Head and neck cancer: Difference between revisions

	Head and Neck cancer Microchapters
Patient Information
Overview
Classification Brain tumor Oral cancer Nasopharyngeal cancer Hypopharyngeal cancer Glomus tumor Salivary gland tumor Laryngeal cancer Thyroid cancer Parathyroid cancer Esophageal cancer
Causes
Differential diagnosis

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Latest revision as of 17:20, 8 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]

Classification

Head and neck cancers comprise of a group of malignancies arising from the oral cavity, pharynx and larynx, paranasal sinuses, nasal cavity or salivary glands with squamous cell carcinoma representing the most common histology.

'Head and neck squamous cell carcinomas (HNSCC's) make up the vast majority of head and neck cancers, and arise from mucosal surfaces throughout this anatomic region. These include tumors of the nasal cavities, paranasal sinuses, oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx.

Oral cavity

Squamous cell cancers are common in the oral cavity, including the inner lip, tongue, floor of mouth, gingivae, and hard palate. Cancers of the oral cavity are strongly associated with tobacco use, especially use of chewing tobacco or "dip", as well as heavy alcohol use. Cancers of this region, particularly the tongue, are more frequently treated with surgery than are other head and neck cancers.

Surgeries for oral cancers include

Maxillectomy (can be done with or without Orbital exenteration
Mandibulectomy (removal of the mandible or lower jaw or part of it)
Glossectomy (tongue removal, can be total, hemi or partial)
Radical neck dissection
Moh's procedure
Combinational e.g. glossectomy and laryngectomy done together.

The defect is covered/improved by using another part of the body and/or skin grafts and/or wearing a prosthesis.

Nasopharynx

Nasopharyngeal cancer arises in the nasopharynx, the region in which the nasal cavities and the Eustachian tubes connect with the upper part of the throat. While some nasopharyngeal cancers are biologically similar to the common HNSCC, "poorly differentiated" nasopharyngeal carcinoma is distinct in its epidemiology, biology, clinical behavior, and treatment, and is treated as a separate disease by many experts.

Surgeries for nasal cancer (cancer of the nose)

Surgery to removal the entire nose or part of the nose. Removal of all of the nose is called a total rhinectomy, for part of the nose it is called a partial rhinectomy. Afterwards to cover the defect, a new nose can be made by using another part of the body and/or a nose prosthesis is made.

Oropharynx

Oropharyngeal cancer begins in the oropharynx, the middle part of the throat that includes the soft palate, the base of the tongue, and the tonsils. Squamous cell cancers of the tonsils are more strongly associated with human papillomavirus infection than are cancers of other regions of the head and neck.

Hypopharynx

The hypopharynx includes the pyriform sinuses, the posterior pharyngeal wall, and the postcricoid area. Tumors of the hypopharynx frequently have an advanced stage at diagnosis, and have the most adverse prognoses of pharyngeal tumors. They tend to metastasize early due to the extensive lymphatic network around the larynx.

Larynx

Laryngeal cancer begins in the larynx or "voice box." Cancer may occur on the vocal cords themselves ("glottic" cancer), or on tissues above and below the true cords ("supraglottic" and "subglottic" cancers respectively). Laryngeal cancer is strongly associated with tobacco smoking.

Surgeries can include partial laryngectomy (removal of part of the larynx) and total laryngectomy (removal of the whole larnyx). If the whole larynx has been removed the person is left with a permanent tracheostomy opening and learns to speak again in a new way with the help of intensive teaching and speech therapy and/or an electronic device.

Also anyone who has had a glossectomy (tongue removal) will be taught to speak again in a new way and have intensive speech therapy

Trachea

Cancer of the trachea is a rare malignancy which can be biologically similar in many ways to head and neck cancer, and is sometimes classified as such.

Most tumors of the salivary glands differ from the common carcinomas of the head and neck in etiology, histopathology, clinical presentation, and therapy, Other uncommon tumors arising in the head and neck include teratomas, adenocarcinomas, adenoid cystic carcinomas, and mucoepidermoid carcinomas. Rarer still are melanomas and lymphomas of the upper aerodigestive tract.

^[1]^[2]^[3]^[4]

History and Symptoms

Throat Cancer usually begins with symptoms that seem harmless enough, like an enlarged lymph node on the outside of the neck, a sore throat or a hoarse sounding voice. However, in the case of throat cancer, these conditions may persist and become chronic. There may be a lump or a sore in the throat or neck that does not heal or go away. There may be difficult or painful swallowing. Speaking may become difficult. There may be a persistent earache. Other possible but less common symptoms include some numbness or paralysis of the face muscles.

Presenting symptoms include:

A lump or sore that does not heal
A sore throat that does not go away
Trouble swallowing
A change or hoarseness in the voice

Other symptoms may include the following:

Oral cavity. A white or red patch on the gums, tongue, or lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.
Nasal cavity and sinuses. Sinuses that are blocked and do not clear, chronic sinus infections that do not respond to treatment with antibiotics, bleeding through the nose, frequent headaches, swelling or other trouble with the eyes, pain in the upper teeth, or problems with dentures.
Salivary glands. Swelling under the chin or around the jawbone; numbness or paralysis of the muscles in the face; or pain that does not go away in the face, chin, or neck.
Oropharynx and hypopharynx. Ear pain.
Nasopharynx. Trouble breathing or speaking, frequent headaches, pain or ringing in the ears, or trouble hearing.
Larynx. Pain when swallowing, or ear pain.
Metastatic squamous neck cancer. Pain in the neck or throat that does not go away.

These symptoms may be caused by cancer or by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms.

Differentiating head and neck cancer from other diseases

Head and neck cancer must be differentiated from congenital abnormalities, and malignant lesions.

