lingual origin, or have not been carefully characterized. Detailed characterization of novel HNSCC cell lines is needed in order to provide researchers a concrete keystone on which to build their investigations. Methods: The USC-HN1 cell line was established from a primary maxillary HNSCC biopsy explant in tissue culture. The immortalized cells were then further characterized by heterotransplantation in Nude mice; immunohistochemical staining for relevant HNSCC biomarkers; flow cytometry for surface markers; cytogenetic karyotypic analysis; human papillomavirus and Epstein-Barr virus screening; qRT-PCR for oncogene and cytokine analysis; investigation of activated, cleaved Notch1 levels; and detailed 35,000 gene microarray analysis. Results: Characterization experiments confirmed the human HNSCC origin of USC-HN1, including a phenotype similar to the original tumor. Viral screening revealed no HPV or EBV infection, while western blotting displayed significant upregulation of activated, cleaved Notch1. Conclusions: USC-HN1, a novel immortalized cell line has been derived from a maxillary HNSCC. Characterization studies have shown that the cell line is of HNSCC origin and displays many of the same markers previously reported in the literature. USC-HN1 is available for public research and will further the investigation of HNSCC and the development of new therapeutic modalities.

HPV & head and neck cancer: a descriptive update

Peter Goon — 2009-10-14T00:00:00Z

The incidence of head and neck squamous cell carcinoma (HNSCC) has been gradually increasing over the last three decades. Recent data have now attributed a viral aetiology to a subset of head and neck cancers. Several studies indicate that oral human papillomavirus (HPV) infection is likely to be sexually acquired. The dominance of HPV 16 in HPV+ HNSCC is even greater than that seen in cervical carcinoma of total worldwide cases. Strong evidence suggests that HPV+ status is an important prognostic factor associated with a favourable outcome in head and neck cancers.Approximately 30 to 40% of HNSCC patients with present with early stage I/II disease. These patients are treated with curative intent using single modality treatments either radiation or surgery alone. A non-operative approach is favored for patients in which surgery followed by either radiation alone or radiochemotherapy may lead to severe functional impairment. Cetuximab, a humanized mouse anti-EGFR IgG1 monoclonal antibody, improved locoregional control and overall survival in combination with radiotherapy in locally advanced tumours but at the cost of some increased cardiac morbidity and mortality.Finally, the improved prognosis and treatment responses to chemotherapy and radiotherapy by HPV+ tumours may suggest that HPV status detection is required to better plan and individualize patient treatment regimes.

Rapid palliation of symptoms with platinum-based chemotherapy plus cetuximab in recurrent oral cancer: a case report

Ricard Mesia — 2010-01-27T00:00:00Z

Background: Symptom control is an important consideration in the choice of treatment for patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). Patients who demonstrate objective tumour responses to platinum-based chemotherapy are more likely to have symptom relief than those who do not have such responses. A phase III trial (EXTREME) showed that adding the epidermal growth factor receptor (EGFR)-targeting IgG1 monoclonal antibody cetuximab to first-line platinum-based chemotherapy significantly prolongs progression-free and overall survival and increases response rate compared with platinum-based chemotherapy alone. We report here the case of a 60-year old female with recurrent squamous cell carcinoma of the gum who had rapid palliation of symptoms and reduction of facial disease mass following treatment with a combination of carboplatin/5-fluorouracil (5-FU) and cetuximab.Case presentationThe patient was diagnosed with T4N0 M0 disease of the oral cavity in November 2006 and underwent surgery, with R0 resection, followed by adjuvant radiotherapy and concomitant cisplatin chemotherapy. Around 3 months later, the disease recurred and the patient had severe pain (9/10 on a visual pain scale), marked facial oedema and a palpable facial mass of 89 mm. The patient received 4 21-day cycles of carboplatin (AUC 5), 5-FU (1,000 mg/m2/day for 4 days) and cetuximab (400 mg/m2 initial dose followed by subsequently weekly doses of 250 mg/m2), with continuation of cetuximab monotherapy at the end of this time, and pain relief with topical fentanyl and oral morphine. After 7 days of treatment, pain had reduced to 2/10, with discontinuation of morphine after 4 days, and the facial mass had reduced to 70 mm. After 2 cycles of treatment, the facial mass had decreased to 40 mm. After 3 cycles of treatment, pain and facial oedema had resolved completely and a cervical computed tomography scan showed a marked reduction in tumour mass. Cetuximab monotherapy was continued uninterrupted for 7 months. Conclusion: This case illustrates the rapid reduction of tumour mass and disease-associated pain and oedema that can be achieved with a combination of platinum-based chemotherapy and cetuximab in recurrent and/or metastatic SCCHN.

