AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 15

Head and Neck Cancer

Clinical Practice Guideline: Hoarseness (Dysphonia) Clinical Practice Guideline: Evaluation of the Neck Mass in Adults

Diagnosis and management of head and neck cancer is a broad topic. This chapter provides background information about the disease, its diagnosis, and management, along with a few case studies. The goal is to help you understand how to integrate information and treatment modalities to create a successful, modern approach to head and neck cancer. Head and neck cancer refers primarily to carcinomas arising from the mucosal surfaces of the head and neck: larynx; naso-, oro- and hypo- pharynx; oral cavity; paranasal sinuses; and the salivary glands. Historically, HNCs occurred in patients with a history of heavy tobacco and alcohol use, and cytopathologically they were squamous cell carci- nomas. While these are still significant risk factors, the incidence of human papilloma virus (HPV)-associated oropharyngeal cancers is increasing, primarily due to high-risk HPV subtypes 16 and 18. The vast majority (95 percent) of HNCs are squamous cell carcinomas. Certainly, an older adult patient with a history of heavy tobacco use and a

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persistent lump in the neck should raise suspicion of a malignant process arising from the upper aerodigestive tract (Figure 15.1). This is in contrast to the HPV- asso- ciated HNC patients who are typically younger, have no history of tobacco use, and present with a persistent, painless neck mass. A single course of antibiotics is warranted if an infectious source is suspected, but preparation should be made for immediate consultation with an otolaryngologist– head and neck surgeon, as there is a high likelihood that this represents a neoplasm.

Figure 15.1. Neck mass in an adult patient with squamous cell carcinoma of the hypopharynx who presented to the primary care physician with a large, firm neck mass. Fine-needle aspiration confirmed the diagnosis of squamous cell carcinoma.

Primary Care Otolaryngology