Category	Diseases		Benign/ Malignant	Clinical manifestation						Paraclinical findings			Gold standard diagnosis	Associated findings
				Demography	History	Symptoms		Signs		Lab findings	Histopathology	Imaging
				Demography	History	Pain	Dysphagia	Mass exam	Others	Lab findings	Histopathology	Imaging
Neoplasm	Salivary gland neoplasm	Pleomorphic adenoma^[5]^[6]	Benign	More common in females Incidence increase with age Incidence: 2-3.5 cases per 100,000 population	History of swelling Dysphagia Hoarseness	−	+	Palpable mass of deep lobe of parotid gland Firm Mobile	−	−	Proliferation of epithelial cells and stromal matrix in the ducts	MRI: Homogenous on T1 Abundant myxochondroid stroma on T2	Biopsy	−
		Warthin's tumor^[7]^[8]	Benign	Male to female ratio: 4:1 More common in people aged 60-70 years old	History of swollen salivary gland Jaw pain Tinnitus	−	+	Non tender Mobile Firm Solitary	−	−	Papillae Fibrous capsule Cystic spaces	Neck CT: Cystic lesion posteriorly within the parotid gland MRI: B/L heterogeneous lesions	Biopsy	−
		Oncocytoma ^[9]	Benign	Race: Caucasian patients predilection Gender: No gender preference Age: 50–70 years	Growing palpable painless mass Facial swelling Lymphadenopathy (if transformed to malignant)	±	±	Firm, multilobulated Mobile mass	Normal Redness Swelling Skin ulceration	Normal Anemia	Epithelial cells with eosinophilic Granular cytoplasm Rich in mitochondria	CT: Isodense expansive mass Enhancement after intravenous contrast Hypodense areas MRI: Isodensties on T1 Mass is hyperintense on T2 Enhancement on contrast	Incisional biopsy and histopathological examination	-
		Monomorphic adenoma ^[10]^[11]^[12]	Benign or malignant	Age: 26-76 years Rare in children Gender: No predilection	Growing palpable painless mass on jaw or in oral cavity Facial swelling Lymphadenopathy (if transformed to malignant) Pain and ulceration (in later stage)	±	±	Nodular Fluctuant swelling	Normal Redness Skin ulceration May have lymphadenopathy	Normal	Straw colored fluid on aspiration	Ultrasound: Used to biopsy the lesion May show cystic an solid components CT: useful for lesions with calcification and venous phleboliths MRI: Test of choice Differentiate benign from malignant Defines tumor extent Shows perineural spread	Incisional biopsy and histopathological examination	-
		Mucoepidermoid carcinoma ^[13]	Malignant	Age: Mean age of 59 Female predilection	Painlesss mass Swelling in oral cavity Lymphadenopathy	±	±	Cystic and solid mass	May have lymphadenopathy	−	Gross findings: Firm Tan-white to yellow Bosselated Cystic Microscopic findings: Encapsulated squamous and glandular components	Cystic and solid component with variable appearance on CT and MRI	Incisional biopsy and histopathological examination	Association with CMV
Category	Diseases		Benign	Demography	History	Pain	Dysphagia	Mass exam	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Neoplasm	Salivary gland neoplasm	Adenoid cystic carcinoma ^[14]	Malignant	Age: 40s-60s Gender: Female predominance	Slow growing rare tumor with low recurrence	±	±	Solid mass	Normal to ulcerated lesions May have lymphadenopathy	−	Gross findings: Tubular Cribriform Solid pattern of growth Microscopic findings: Components of large cells with pleomorphic nuclei Increased mitotic activity Focal necrosis	Imaging reveal dimensions of the tumor, local spread, and distant metastasis	Biopsy and histopathological examination	−
		Adenocarcinoma ^[15]	Malignant	Age: young age predilection	Its a tumor of minor salivary glands May present as small ulceration or nodules in oral cavity	−	−	Small nodules in oral cavity With or without lymphadenopathy	Normal to ulcerated lesions May have lymphadenopathy	May be normal Or may show anemia and blood cell disorders with distant bone invasion	On histology it is confused with Adeocyctic carcinoma Components of gland and cyst formations More perineural invasion	CT and MRI MRI being more accurate for adjacent tissue involvement and lymphadenopathy	Biopsy and histopathological examination	−
		Salivary duct cancer^[16]^[17]^[18]	Malignant (Highly aggressive)	Incidence: 1-3% Gender: Male predilection Mean age: 55-61 years old	Rapidly growing mass with jaw involvement	±	±	Painless Hard Non-compressible mass	Ulceration of mucosa and skin May have lymphadenopathy facial paralysis in case of facial nerve involvement	Pathomorphologically tumor of salivary ducts resembles tumor of breast ducts	Gross findings: Firm mass Cystic component of variable size and dimension Microscopic finding: Resembling ductal carcinoma of breast Intraductal components invading surrounding tissue in several forms: cribriform papillary Solid with comedo-like central necrosis	Non-specific features on CT and MRI Shows neural and jaw involvement	Biopsy and histopathological examination	−
		Squamous cell carcinoma^[19]^[20]	Malignant	Incidence: rare Age: Old age , 61-68 years Male predilection	Present as painful growing mass on jaw	+	−	Teneder Firm Solitary swelling on jaw	Submandibular gland predilection Thinning and discoloration of skin	Past radiation exposure is a strong risk factor	Gross findings: Thinning of skin Microscopically findings: Nest and solid sheets of tumor cells arranged in glandular pattern Immunohistochemical staining can be used to mark the squamous and keratin component	Tumor dimension can be delineated using both CT and MRI	Biopsy and histopathological examination	−
Category	Diseases		Benign	Demography	History	Pain	Dysphagia	Mass exam	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Neoplasm	Hypopharyngeal cancer^[21]^[22]^[23]		Malignant	More common in males Age: 55-65 years old Incidence: < 1/100,000 in U.S. More common in Japan, India, Iran	Tobacco use Abuse alcohol consumption HPV infection Lump in the neck Odynophagia Hoarseness	−	+	Non tender cervical node	Lymphadenopathy	−	Spindle cells Nuclear atypia Basaloid cells Abundant chromatin	Neck CT scan: Soft tissue mass Irregular thickening of mucosa Necrotic region MRI: Tumors are hypointense on T1 and hyperintense on T2	Biopsy	−
	Parathyroid cancer^[24]^[25]^[26]		Malignant	Incidence: Rare Mean age : 44-54 years old Gender: Female predilection	Presents with the hyperparathyroidism Bone pains Abdominal pain Nausea and vomiting Fatigue Confusion	+	+	Lower neck mass	Tachycardia Weight loss Sweating Neck swelling	Low TSH Increased T4 and T3 Hypercalcemia	Microscopic findings: Trabecular growth pattern High mitosis Surrounding thick fibrotic bands Capsular involvement Vascular invasion is common	CT and MRI shows more frequent lower lobe involvement, vascular involvement , lymph node metastasis, and perineural involvement Bone scan may show decreasing bone density	Biopsy and histopathological examination	Hereditary syndromes MEN-2B syndrome Neurofibromatosis type 1 VHL disease
	Carotid body tumors^[27]^[28]^[29]^[30]		Benign	Age: 26-55 years Male predominance	A slow growing neck mass	+	−	Mobile Non-tender neck mass (horizontally more than vertically) Pulsatile Bruit may be present	Change in voice Dizziness Tinnitus Headache	Rasised catecholamine levels	Microscopically they are extra-adrenal paragangliomas	Doppler ultrasound, CT, MRI and angiography is used to visualize the tumor Metaiodobenzylguanidine (MIBG) testing	Histopathology analysis and catecholamine levels	−