Unicystic ameloblastoma of the mandible - an unusual case report and review of literature

Rakesh Ramesh — 2010-01-14T00:00:00Z

Ameloblastoma is a true neoplasm of odontogenic epithelial origin. It is the second most common odontogenic neoplasm, and only odontoma outnumbers it in reported frequency of occurrence. Its incidence, combined with its clinical behavior, makes ameloblastoma the most significant odontogenic neoplasm. Unicystic ameloblastoma (UA) refers to those cystic lesions that show clinical, radiographic, or gross features of a mandibular cyst, but on histologic examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor growth. It accounts for 5-15% of all intraosseous ameloblastomas. We report a case of unicystic ameloblastoma in a 30-year-old female, and review the literature.

Refeeding syndrome - awareness, prevention and management

Hisham Mehanna — 2009-01-26T00:00:00Z

Background: Refeeding syndrome is an important, yet commonly overlooked condition affecting patients. It occurs when feeding is commenced after a period of starvation. Head and neck cancer patients are at particular risk owing to prolonged periods of poor nutritional intake. This may be from general effects such as cancer anorexia or from more specific problems of dysphagia associated with this group of patients. Awareness of the condition is crucial in identifying patients at risk and taking measures to prevent its occurrence.ObjectivesThe aims of this review are to:1) Highlight the condition and stress the importance of its consideration when admitting head and neck cancer patients.2) Discuss the pathophysiology behind refeeding syndrome.3) Review the literature for the best available evidence and guidelines.4) Highlight the need for further high quality research. Conclusion: Refeeding syndrome is potentially fatal, yet is preventable. Awareness and identification of at-risk patients is crucial to improving management.Refeeding syndrome is caused by rapid refeeding after a period of under-nutrition, characterised by hypophosphataemia, electrolyte shifts and has metabolic and clinical complications.High risk patients include the chronically under-nourished and those with little intake for greater than 10 days. Patients with dysphagia are at particular risk.Refeeding should commence at 10 kcal/kg per day in patients at risk, and increased slowly. Thiamine, vitamin B complex and multi-vitamin supplements should be started with refeeding.New NICE guidelines state that pre-feeding correction of electrolyte and fluid deficits is unnecessary, but should be done concurrently with re-feeding.More research in this field is needed as the evidence base is lacking.

Organ preservation surgery for laryngeal cancer

Sharad Chawla — 2009-05-15T00:00:00Z

The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the loco-regional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented.

Prevention of complications in neck dissection

Cyrus Kerawala — 2009-10-12T00:00:00Z

Background: The neck dissection has remained a pivotal aspect of head and neck cancer management for over a century. During this time its role has expanded from a purely therapeutic option into an elective setting, in part promoted by efforts to reduce its morbidity.ObjectivesThis review will consider the potential complications of neck dissection and on the basis of the available evidence describe both their management and prevention. Conclusion: Although the neck dissection continues to provide clinicians with a method of addressing cervical disease, its reliability and safety can only be assured if surgeons remain cognisant of the potential complications and aim to minimise such morbidity by appropriate management in the peri-operative period.

Epithelial-Myoepithelial Carcinoma of the tongue base: A case for the case-report and review of the literature

Peter Peters — 2010-02-02T00:00:00Z

A 60 year old lady was referred to the Princess Alexandra Hospital (Brisbane, Queensland, Australia) tertiary Otolaryngology, Head and Neck Unit from a peripheral hospital for investigation and management of a tumour at the base of the tongue. Biopsy of the tumour revealed it to be an epithelial-myoepithelial carcinoma of the base of the tongue. This is an extremely rare tumour in this location with only 2 other case reports in the world literature: the patients were treated with chemo-radiotherapy and surgery respectively. Our patient was made aware of the world literature and was able to make a fully informed decision on her choice of treatment modality and was treated with radiotherapy. Increasingly journals are limiting publication of case reports to "world firsts" only. We present a case where such a policy would have denied patient choice and possibly led to detrimental treatment.We review the world literature of tongue base epithelial-myoepithelial carcinoma of the tongue.

Low prevalence of Human Papillomavirus in oral cavity carcinomas

Jerry Machado — 2010-03-12T00:00:00Z

Background: Increasing evidence shows that Human Papillomavirus (HPV) is preferentially associated with some head and neck squamous cell carcinomas (HNSCCs), with variable infection rates reported. Methods: We assessed HPV involvement in HNSCC using the Roche Linear Array HPV Genotyping Test, which can detect 37 different HPV types. We examined the prevalence of HPV infection in 92 HNSCCs (oropharynx, oral cavity, and other HNSCC sites). Results: HPV was frequently detected in oropharyngeal cancers (OPCs) (16/22, 73%), but was uncommon in oral cavity cancers (2/53, 4%), and in other HNSCC subsites (1/17, 6%). HPV positive tumors were associated with patients that were 40-60 years old (p=0.02), and node positive (p=<0.0001). HPV 16 was the most prevalent type, but other types detected included 6, 18, 33, 35, 45, and 52/58. Conclusion: Our results show that in contrast to oropharyngeal cancers, oral cancers and other HNSCCs infrequently harbor HPV.