Head and Neck Cancer
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Epidemiology and Etiology
Head and neck squamous cell cancer (HNSCC) includes carcinoma of the lip, oral cavity, pharynx, nasopharynx, and larynx. It is estimated that nearly 51,540 patients will be diagnosed with HNSCC in the year 2018. Tobacco use and alcohol consumption are associated with increased risk of developing HNSCC. HPV infection is implicated in oropharyngeal squamous cell carcinomas, and the incidence of HPV-associated HNSCC has quadrupled since the 1980s. EBV infection is associated with nasopharyngeal cancers.
- Field cancerization is an important concept in HNSCC. Given the diffuse nature of mucosal exposure to tobacco smoke, the primary cancer site is often surrounded by areas of premalignant lesions (carcinoma in situ and dysplasia). For this reason, patients with tobacco-associated HNSCC are at increased risk for developing secondary cancers.
- Leukoplakia and erythroleukoplakia are premalignant lesions of the oral mucosa. Leukoplakia refers to a white mucosal patch that cannot be scraped out, whereas erythroleukoplakia appears red and velvety. Erythroleukoplakias are associated with a higher risk of malignant transformation.