	Paraganglioma^[31]^[32]^[33]		Benign (Majority) Malignant (rare)	Age 50-70 years More in females	May be an accidental finding depending on their secretory nature or present with following symptoms: Palpitation Tremor Pulse-like vibratory sense Headache Change in voice Vertigo Catecholamine secreting paragangliomas presents with : Hypertension Headache Sweating Tachycardia	−	−	No visible mass Located deep in the the neck along the glossopharyngeal nerve	−	Biochemical testing may show catecholamine metabolites in serum or urine samples	Highly vascular tumors that involves nerves around vessels Gross findings: Fleshy tumor Pink to red-brown to gray in color Associated with hemorrhage or fibrosis Microscopic findings: Round or polygonal cells Nests or trabecular structures inside the capsule	Ultrasound Computed tomography Magnetic resonance imaging Angiography metaiodobenzylguanidine (MIBG) 18F-fluoro-2-deoxyglucose Positron emission tomography (FDG-PET)	Imaging and serum catecholamine analysis	−
Category	Diseases		Benign	Demography	History	Pain	Dysphagia	Mass exam	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Neoplasm	Schwannoma^[34]^[35]^[36]		Benign	Rare tumor Incidence: 1-10%	Slow growing mass Localized neural deficit depending on the site of peripheral nerve involved Vagus nerve or superior cervical sympathetic chain involvement (most common locations)	+	±	Multiple Slow growing nodules on the skin	Vagal involvement: Hoarseness Dysphagia Sympathetic nerve involvement may present as Horner's syndrome: Dilated pupil Decrease sweating Dropping eyelid Vestibular nerve involvement & Hearing impairment (most common)	May be normal	Encapsulated neural tissue growth	Resembling Carotid body tumor on CT MRI and MRI angiography confirm the diagnosis	Imaging	neurofibromatosis type II
	Lymphoma ^[37]^[38]^[39]^[40]^[41]^[42]		Benign or malignant	Age: Predilection for older age Mean age: 55	Insidious onset slow growing lymph nodes Non-specific systemic B symptoms: Fever Night sweats Weight loss) Rash Waxing and waning lymphadenopathy Abdominal fullness	−	±	Multiple chain lymphadenopathy Hepatosplenomegaly Ascites Crackles heard on chest auscultation	Rash and pruritus	Pancytopenia Hypercalcemia Hyperuricemia (increased cell turnover) Monoclonal immunoglobulin (M-spike) Raised LDH levels	On complete node analysis four patterns are described: Nodular/follicular Diffuse pattern Transition from a nodular to a diffuse pattern in adjacent nodes Transition from a lower to a higher grade of involvement within a single node	Imaging to stage the disease Positron emission tomography with computed tomography is preferred over MRI	Lymph node biopsy coupled with cytometry	Infections due to cytopenias With acquired form of C1 inhibitor deficiency patients may develop angioedema
	Liposarcoma ^[43]^[44]^[45]^[46]		Malignant	Rare tumor Age: Relatively in older age Gender: No gender predilection	Mobile mass Few symptoms until they grow enough to compress the surrounding structures Symptoms of neural deficit, pain, tingling, or skin changes	±	−	Mobile soft mass Intact overlying skin Blue discoloration due to intra-lesion hemorrhage	Intact skin and normal color	Normal	Gross examination: Bulk of yellow colored fat tissue Microscopic features: Adipose tissue containing lipoblasts Atypical nucleus pushed to side by intracytoplasmic vacuoles Tissue biopsy may show histological sub-groups: Well-differentiated Myxoid/round cell Pleomorphic liposarcomas	Imaging not usually required for diagnosis May show deeper invasion Ultrasound shows homogeneous hyperechoic mass	Biopsy and histopathology analysis	−
Category	Diseases		Benign	Demography	History	Pain	Dysphagia	Mass exam	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Neoplasm	Lipoma ^[47]^[48]^[49]		Benign	Genetic predisposition Unspecific gender or age association	One or multiple soft, painless skin nodules May causes pain or compressive symptoms	±	−	Mobile soft nodule Intact overlying skin	Normal	Normal	Diagnoses is usually clinical Tissue biopsy may show: Bundle of well-demarcated lipocytes Single nuclei aligned to the side Intra-cytoplasimic fat granules	Diagnosis is usually clinical ultrasound is used to differentiate lipoma from other benign lesions such as: Epidermoid cyst A ganglion	Clinical evaluation	Multiple lipomas Associated with familial multiple lipomatosis
	Glomus vagale, glomus jugulare tumors^[50]^[51]^[52]^[53]^[54]^[55]		Benign	Rare tumor	Painless slowly enlarging mass in the neck	−	±	Non-compressible Firm Non-tender swelling No thrill or bruit Normal overlying skin	Secretory tumors May have compressive signs such as: Dysphagia Hoarseness Cranial nerves deficits Horner's syndrome	Normal	Glomus tumors arise from Non Chromaffin cells histopathology reveals "salt and pepper" chromatin On immunohistochemistry tumor cells show chromogranin and S-100 positivity	MRI (Imaging of choice): Typical appearance of the tumor along vagus nerve Ultrasonography (early stage of diagnosis): Isoechoic to hypoechoic well defined tumor CT: Vascularity of the tumor Biochemical testing: Shows secretary nature of the tumor	Imaging and Metaiodobenzylguanidine (MIBG) testing	−
	Metastatic head and neck cancer^[56]^[57]		Malignant	Depends on the nature of metastatic tumor	Asymptomatic Painless lymphadenopathy Supra clavicular fullness in case of stomach cancer metastasis	−	±	Non-tender mass in the neck Non-tender lymphadenopathy	Majority of metastatic head and neck cancer Metastatise from GIT and lungs	Vary depending on the underlying cancer	Histology of primary cancer	CT and MRI to see extent of tumor	Biopsy and histopathology of the primary site of tumor	−
Category	Diseases		Benign	Demography	History	Pain	Dysphagia	Mass exam	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Other	Laryngeal cancer^[58]^[59]		Benign/Malignant	Older males Younger patients with HPV infection or smoking history	Neck mass Hoarseness Throat pain Snoring Obstructive sleep apnea	±	±	Examination of neck and oral cavity may show : mass lymphadenopathy Examination of laryngeal cancer is done using flexible laryngoscopy under anesthesia.	Smoking is the most common risk factor Smoking with alcohol increases the risk Oropharyngeal cancers presenting with neck masses are associated with human papillomavirus (HPV) infection	HPV testing may show HPV infection	FNA of neck mass Followed by biopsy of laryngeal cancer Show type cancer cells	CT, MRI and PET are used to see local infiltration by cancer Also to see distant metastases. Panendoscopy is done to see extent of the tumor.	Laryngoscopy and biopsy	−
	Arteriovenous fistula ^[60]^[61]		Benign/Malignant	Depends on the risk factors	Expanding neck mass Headaches Dizziness Neurological sequels	−	−	Pulsating neck mass Bruit	May be associated with vasculopathies metastatic invasion of vessels and neck surgery		Varies depending on the etiology	MR angiography	MR angiography	−
	Thyroid nodule/ Goiter ^[62]^[63]^[64]^[65]		Benign/ Malignant	Female predominance Young age (benign causes) Old age (malignant etiology)	Growing painless neck mass in front of neck Weight loss Palpitation Hoarseness Irritability	±	±	Painless Non-tender Asymmetrical neck mass in front of neck With smooth overlying skin Nodular surface Depending on the type: May be mobile Adherent to the underlying structure Lymphadenopathy in case of malignant features	Goiter is most commonly associated with iodine deficiency	Normal to low TSH levels in case of malignancy High TSH levels in case of goiter	FNA is done in case of goiter Core biopsy is performed if malignancy is suspected	USG: Shows nodular or non- nodular lesions in Thyroid US is better than CT. Thyroid radionuclide imaging: Shows radioiodine uptake Cold in case of malignancy Cold or hot in case of goiter.	Biopsy and histopathology of nodules	−
Category	Diseases		Benign	Demography	History	Pain	Dysphagia	Mass exam	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings

