Overview of the diagnosis and staging of head and neck cancer
- Colin S Poon, MD, PhD, FRCPC
Colin S Poon, MD, PhD, FRCPC
- Clinical Assistant Professor of Radiology
- Department of Diagnostic Radiology
- Yale University School of Medicine
- Kerstin M Stenson, MD, FACS
Kerstin M Stenson, MD, FACS
- Professor of Otolaryngology
- Chief, Head and Neck Cancer Program, Rush University Medical Center
- Department of Otolaryngology/Head and Neck Surgery
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Head and neck cancers can arise in the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, thyroid, and salivary glands and include a variety of histopathologic tumors.
An overview of the epidemiology, clinical presentation, diagnosis, and staging for head and neck cancer is presented here. More detailed discussions for specific primary tumor site are presented in the relevant site-specific topics. A general overview of treatment is also presented separately. (See "Overview of treatment for head and neck cancer".)
EPIDEMIOLOGY AND RISK FACTORS
There are large geographic differences in the incidence and primary site of head and neck cancers. These likely reflect the prevalence of risk factors, such as tobacco and alcohol consumption, as well as ethnic and genetic differences among populations.
Although the highest rates of head and neck cancer are in older males, the incidence has been increasing in females as more women use tobacco, and in young non-smokers as human papillomavirus (HPV) plays an increasingly prominent role as an etiologic factor in the development of oropharyngeal head and neck cancer.
Tobacco (smoked and smokeless) is the most important known risk factor for the development of head and neck cancer. There is some evidence for a genetic predisposition to the carcinogenic effects of tobacco. In addition, tobacco and alcohol consumption appear to have a synergistic effect. The repeated exposure of the mucosa of the upper aerodigestive tract to the carcinogenic effects of tobacco, alcohol, or both appears to cause multiple primary and secondary tumors in this "condemned mucosa," a phenomenon described as "field cancerization."
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- EPIDEMIOLOGY AND RISK FACTORS
- ANATOMIC SUBSITES
- CLINICAL PRESENTATION
- TNM STAGING SYSTEM
- DIAGNOSIS AND STAGING EVALUATION
- Initial evaluation
- Fine needle aspiration biopsy
- Imaging studies
- - CT scan
- - Magnetic resonance imaging
- - PET and integrated PET/CT
- Evaluation for distant metastases
- Incidence of second and multiple primaries
- Future molecular staging methods
- INFORMATION FOR PATIENTS