Targeted Therapies of Head & Neck Squamous Cell Carcinoma
Almutasim Bellah Ahmed Mohammed;
Abstract
HNSCC are a broad category of diverse tumor types arising from various anatomic structures including the craniofacial bones, soft tissues, salivary glands, skin, and mucosal membranes. (HNSCC) has an incidence of more than 600,000 new cases worldwide per year.
The most well known risk factor for developing head and neck cancer is the deleterious effects of tobacco. HNSCC was one of the first carcinomas to be linked with p53 mutations caused by tobacco usage. Alcohol use is synergistic with tobacco in causing HNSCC. The carcinogenic properties of marijuana smoke are similar to those of tobacco.
The oncogenic HPV infection, mainly HPV-16, is an established cause of oropharyngeal cancer (predominantly tonsils and base of tongue).
High-risk HPV strains (16 and 18) associated with oropharyngeal squamous cell carcinoma (as well as cervical cancer) manipulate cellular pathways within affected cells to activate cell growth and suppress apoptosis.
Both CT scanner and magnetic resonance imaging (MRI) are giving highly relevant information about location, size, shape, and contours of the primary tumor. PET has been evaluated in both primary and recurrent HNSCC, to distinguish between benign and malignant processes, grade tumors, identify metastases, and diagnose tumor recurrence PET-CT has specific value in evaluating the patient with metastatic lymph nodes and an unknown primary.
The DWI technique allows tumor characterization at initial work-up (benign versus malignant), early treatment response evaluation, and recurrence detection. For nodal imaging, DWI seems extremely useful to differentiate tumoral and non-tumoral nodes.
Histologic examination to confirm malignancy is mandatory before initiating treatment of head and neck cancer. When no mucosal tumor is accessible for biopsy, diagnosis may be founded on cervical adenopathy.
Lymph node metastases and distant metastases are the most important predictors of prognosis. Early stage (I and II) patients have a 60% to 95% chance of cure with local treatment alone, but for the two-thirds of patients who continue to present with locally advanced disease, the risk of recurrence or development of distant metastatic disease is greater than 50%.
The treatment choice depends on the location of the primary tumor, the stage of the disease, and the expected oncological and functional outcomes. American Joint Committee on Cancer (AJCC) early-stage (I/II) SCCHN is usually treated with single-modality therapy (i.e. surgery or radiotherapy [RT]). The management of locally advanced disease (AJCC stage III/IV) generally requires various combinations of RT, surgery, and chemotherapy.
HNSCC continues to be difficult to treat and conventional treatment strategies result in a plethora of side effects that affect normal physiological functions including speech, swallowing and physical appearance. Moreover, aggressive therapy is often difficult secondary to co-morbidities common in HNSCC patients currently, treatment is based on site of disease and degree of invasion and metastases.
The most well known risk factor for developing head and neck cancer is the deleterious effects of tobacco. HNSCC was one of the first carcinomas to be linked with p53 mutations caused by tobacco usage. Alcohol use is synergistic with tobacco in causing HNSCC. The carcinogenic properties of marijuana smoke are similar to those of tobacco.
The oncogenic HPV infection, mainly HPV-16, is an established cause of oropharyngeal cancer (predominantly tonsils and base of tongue).
High-risk HPV strains (16 and 18) associated with oropharyngeal squamous cell carcinoma (as well as cervical cancer) manipulate cellular pathways within affected cells to activate cell growth and suppress apoptosis.
Both CT scanner and magnetic resonance imaging (MRI) are giving highly relevant information about location, size, shape, and contours of the primary tumor. PET has been evaluated in both primary and recurrent HNSCC, to distinguish between benign and malignant processes, grade tumors, identify metastases, and diagnose tumor recurrence PET-CT has specific value in evaluating the patient with metastatic lymph nodes and an unknown primary.
The DWI technique allows tumor characterization at initial work-up (benign versus malignant), early treatment response evaluation, and recurrence detection. For nodal imaging, DWI seems extremely useful to differentiate tumoral and non-tumoral nodes.
Histologic examination to confirm malignancy is mandatory before initiating treatment of head and neck cancer. When no mucosal tumor is accessible for biopsy, diagnosis may be founded on cervical adenopathy.
Lymph node metastases and distant metastases are the most important predictors of prognosis. Early stage (I and II) patients have a 60% to 95% chance of cure with local treatment alone, but for the two-thirds of patients who continue to present with locally advanced disease, the risk of recurrence or development of distant metastatic disease is greater than 50%.
The treatment choice depends on the location of the primary tumor, the stage of the disease, and the expected oncological and functional outcomes. American Joint Committee on Cancer (AJCC) early-stage (I/II) SCCHN is usually treated with single-modality therapy (i.e. surgery or radiotherapy [RT]). The management of locally advanced disease (AJCC stage III/IV) generally requires various combinations of RT, surgery, and chemotherapy.
HNSCC continues to be difficult to treat and conventional treatment strategies result in a plethora of side effects that affect normal physiological functions including speech, swallowing and physical appearance. Moreover, aggressive therapy is often difficult secondary to co-morbidities common in HNSCC patients currently, treatment is based on site of disease and degree of invasion and metastases.
Other data
| Title | Targeted Therapies of Head & Neck Squamous Cell Carcinoma | Other Titles | ﺇستخدام العلاجات الموجهه في أورام الرأس والرقبة الحرشوفية | Authors | Almutasim Bellah Ahmed Mohammed | Issue Date | 2015 |
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