Primary Prevention

Avoidance of recognised risk factors (as described above)is the single most effective form of prevention. Regular dental examinations may identify pre-cancerous lesions in the oral cavity.
It will be interesting to see what effect the widespread use of HPV vaccines has on the incidence of HPV-related H&N cancers.
People who have been treated for head and neck cancer have an increased chance of developing a new cancer, usually in the head and neck, esophagus, or lungs. The chance of a second primary cancer varies depending on the original diagnosis, but is higher for people who smoke and drink alcohol. Patients who do not smoke should never start. Those who smoke should do their best to quit. Studies have shown that continuing to smoke or drink (or both) increases the chance of a second primary cancer for up to 20 years after the original diagnosis.
Some research has shown that isotretinoin (13-cis-retinoic acid), a substance related to vitamin A, may reduce the risk of the tumor recurring (coming back) in patients who have been successfully treated for cancers of the oral cavity, oropharynx, and larynx. However, treatment with isotretinoin has not yet been shown to improve survival or to prevent future cancers.

References

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↑ Pellitteri PK, Rinaldo A, Myssiorek D, Gary Jackson C, Bradley PJ, Devaney KO, Shaha AR, Netterville JL, Manni JJ, Ferlito A (July 2004). "Paragangliomas of the head and neck". Oral Oncol. 40 (6): 563–75. doi:10.1016/j.oraloncology.2003.09.004. PMID 15063383.
↑ Darouassi Y, Alaoui M, Mliha Touati M, Al Maghraoui O, En-Nouali A, Bouaity B, Ammar H (August 2017). "Carotid Body Tumors: A Case Series and Review of the Literature". Ann Vasc Surg. 43: 265–271. doi:10.1016/j.avsg.2017.03.167. PMID 28478173.
↑ Neumann HP, Pawlu C, Peczkowska M, Bausch B, McWhinney SR, Muresan M, Buchta M, Franke G, Klisch J, Bley TA, Hoegerle S, Boedeker CC, Opocher G, Schipper J, Januszewicz A, Eng C (August 2004). "Distinct clinical features of paraganglioma syndromes associated with SDHB and SDHD gene mutations". JAMA. 292 (8): 943–51. doi:10.1001/jama.292.8.943. PMID 15328326.
↑ Erickson D, Kudva YC, Ebersold MJ, Thompson GB, Grant CS, van Heerden JA, Young WF (November 2001). "Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients". J. Clin. Endocrinol. Metab. 86 (11): 5210–6. doi:10.1210/jcem.86.11.8034. PMID 11701678.
↑ O'Riordain DS, Young WF, Grant CS, Carney JA, van Heerden JA (September 1996). "Clinical spectrum and outcome of functional extraadrenal paraganglioma". World J Surg. 20 (7): 916–21, discussion 922. PMID 8678971.
↑ Hilton DA, Hanemann CO (April 2014). "Schwannomas and their pathogenesis". Brain Pathol. 24 (3): 205–20. doi:10.1111/bpa.12125. PMID 24450866.
↑ Albert P, Patel J, Badawy K, Weissinger W, Brenner M, Bourhill I, Parnell J (2017). "Peripheral Nerve Schwannoma: A Review of Varying Clinical Presentations and Imaging Findings". J Foot Ankle Surg. 56 (3): 632–637. doi:10.1053/j.jfas.2016.12.003. PMID 28237565.
↑ Wong B, Bathala S, Grant D (January 2017). "Laryngeal schwannoma: a systematic review". Eur Arch Otorhinolaryngol. 274 (1): 25–34. doi:10.1007/s00405-016-4013-6. PMID 27020268. Vancouver style error: initials (help)
↑ Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). "Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute". Cancer. 50 (12): 2699–707. PMID 7139563.
↑ Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). "Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute". Cancer. 50 (12): 2699–707. PMID 7139563.
↑ Negri E, Little D, Boiocchi M, La Vecchia C, Franceschi S (August 2004). "B-cell non-Hodgkin's lymphoma and hepatitis C virus infection: a systematic review". Int. J. Cancer. 111 (1): 1–8. doi:10.1002/ijc.20205. PMID 15185336.
↑ Moormeier JA, Williams SF, Golomb HM (February 1990). "The staging of non-Hodgkin's lymphomas". Semin. Oncol. 17 (1): 43–50. PMID 2406917.
↑ Negri E, Little D, Boiocchi M, La Vecchia C, Franceschi S (August 2004). "B-cell non-Hodgkin's lymphoma and hepatitis C virus infection: a systematic review". Int. J. Cancer. 111 (1): 1–8. doi:10.1002/ijc.20205. PMID 15185336.
↑ Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). "Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute". Cancer. 50 (12): 2699–707. PMID 7139563.
↑ Evans HL (January 2007). "Atypical lipomatous tumor, its variants, and its combined forms: a study of 61 cases, with a minimum follow-up of 10 years". Am. J. Surg. Pathol. 31 (1): 1–14. doi:10.1097/01.pas.0000213406.95440.7a. PMID 17197914.
↑ Conyers R, Young S, Thomas DM (2011). "Liposarcoma: molecular genetics and therapeutics". Sarcoma. 2011: 483154. doi:10.1155/2011/483154. PMC 3021868. PMID 21253554.
↑ Alaggio R, Coffin CM, Weiss SW, Bridge JA, Issakov J, Oliveira AM, Folpe AL (May 2009). "Liposarcomas in young patients: a study of 82 cases occurring in patients younger than 22 years of age". Am. J. Surg. Pathol. 33 (5): 645–58. doi:10.1097/PAS.0b013e3181963c9c. PMID 19194281.
↑ Serpell JW, Chen RY (July 2007). "Review of large deep lipomatous tumours". ANZ J Surg. 77 (7): 524–9. doi:10.1111/j.1445-2197.2007.04042.x. PMID 17610686.
↑ de Bree E, Karatzanis A, Hunt JL, Strojan P, Rinaldo A, Takes RP, Ferlito A, de Bree R (May 2015). "Lipomatous tumours of the head and neck: a spectrum of biological behaviour". Eur Arch Otorhinolaryngol. 272 (5): 1061–77. doi:10.1007/s00405-014-3065-8. PMID 24800932.
↑ Rydholm A, Berg NO (December 1983). "Size, site and clinical incidence of lipoma. Factors in the differential diagnosis of lipoma and sarcoma". Acta Orthop Scand. 54 (6): 929–34. PMID 6670522.
↑ Myhre-Jensen O (June 1981). "A consecutive 7-year series of 1331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas". Acta Orthop Scand. 52 (3): 287–93. PMID 7282321.
↑ Urquhart AC, Johnson JT, Myers EN, Schechter GL (April 1994). "Glomus vagale: paraganglioma of the vagus nerve". Laryngoscope. 104 (4): 440–5. doi:10.1288/00005537-199404000-00008. PMID 8164483.
↑ Valavanis A, Schubiger O, Oguz M (1983). "High-resolution CT investigation of nonchromaffin paragangliomas of the temporal bone". AJNR Am J Neuroradiol. 4 (3): 516–9. PMID 6308990.
↑ Urquhart AC, Johnson JT, Myers EN, Schechter GL (April 1994). "Glomus vagale: paraganglioma of the vagus nerve". Laryngoscope. 104 (4): 440–5. doi:10.1288/00005537-199404000-00008. PMID 8164483.
↑ Stein PP, Black HR (January 1991). "A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience". Medicine (Baltimore). 70 (1): 46–66. PMID 1988766.
↑ Sajid MS, Hamilton G, Baker DM (August 2007). "A multicenter review of carotid body tumour management". Eur J Vasc Endovasc Surg. 34 (2): 127–30. doi:10.1016/j.ejvs.2007.01.015. PMID 17400487.
↑ Boedeker CC, Ridder GJ, Schipper J (2005). "Paragangliomas of the head and neck: diagnosis and treatment". Fam. Cancer. 4 (1): 55–9. doi:10.1007/s10689-004-2154-z. PMID 15883711.
↑ Gluckman JL, Robbins KT, Fried MP (1990). "Cervical metastatic squamous carcinoma of unknown or occult primary source". Head Neck. 12 (5): 440–3. PMID 2211107.
↑ Waltonen JD, Ozer E, Hall NC, Schuller DE, Agrawal A (October 2009). "Metastatic carcinoma of the neck of unknown primary origin: evolution and efficacy of the modern workup". Arch. Otolaryngol. Head Neck Surg. 135 (10): 1024–9. doi:10.1001/archoto.2009.145. PMID 19841343.
↑ Feldman PS, Kaplan MJ, Johns ME, Cantrell RW (November 1983). "Fine-needle aspiration in squamous cell carcinoma of the head and neck". Arch Otolaryngol. 109 (11): 735–42. PMID 6639441.
↑ Grénman R, Koivunen P, Minn H (2015). "[Laryngeal cancer in Finland]". Duodecim (in Finnish). 131 (4): 331–7. PMID 26237923.
↑ Guneyli S, Cinar C, Bozkaya H, Korkmaz M, Oran I (September 2016). "Endovascular management of congenital arteriovenous fistulae in the neck". Diagn Interv Imaging. 97 (9): 871–5. doi:10.1016/j.diii.2015.08.006. PMID 26972281.
↑ Gobin YP, Garcia de la Fuente JA, Herbreteau D, Houdart E, Merland JJ (November 1993). "Endovascular treatment of external carotid-jugular fistulae in the parotid region". Neurosurgery. 33 (5): 812–6. PMID 8264877.
↑ Madjar S, Weissberg D (July 1995). "Retrosternal goiter". Chest. 108 (1): 78–82. PMID 7606997.
↑ Hedayati N, McHenry CR (March 2002). "The clinical presentation and operative management of nodular and diffuse substernal thyroid disease". Am Surg. 68 (3): 245–51, discussion 251–2. PMID 11893102.
↑ Hughes K, Eastman C (August 2012). "Goitre - causes, investigation and management". Aust Fam Physician. 41 (8): 572–6. PMID 23145396.
↑ Hermus AR, Huysmans DA (August 2000). "[Diagnosis and therapy of patients with euthyroid goiter]". Ned Tijdschr Geneeskd (in Dutch; Flemish). 144 (34): 1623–7. PMID 10972051.

Case Studies

Case#1

Related chapters

oral cancer
cancer of the larynx
thyroid cancer
adenoid cystic carcinoma - a type of salivary gland cancer
Burkitt's lymphoma - a type of lymphoma that affects the head and neck
Dermatofibrosarcoma protuberans - a type of sarcoma that may involve the head and neck
Hodgkin's disease - a lymphoma that often involves the lymph nodes in the neck
paraganglioma - usually found in the head and neck region
skin cancers - may involve the head and neck
Bobby Hamilton - a NASCAR driver who died of head and neck cancer

External Links

Head and Neck Cancer - Learn more from MedlinePlus
Head and Neck Cancer Information
Head and Neck Cancer: Questions and Answers
Head and Neck Cancer: Treatment
RadiologyInfo - The radiology information resource for patients: Head and Neck Cancer

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[pmid158837112-28] Boedeker CC, Ridder GJ, Schipper J (2005). "Paragangliomas of the head and neck: diagnosis and treatment". Fam. Cancer. 4 (1): 55–9. doi:10.1007/s10689-004-2154-z. PMID 15883711.

[pmid15063383-29] Pellitteri PK, Rinaldo A, Myssiorek D, Gary Jackson C, Bradley PJ, Devaney KO, Shaha AR, Netterville JL, Manni JJ, Ferlito A (July 2004). "Paragangliomas of the head and neck". Oral Oncol. 40 (6): 563–75. doi:10.1016/j.oraloncology.2003.09.004. PMID 15063383.

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[pmid15328326-31] Neumann HP, Pawlu C, Peczkowska M, Bausch B, McWhinney SR, Muresan M, Buchta M, Franke G, Klisch J, Bley TA, Hoegerle S, Boedeker CC, Opocher G, Schipper J, Januszewicz A, Eng C (August 2004). "Distinct clinical features of paraganglioma syndromes associated with SDHB and SDHD gene mutations". JAMA. 292 (8): 943–51. doi:10.1001/jama.292.8.943. PMID 15328326.

[pmid11701678-32] Erickson D, Kudva YC, Ebersold MJ, Thompson GB, Grant CS, van Heerden JA, Young WF (November 2001). "Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients". J. Clin. Endocrinol. Metab. 86 (11): 5210–6. doi:10.1210/jcem.86.11.8034. PMID 11701678.

[pmid8678971-33] O'Riordain DS, Young WF, Grant CS, Carney JA, van Heerden JA (September 1996). "Clinical spectrum and outcome of functional extraadrenal paraganglioma". World J Surg. 20 (7): 916–21, discussion 922. PMID 8678971.

[pmid24450866-34] Hilton DA, Hanemann CO (April 2014). "Schwannomas and their pathogenesis". Brain Pathol. 24 (3): 205–20. doi:10.1111/bpa.12125. PMID 24450866.

[pmid28237565-35] Albert P, Patel J, Badawy K, Weissinger W, Brenner M, Bourhill I, Parnell J (2017). "Peripheral Nerve Schwannoma: A Review of Varying Clinical Presentations and Imaging Findings". J Foot Ankle Surg. 56 (3): 632–637. doi:10.1053/j.jfas.2016.12.003. PMID 28237565.

[pmid27020268-36] Wong B, Bathala S, Grant D (January 2017). "Laryngeal schwannoma: a systematic review". Eur Arch Otorhinolaryngol. 274 (1): 25–34. doi:10.1007/s00405-016-4013-6. PMID 27020268. Vancouver style error: initials (help)

[pmid7139563-37] Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). "Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute". Cancer. 50 (12): 2699–707. PMID 7139563.

[pmid71395632-38] Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). "Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute". Cancer. 50 (12): 2699–707. PMID 7139563.

[pmid15185336-39] Negri E, Little D, Boiocchi M, La Vecchia C, Franceschi S (August 2004). "B-cell non-Hodgkin's lymphoma and hepatitis C virus infection: a systematic review". Int. J. Cancer. 111 (1): 1–8. doi:10.1002/ijc.20205. PMID 15185336.

