Summary
Definition
History and exam
Key diagnostic factors
- oral pain
- weight loss
Other diagnostic factors
- sore throat
- neck lump
- indurated or ulcerated mass
- dysphagia
- neck lymphadenopathy
- otalgia
- trismus
- white plaques (leukoplakia) and red plaques (erythroplakia)
Risk factors
- smoking tobacco cigarettes
- alcohol
- human papillomavirus (HPV)-16 infection
- tobacco and betel nut chewing
Diagnostic investigations
1st investigations to order
- biopsy of the primary site
- PET-CT of the head and neck
- fine needle aspiration cytology (FNAC) of neck nodes
- excision biopsy of neck nodes
Investigations to consider
- CT scan of the head and neck
- MRI of the head and neck
- panendoscopy or triple endoscopy
- modified barium swallow
- in situ hybridization for HPV-16, p16 immunohistochemistry, or PCR in biopsy specimen
- CBC
- electrolytes
- BUN
- serum creatinine
- total protein
- albumin
- prealbumin
- LFTs
Treatment algorithm
stage I or II (early stage disease)
stage III or IVA (locally advanced and resectable)
stage IVB (locally advanced and unresectable)
stage IVC (distant metastases at presentation)
recurrent disease
Contributors
Authors
Nam P. Nguyen, MD
Professor and Chair
Radiation Oncology Department
Howard University
Washington
DC
Disclosures
NPN is an author of a number of references cited in this topic.
Fabio Almeida, MD
Assistant Professor of Radiology
University of Arizona
Tucson
AZ
Disclosures
FA declares that he has no competing interests.
Acknowledgements
Dr Nam P. Nguyen and Dr Fabio Almeida would like to gratefully acknowledge Dr Linda Garland, a previous contributor to this topic.
Disclosures
LG is on the speakers' bureau for Sanofi-Aventis, maker of Taxotere.
Peer reviewers
AJ Balm, MD, PhD, FACS, FRCS
Chair Emeritus
Head and Neck Multidisciplinary Cooperative Group
Department of Head & Neck Oncology and Surgery
The Netherlands Cancer Institute
Amsterdam
The Netherlands
Disclosures
AJB declares that he has no competing interests.
Andy Trotti, MD
Specializing in Head & Neck Cancer
Director of Clinical Trials
Radiation Oncology
H. Lee Moffitt Cancer Center & Research Institute
Tampa
FL
Disclosures
AT is an author of a reference cited in this topic.
Hari Deshpande, MD
Assistant Professor of Medicine
Yale Cancer Center
Yale University
New Haven
CT
Disclosures
HD is on the speakers' bureau for Sanofi-Aventis and has received reimbursement for talks given about their product Taxotere.
Differentials
- Tonsillitis
- Aphthous ulcer
- Oral syphilis
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: head and neck cancers
- Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up
More GuidelinesPatient leaflets
Quitting smoking
Sore throat
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