[pmid2406917-40] Moormeier JA, Williams SF, Golomb HM (February 1990). "The staging of non-Hodgkin's lymphomas". Semin. Oncol. 17 (1): 43–50. PMID 2406917.

[pmid151853362-41] Negri E, Little D, Boiocchi M, La Vecchia C, Franceschi S (August 2004). "B-cell non-Hodgkin's lymphoma and hepatitis C virus infection: a systematic review". Int. J. Cancer. 111 (1): 1–8. doi:10.1002/ijc.20205. PMID 15185336.

[pmid71395633-42] Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). "Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute". Cancer. 50 (12): 2699–707. PMID 7139563.

[pmid171979142-43] Evans HL (January 2007). "Atypical lipomatous tumor, its variants, and its combined forms: a study of 61 cases, with a minimum follow-up of 10 years". Am. J. Surg. Pathol. 31 (1): 1–14. doi:10.1097/01.pas.0000213406.95440.7a. PMID 17197914.

[pmid21253554-44] Conyers R, Young S, Thomas DM (2011). "Liposarcoma: molecular genetics and therapeutics". Sarcoma. 2011: 483154. doi:10.1155/2011/483154. PMC 3021868. PMID 21253554.

[pmid19194281-45] Alaggio R, Coffin CM, Weiss SW, Bridge JA, Issakov J, Oliveira AM, Folpe AL (May 2009). "Liposarcomas in young patients: a study of 82 cases occurring in patients younger than 22 years of age". Am. J. Surg. Pathol. 33 (5): 645–58. doi:10.1097/PAS.0b013e3181963c9c. PMID 19194281.

[pmid176106862-46] Serpell JW, Chen RY (July 2007). "Review of large deep lipomatous tumours". ANZ J Surg. 77 (7): 524–9. doi:10.1111/j.1445-2197.2007.04042.x. PMID 17610686.

[pmid24800932-47] Bree E, Karatzanis A, Hunt JL, Strojan P, Rinaldo A, Takes RP, Ferlito A, de Bree R (May 2015). "Lipomatous tumours of the head and neck: a spectrum of biological behaviour". Eur Arch Otorhinolaryngol. 272 (5): 1061–77. doi:10.1007/s00405-014-3065-8. PMID 24800932.

[pmid6670522-48] Rydholm A, Berg NO (December 1983). "Size, site and clinical incidence of lipoma. Factors in the differential diagnosis of lipoma and sarcoma". Acta Orthop Scand. 54 (6): 929–34. PMID 6670522.

[pmid7282321-49] Myhre-Jensen O (June 1981). "A consecutive 7-year series of 1331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas". Acta Orthop Scand. 52 (3): 287–93. PMID 7282321.

[pmid8164483-50] Urquhart AC, Johnson JT, Myers EN, Schechter GL (April 1994). "Glomus vagale: paraganglioma of the vagus nerve". Laryngoscope. 104 (4): 440–5. doi:10.1288/00005537-199404000-00008. PMID 8164483.

[pmid6308990-51] Valavanis A, Schubiger O, Oguz M (1983). "High-resolution CT investigation of nonchromaffin paragangliomas of the temporal bone". AJNR Am J Neuroradiol. 4 (3): 516–9. PMID 6308990.

[pmid81644832-52] Urquhart AC, Johnson JT, Myers EN, Schechter GL (April 1994). "Glomus vagale: paraganglioma of the vagus nerve". Laryngoscope. 104 (4): 440–5. doi:10.1288/00005537-199404000-00008. PMID 8164483.

[pmid1988766-53] Stein PP, Black HR (January 1991). "A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience". Medicine (Baltimore). 70 (1): 46–66. PMID 1988766.

[pmid17400487-54] Sajid MS, Hamilton G, Baker DM (August 2007). "A multicenter review of carotid body tumour management". Eur J Vasc Endovasc Surg. 34 (2): 127–30. doi:10.1016/j.ejvs.2007.01.015. PMID 17400487.

[pmid15883711-55] Boedeker CC, Ridder GJ, Schipper J (2005). "Paragangliomas of the head and neck: diagnosis and treatment". Fam. Cancer. 4 (1): 55–9. doi:10.1007/s10689-004-2154-z. PMID 15883711.

[pmid2211107-56] Gluckman JL, Robbins KT, Fried MP (1990). "Cervical metastatic squamous carcinoma of unknown or occult primary source". Head Neck. 12 (5): 440–3. PMID 2211107.

[pmid19841343-57] Waltonen JD, Ozer E, Hall NC, Schuller DE, Agrawal A (October 2009). "Metastatic carcinoma of the neck of unknown primary origin: evolution and efficacy of the modern workup". Arch. Otolaryngol. Head Neck Surg. 135 (10): 1024–9. doi:10.1001/archoto.2009.145. PMID 19841343.

[pmid6639441-58] Feldman PS, Kaplan MJ, Johns ME, Cantrell RW (November 1983). "Fine-needle aspiration in squamous cell carcinoma of the head and neck". Arch Otolaryngol. 109 (11): 735–42. PMID 6639441.

[pmid26237923-59] Grénman R, Koivunen P, Minn H (2015). "[Laryngeal cancer in Finland]". Duodecim (in Finnish). 131 (4): 331–7. PMID 26237923.

[pmid26972281-60] Guneyli S, Cinar C, Bozkaya H, Korkmaz M, Oran I (September 2016). "Endovascular management of congenital arteriovenous fistulae in the neck". Diagn Interv Imaging. 97 (9): 871–5. doi:10.1016/j.diii.2015.08.006. PMID 26972281.

[pmid8264877-61] Gobin YP, Garcia de la Fuente JA, Herbreteau D, Houdart E, Merland JJ (November 1993). "Endovascular treatment of external carotid-jugular fistulae in the parotid region". Neurosurgery. 33 (5): 812–6. PMID 8264877.

[pmid7606997-62] Madjar S, Weissberg D (July 1995). "Retrosternal goiter". Chest. 108 (1): 78–82. PMID 7606997.

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[pmid23145396-64] Hughes K, Eastman C (August 2012). "Goitre - causes, investigation and management". Aust Fam Physician. 41 (8): 572–6. PMID 23145396.

[pmid10972051-65] Hermus AR, Huysmans DA (August 2000). "[Diagnosis and therapy of patients with euthyroid goiter]". Ned Tijdschr Geneeskd (in Dutch; Flemish). 144 (34): 1623–7. PMID 10972051.

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-'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
+__NOTOC__
+{{Head and neck cancer}}
-{{Infobox_Disease |
-  Name           = {{PAGENAME}} |
-  Image          = |
-  Caption        = | they have no neck
-  DiseasesDB     = |
-  ICD10          = {{ICD10|C|07||c|00}}-{{ICD10|C|14||c|00}}<BR>{{ICD10|C|32||c|30}}-{{ICD10|C|33||c|30}} |
-  ICD9           = |
-  ICDO           = |
-  OMIM           = |
-  MedlinePlus    = |
-  MeshID         = D006258 |
-}}
-{{SI}}
-{{CMG}}
-{{Editor Help}}
-==Overview==
-The term '''head and neck cancer''' refers to a group of biologically similar cancers originating from the upper aerodigestive tract, including the [[lip]], [[oral cavity]] ([[mouth]]), [[nasal cavity]], [[paranasal sinuses]], [[pharynx]], and [[larynx]]. Most head and neck cancers are [[squamous cell carcinoma]]s, originating from the [[mucosa]]l lining ([[epithelium]]) of these regions.<ref>[http://www.cancer.gov/templates/doc.aspx?viewid=7BDB0B90-2F6E-48A0-BCEA-00B2920A8933 NCI factsheet on head and neck cancer]</ref> Head and neck cancers often spread to the [[lymph node]]s of the [[neck]], and this is often the first (and sometimes only) manifestation of the disease at the time of diagnosis. Head and neck cancer is strongly associated with certain environmental and lifestyle risk factors, including [[tobacco smoking]], [[alcohol]] consumption, and certain strains of the sexually transmitted [[human papillomavirus]]. Head and neck cancer is highly curable if detected early, most often through a combination of [[chemotherapy]] and [[radiation therapy]], although [[surgery]] may also play an important role.
 ==Classification==
-''Head and neck squamous cell carcinomas (HNSCC's)'' make up the vast majority of head and neck cancers, and arise from [[mucosal]] surfaces throughout this anatomic region. These include tumors of the [[nasal cavity|nasal cavities]], [[paranasal sinuses]], [[oral cavity]], [[nasopharynx]], [[oropharynx]], [[hypopharynx]], and [[larynx]].
+*Head and neck cancers comprise of a group of malignancies arising from the oral cavity, pharynx and larynx, paranasal sinuses, nasal cavity or salivary glands with squamous cell carcinoma representing the most common histology.
+'Head and neck squamous cell carcinomas (HNSCC's)'' make up the vast majority of head and neck cancers, and arise from [[mucosal]] surfaces throughout this anatomic region. These include tumors of the [[nasal cavity|nasal cavities]], [[paranasal sinuses]], [[oral cavity]], [[nasopharynx]], [[oropharynx]], [[hypopharynx]], and [[larynx]].
 <!--
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 Most tumors of the [[salivary glands]] differ from the common carcinomas of the head and neck in [[etiology]], [[histopathology]], clinical presentation, and therapy, Other uncommon tumors arising in the head and neck include [[teratoma]]s, [[adenocarcinomas]], [[adenoid cystic carcinoma]]s, and [[mucoepidermoid carcinoma]]s. Rarer still are [[melanomas]] and [[lymphomas]] of the upper aerodigestive tract.
-==Etiology==
+<ref name="pmid22963591">{{cite journal| author=Howren MB, Christensen AJ, Karnell LH, Funk GF| title=Psychological factors associated with head and neck cancer treatment and survivorship: evidence and opportunities for behavioral medicine. | journal=J Consult Clin Psychol | year= 2013 | volume= 81 | issue= 2 | pages= 299-317 | pmid=22963591 | doi=10.1037/a0029940 | pmc=3587038 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22963591  }} </ref><ref name="pmid28945835">{{cite journal| author=Giraldi L, Leoncini E, Pastorino R, Wünsch-Filho V, de Carvalho M, Lopez R et al.| title=Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: a pooled analysis within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. | journal=Ann Oncol | year= 2017 | volume= 28 | issue= 11 | pages= 2843-2851 | pmid=28945835 | doi=10.1093/annonc/mdx486 | pmc=5834132 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28945835  }} </ref><ref name="pmid22525604">{{cite journal| author=Ojo B, Genden EM, Teng MS, Milbury K, Misiukiewicz KJ, Badr H| title=A systematic review of head and neck cancer quality of life assessment instruments. | journal=Oral Oncol | year= 2012 | volume= 48 | issue= 10 | pages= 923-937 | pmid=22525604 | doi=10.1016/j.oraloncology.2012.03.025 | pmc=3406264 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22525604  }} </ref><ref name="pmid25826749">{{cite journal| author=Wen Y, Grandis JR| title=Emerging drugs for head and neck cancer. | journal=Expert Opin Emerg Drugs | year= 2015 | volume= 20 | issue= 2 | pages= 313-29 | pmid=25826749 | doi=10.1517/14728214.2015.1031653 | pmc=5678969 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25826749  }} </ref>
+==History and Symptoms==
-[[ethanol|Alcohol]]<ref>{{cite journal |author=Spitz M |title=Epidemiology and risk factors for head and neck cancer |journal=Semin Oncol |volume=21 |issue=3 |pages=281-8 |year=1994 |pmid=8209260}}</ref>
+'''Throat Cancer''' usually begins with symptoms that seem harmless enough, like an enlarged [[lymph node]] on the outside of the neck, a sore throat or a hoarse sounding voice. However, in the case of throat cancer, these conditions may persist and become chronic. There may be a lump or a sore in the throat or neck that does not heal or go away. There may be difficult or [[painful swallowing]]. Speaking may become difficult. There may be a persistent earache. Other possible but less common symptoms include some numbness or [[paralysis]] of the face muscles.
-and [[tobacco]] use are the most common risk factors for head and neck cancer in the United States. Alcohol and tobacco are likely synergistic in causing cancer of the head and neck.<ref>{{cite journal |author=Murata M, Takayama K, Choi B, Pak A |title=A nested case-control study on alcohol drinking, tobacco smoking, and cancer |journal=Cancer Detect Prev |volume=20 |issue=6 |pages=557-65 |year=1996 |pmid=8939341}}</ref>
-Smokeless tobacco is an etiologic agent for oral and [[pharyngeal]] cancers.<ref>{{cite journal |author=Winn D |title=Smokeless tobacco and aerodigestive tract cancers: recent research directions |journal=Adv Exp Med Biol |volume=320 |issue= |pages=39-46 |year= |pmid=1442283}}</ref>
-[[Cigar]] smoking is an important risk factor for oral cancers as well.<ref>{{cite journal |author=Iribarren C, Tekawa I, Sidney S, Friedman G |title=Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men |journal=N Engl J Med |volume=340 |issue=23 |pages=1773-80 |year=1999 |pmid=10362820}}</ref>
-Other potential environmental [[carcinogens]] include [[cannabis (drug)|marijuana]] and occupational exposures such as nickel refining, exposure to textile fibers, and woodworking.  [[Cigarette]] smokers have a lifetime increased risk for head and neck cancers that is 5- to 25-fold increased over the general population.<ref>{{cite journal |author=Andre K, Schraub S, Mercier M, Bontemps P |title=Role of alcohol and tobacco in the aetiology of head and neck cancer: a case-control study in the Doubs region of France |journal=Eur J Cancer B Oral Oncol |volume=31B |issue=5 |pages=301-9 |year=1995 |pmid=8704646}}</ref>
-The ex-smoker's risk for squamous cell cancer of the head and neck begins to approach the risk in the general population twenty years after smoking cessation. The high prevalence of tobacco and alcohol use worldwide and the high association of these cancers with these substances makes them ideal targets for enhanced cancer prevention.
-Dietary factors may contribute. Excessive consumption of processed meats and red meat were associated with increased rates of cancer of the head and neck in one study, while consumption of raw and cooked vegetables seemed to be protective.<ref>{{cite journal |author=Levi F, Pasche C, La Vecchia C, Lucchini F, Franceschi S, Monnier P |title=Food groups and risk of oral and pharyngeal cancer |journal=Int J Cancer |volume=77 |issue=5 |pages=705-9 |year=1998 |pmid=9688303}}</ref>
-[[Vitamin E]] was not found to prevent the development of [[leukoplakia]], the white plaques that are the precursor for carcinomas of the mucosal surfaces, in adult smokers.<ref>{{cite journal |author=Liede K, Hietanen J, Saxen L, Haukka J, Timonen T, Häyrinen-Immonen R, Heinonen O |title=Long-term supplementation with alpha-tocopherol and beta-carotene and prevalence of oral mucosal lesions in smokers |journal=Oral Dis |volume=4 |issue=2 |pages=78-83 |year=1998 |pmid=9680894}}</ref>
-Another study examined a combination of [[Vitamin E]] and [[beta carotene]] in smokers with early-stage cancer of the oropharynx, and found a worse prognosis in the vitamin users.<ref>{{cite journal |author=Bairati I, Meyer F, Gélinas M, Fortin A, Nabid A, Brochet F, Mercier J, Têtu B, Harel F, Mâsse B, Vigneault E, Vass S, del Vecchio P, Roy J |title=A randomized trial of antioxidant vitamins to prevent second primary cancers in head and neck cancer patients |journal=J Natl Cancer Inst |volume=97 |issue=7 |pages=481-8 |year=2005 |pmid=15812073}}</ref>
-Betel-nut chewing is associated with an increased risk of squamous cell cancer of the head and neck.<ref>{{cite journal |author=Jeng J, Chang M, Hahn L |title=Role of areca nut in betel quid-associated chemical carcinogenesis: current awareness and future perspectives |journal=Oral Oncol |volume=37 |issue=6 |pages=477-92 |year=2001 |pmid=11435174}}</ref>
-Some head and neck cancers may have a viral etiology.<ref name=AMN>{{cite web | author = Everett E. Vokes | title =Head and Neck Cancer | work =Head and Neck Cancer | url=http://www.health.am/cr/head-and-neck-cancer/ | year = 2006 | month= June 28 | publisher=Armenian Health Network, Health.am | accessdate=2007-09-25}}</ref> The [[DNA]] of [[human papillomavirus]] has been detected in the tissue of oral and tonsil cancers, and may predispose to oral cancer in the absence of [[tobacco]] and [[alcohol]] use.  [[Epstein-Barr virus]] (EBV) infection is associated with [[nasopharyngeal carcinoma|nasopharyngeal cancer]].<ref name="AMN" />
-Nasopharyngeal cancer occurs endemically in some countries of the Mediterranean and Asiat, where EBV [[antibody]] titers can be measured to screen high-risk populations.<ref name="AMN" />
-Nasopharyngeal cancer has also been associated with consumption of salted fish, which may contain high levels of [[nitrites]].
-There are a wide variety of factors which can put someone at a heightened risk for throat cancer. Such factors include [[tobacco smoking|smoking]] or [[chewing tobacco|chewing]] [[tobacco]] or other things, such as [[betel]], gutkha, [[cannabis (drug)|marijuana]] or paan, heavy [[alcohol]] consumption, poor diet resulting in [[vitamin]] deficiencies (worse if this is caused by heavy alcohol intake), weakened [[immune system]], [[asbestos]] exposure, prolonged exposure to wood dust or paint fumes, exposure to petroleum industry chemicals, and being over the age of 55 years. Another risk factor includes the appearance of white patches or spots in the mouth, known as [[leukoplakia]]; in about ⅓ of the cases this develops into cancer.
-The presence of [[Gastroesophageal reflux disease|acid reflux disease]] (GERD - gastroesphogeal reflux disease) or larynx reflux disease can also be a major factor. In the case of acid reflux disease, stomach acids flow up into the [[esophagus]] and damage its lining, making it more susceptible to throat cancer.
-Ethnicitymay also play a part, with African American men in the [U.S.]being found to be at a 50% higher risk of throat cancer than Caucasian men.
-==Diagnosis==
-===Symptoms===
-'''Throat Cancer''' usually begins with symptoms that seem harmless enough, like an enlarged [[lymph node]] on the outside of the neck, a sore throat or a hoarse sounding voice. However, in the case of throat cancer, these conditions may persist and become chronic. There may be a lump or a sore in the throat or neck that does not heal or go away. There may be difficult or painful swallowing. Speaking may become difficult. There may be a persistent earache. Other possible but less common symptoms include some numbness or [[paralysis]] of the face muscles.
-Presenting symptoms include
-*Mass in the neck
-*Neck pain
-*Weight loss
-*Bleeding from the mouth
-*Sinus congestion, especially with [[nasopharyngeal carcinoma]]
-===Diagnostic approach===
-A patient usually presents to the physician complaining of one or more of the above [[symptoms]]  The patient will typically undergo a [[needle biopsy]] of this lesion, and a [[histopathologic]] information is available, a multidisciplinary discussion of the optimal treatment strategy will be undertaken between the [[radiation oncologist]], [[surgical oncology|surgical oncologist]], and [[medical oncology|medical oncologist]].
-===Histopathology===
-Throat cancers are classified according to their [[histology]] or cell structure, and are commonly referred to by their location in the oral cavity and neck. This is because where the cancer appears in the throat affects the prognosis - some throat cancers are more aggressive than others depending upon their location. The stage at which the cancer is diagnosed is also a critical factor in the prognosis of throat cancer.
-====Squamous Cell Carcinoma====
-[[Squamous cell]]s are the [[epithelium]] (tissue layer) that is the surface cells of much of the body. [[Skin]] and [[mucous membranes]] are squamous cells. This is the most common form of larynx cancer, accounting for over 90% of throat cancer.<font color=red><sup></sup></font> Squamous Cell Carcinoma is most likely to appear in males over 40 years of age with a history of heavy alcohol use coupled with smoking.
-====Epidimoid Cancer====
-(See [[Squamous cell carcinoma]])
-====Adenocarcinoma====
-[[Adenocarcinoma]] is a cancer of the [[columnar epithelium]] typical of the lower [[esophagus]]. It is typical of Barrett's Esophagus but may be at another location. Adenocarcinoma is thought of as a product of Barrett's Esophagus.
-==Treatment==
-===General considerations===
-Improvements in diagnosis and local management, as well as [[targeted therapy]], have led to improvements in quality of life and survival for head and neck cancer patients since 1992<ref> {{cite journal |author=Al-Sarraf M |title=Treatment of locally advanced head and neck cancer: historical and critical review |journal=Cancer Control |volume=9 |issue=5 |pages=387-99 |year= |pmid=12410178}}</ref>
-After a histologic diagnosis has been established and tumor extent determined, the selection of appropriate treatment for a specific cancer depends on a complex array of variables, including tumor site, relative morbidity of various treatment options, patient performance and nutritional status, concomitant health problems, social and logistic factors, previous primary tumors, and patient preference.   Treatment planning generally requires a multidisciplinary approach involving specialist surgeons and medical and radiation oncologists.
-Several generalizations are useful in therapeutic decision making, but variations on these themes are numerous. Surgical resection and radiation therapy are the mainstays of treatment for most head and neck cancers and remain the standard of care in most cases. For small primary cancers without regional metastases (stage I or II), wide surgical excision alone or curative radiation therapy alone is used. More extensive primary tumors, or those with regional metastases (stage III or IV), planned combinations of pre- or postoperative radiation and complete surgical excision are generally used. Survival and recurrence risk has been roughly equivalent between surgical and radiation-based approaches, with a head-to-head comparison in only one randomized study. More recently, as historical survival and control rates are recognized as less than satisfactory, there has been an emphasis on the use of various induction or concomitant chemotherapy regimens.
-Patients with head and neck cancer can be categorized into three clinical groups: those with localized disease, those with locally or regionally advanced disease, and those with recurrent and/or metastatic disease. Comorbidities (medical problems in addition to the diagnosed cancer) associated with tobacco and alcohol abuse can affect treatment outcome and the tolerability of aggressive treatment in a given patient.
-Many different treatments and therapies are used in the treatment of throat cancer. The type of treatment and therapies used are largely determined by the location of the cancer in the throat area and also the extent to which the cancer has spread at time of diagnosis. Patients’ also have the right to decide whether or not they wish to consent to a particular treatment. For example, some may decide to not undergo radiation therapy which has serious side effects if it means they will be extending their lives by only a few months or so. Others may feel that the extra time is worth it and wish to pursue the treatments.
-===Surgery===
-[[Surgery]] as a treatment is sometimes used in cases of throat cancer. In such cases an attempt is made to remove the cancerous cells. This can be particularly tricky if the cancer is near the [[larynx]] and can result in the patient being unable to speak. Surgery is more commonly used to [[resection]] (remove) some of the lymph nodes to prevent further spread of the disease.
-===Radiation therapy===
-[[Radiation therapy]] is the most common form of treatment. There are different forms of radiation therapy. One of newer treatments is Intensity-modulated radiotherapy or IMRT  which is able to focus more precisely so that fewer healthy cells are destroyed than was the case with some of the older radiation therapies. IMRT reduces incidental damage to the many important structures of the throat and mouth that may not be involved. However, if the cancer has [[Metastasis|metastisized]] or is widespread, the older form of treatment may be the most effective at slowing the progression of the disease. Radiation will generally cause the patient to feel sicker and weaker for several weeks following the treatment, but is a very effective treatment in stopping the disease.
-[[Image:radiation-mask.jpg|right|thumb|280px|Radiation mask used in treatment of throat cancer]]
-===Chemotherapy===
-[[Chemotherapy]] in throat cancer is not generally used to ''cure'' the cancer as such. Instead, it is used to provide an inhospitable environment for metastases so that they will not establish in other parts of the body. Typical chemotherapy agents are a combination of [[Taxol]] and [[Carboplatin]]. [[Erbitux]] is also used in the treatment of throat cancer.
-While not specifically a chemotherapy, [[Amifostine]] is often administered [[intravenously]] by a chemotherapy clinic prior to a patient's radiotherapy sessions. Amifostine protects the patient's gums and [[salivary glands]] from the effects of radiation.
-===Targeted therapy===
-[[Targeted therapy]], according to the [[National Cancer Institute]], is "a type of treatment that uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells without harming normal cells."  Some [[targeted therapy]] used in squamous cell cancers of the head and neck include [[cetuximab]], [[bevacizumab]], and [[erlotinib]].
-The best quality data are available for [[cetuximab]] since the 2006 publication of a randomized clinical trial comparing radiation treatment plus cetuximab versus radiation treatment alone.<ref>{{cite journal |author=Bonner J, Harari P, Giralt J, Azarnia N, Shin D, Cohen R, Jones C, Sur R, Raben D, Jassem J, Ove R, Kies M, Baselga J, Youssoufian H, Amellal N, Rowinsky E, Ang K |title=Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck |journal=N Engl J Med |volume=354 |issue=6 |pages=567-78 |year=2006 |pmid=16467544}}</ref> This study found that concurrent [[cetuximab]] and radiotherapy improves survival and locoregional disease control compared to radiotherapy alone, without a substantial increase in [[side effects]], as would be expected with the concurrent chemoradiotherapy, which is the current gold standard treatment for advanced head and neck cancer. Whilst this study is of pivotal significance, interpretation is difficult since cetuximab-radiotherapy was not directly compared to chemoradiotherapy. The results of ongoing studies to clarify the role of [[cetuximab]] in this disease are awaited with interest.
-Another study evaluated the impact of adding [[cetuximab]] to conventional chemotherapy ([[cisplatin]]) versus [[cisplatin]] alone. This study found no improvement in survival or disease-free survival with the addition of [[cetuximab]] to the conventional chemotherapy.<ref>{{cite journal |author=Burtness B, Goldwasser M, Flood W, Mattar B, Forastiere A |title=Phase III randomized trial of cisplatin plus placebo compared with cisplatin plus cetuximab in metastatic/recurrent head and neck cancer: an Eastern Cooperative Oncology Group study |journal=J Clin Oncol |volume=23 |issue=34 |pages=8646-54 |year=2005 |pmid=16314626}}</ref>
-However, another study which completed in March 2007 found that there was an improvement in survival.
-The EXTREME (Erbitux in First-Line Treatment of Recurrent or Metastatic Head & Neck Cancer) study is a European multicenter phase III trial to determine whether adding cetuximab improves the impact of platinum-based chemotherapy.
-Between December 2004 and March 2007, researchers enrolled 442 patients in 17 countries who had stage III or IV recurrent and/or metastatic SCCHN, and who were not candidates for further surgery or radiation. About half of the patients had cancer in their pharynx (throat), and a quarter in their larynx (voice box), but none in the nasopharynx (upper part of the throat). The patients averaged 57 years of age. Only about 10 percent were women.
-Patients were randomly assigned to receive either chemotherapy (222 patients) or the same chemotherapy with cetuximab (220 patients). Chemotherapy consisted of 5-fluorouracil plus either carboplatin or cisplatin.
-The trial was led by Jan Vermorken, M.D., Ph.D., of the University of Antwerp in Belgium. Vermmorken as well as other researchers involved in the trial have various relationships with Merck KGaA, Amgen, Oxygene, and sanofi-aventis. Merck KGaA provided funding for the study. (See the protocol summary.)
-Results
-Patients treated with cetuximab reduced their risk of dying by 20 percent, surviving a median of 10.1 months compared to 7.4 months for those receiving chemotherapy alone.
-Head and neck cancer clinical trials employing [[bevacizumab]], an inhibitor of the [[angiogenesis]] receptor [[VEGF]], are recruiting patients as of March, 2007. No published clinical trial information is available as of that date.
-[[Erlotinib]] is an oral [[EGFR]] inhibitor, and was found in one [[Clinical trial#Phase II|Phase II clinical trial]] to retard disease progression.<ref>{{cite journal |author=Soulieres D, Senzer N, Vokes E, Hidalgo M, Agarwala S, Siu L |title=Multicenter phase II study of erlotinib, an oral epidermal growth factor receptor tyrosine kinase inhibitor, in patients with recurrent or metastatic squamous cell cancer of the head and neck |journal=J Clin Oncol |volume=22 |issue=1 |pages=77-85 |year=2004 |pmid=14701768}}</ref>
-Scientific evidence for the effectiveness of [[erlotinib]] is otherwise lacking to this point. A clinical trial evaluating the use of [[erlotinib]] in [[metastatic]] head and neck cancer is recruiting patients as of March, 2007.
-==Prognosis==
-Although early-stage head and neck cancers (especially laryngeal and oral cavity) have high cure rates, up to 50% of head and neck cancer patients present with advanced disease.<ref>{{cite journal |author=Gourin C, Podolsky R |title=Racial disparities in patients with head and neck squamous cell carcinoma |journal=Laryngoscope |volume=116 |issue=7 |pages=1093-106 |year=2006 |pmid=16826042}}</ref>
-Cure rates decrease in locally advanced cases, whose probability of cure is inversely related to tumor size and even more so to the extent of regional node involvement.
-Consensus panels in America (American Joint Committee on Cancer AJCC and Europe) have established staging systems for head and neck squamous cancers. These staging systems attempt to standardize clinical trial criteria for research studies, and attempt to define prognostic categories of disease. Squamous cell cancers of the head and neck are staged according to the [[TNM]] classification system, where T is the size and configuration of the tumor, N is the presence or absence of lymph node metastases, and M is the presence or absence of distant metastases. The T, N, and M characteristics are combined to produce a “stage” of the cancer, from I to IVB.<ref>{{cite journal |author=Iro H, Waldfahrer F |title=Evaluation of the newly updated TNM classification of head and neck carcinoma with data from 3247 patients |journal=Cancer |volume=83 |issue=10 |pages=2201-7 |year=1998 |pmid=9827726}}</ref>
-===Residual deficits===
-Even after successful definitive therapy, head and neck cancer patients face tremendous impacts on quality of life. Despite marked advances in reconstructive surgery and rehabilitation, intensity-modulated radiotherapy (IMRT) and conservation approaches to certain malignancies, some patients continue to have significant functional deficits.
-===Problem of second primaries===
+====Presenting symptoms include:====
-Survival advantages provided by new treatment modalities have been undermined by the significant percentage of patients cured of head and neck squamous cell carcinoma (HNSCC) who subsequently develop second primary tumors. The incidence of second primary tumors ranges in studies from 9.1%<ref>{{cite journal |author=Jones A, Morar P, Phillips D, Field J, Husband D, Helliwell T |title=Second primary tumors in patients with head and neck squamous cell carcinoma |journal=Cancer |volume=75 |issue=6 |pages=1343-53 |year=1995 |pmid=7882285}}</ref>
+*A [[lump]] or sore that does not heal
-to 23%<ref>{{cite journal |author=Cooper J, Pajak T, Rubin P, Tupchong L, Brady L, Leibel S, Laramore G, Marcial V, Davis L, Cox J |title=Second malignancies in patients who have head and neck cancer: incidence, effect on survival and implications based on the RTOG experience |journal=Int J Radiat Oncol Biol Phys |volume=17 |issue=3 |pages=449-56 |year=1989 |pmid=2674073}}</ref>
+*A [[sore throat]] that does not go away
-at 20 years. Second primary tumors are the major threat to long-term survival after successful therapy of early-stage HNSCC. Their high incidence results from the same carcinogenic exposure responsible for the initial primary process, called field cancerization.
+*Trouble [[swallowing]]
+*A change or hoarseness in the voice
-Throat cancer has numerous negative effects on the body systems.
+Other [[symptoms]] may include the following:
+*'''[[Oral cavity]].''' A white or red patch on the [[gums]], [[tongue]], or lining of the [[mouth]]; a swelling of the [[jaw]] that causes [[dentures]] to fit poorly or become uncomfortable; and unusual [[bleeding]] or [[pain]] in the [[mouth]].
+*'''[[Nasal cavity]] and [[sinuses]].''' [[Sinuses]] that are blocked and do not clear, chronic sinus infections that do not respond to treatment with [[antibiotics]], [[bleeding]] through the [[nose]], frequent [[headaches]], swelling or other trouble with the [[eyes]], pain in the upper [[teeth]], or problems with [[dentures]].
+*'''[[Salivary glands]].''' Swelling under the [[chin]] or around the [[jawbone]]; [[numbness]] or [[paralysis]] of the [[muscles]] in the [[face]]; or pain that does not go away in the [[face]], [[chin]], or [[neck]].
+*'''[[Oropharynx]] and [[hypopharynx]].''' Ear pain.
+*'''[[Nasopharynx]].''' Trouble breathing or speaking, frequent [[headaches]], pain or ringing in the ears, or trouble hearing.
+*'''[[Larynx]].''' Pain when swallowing, or ear pain.
+*'''Metastatic squamous neck cancer.''' Pain in the [[neck]] or [[throat]] that does not go away.
-===Digestive system===
+These [[symptoms]] may be caused by [[cancer]] or by other, less serious conditions. It is important to check with a doctor or [[dentist]] about any of these [[symptoms]].
-As it can impair a person’s ability to swallow and eat, throat cancer affects the [[digestive system]]. The difficulty in swallowing can lead to a person to [[choking|choke]] on their food in the early stages of digestion and interfere with the food’s smooth travels down into the [[esophagus]] and beyond.
+==Differentiating head and neck cancer from other diseases==
-The treatments for throat cancer can also be harmful to the digestive system as well as other body systems. Radiation therapy can lead to [[nausea]] and [[vomiting]], which can deprive a body of vital fluids (although these may be obtained through intravenous fluids if necessary). Frequent vomiting can lead to an electrolyte imbalance which has serious consequences for the proper functioning of the heart. Frequent vomiting can also upset the balance of stomach acids which has a negative impact on the digestive system, especially the lining of the stomach and esophagus.
-===Respiratory system===
+Head and neck cancer must be differentiated from [[Congenital disorder|congenital abnormalities]], and [[malignant]] lesions.
-In the cases of some throat cancers, the air passages in the [[mouth]] and behind the [[nose]] may become blocked from lumps or the swelling from the open sores. If the throat cancer is near the bottom of the throat it has a high likelihood of spreading to the [[lung]]s and interfering with the person’s ability to [[breath]]e; this is even more likely if the patient is a smoker, because they are highly susceptible to [[lung cancer]]. If the respiratory system is unable to bring oxygen into the body, the oxygen deprivation will cause the body's cells to wither and die, causing one to become weaker and sicker.
-===Others===
+{|
-Like any [[cancer]], [[metastasize|metastasization]] affects many areas of the body, as the cancer spreads from cell to cell and [[organ (biology)|organ]] to organ. For example, if it spreads to the [[bone marrow]], it will prevent the body from producing enough [[red blood cell]]s and affects the proper functioning of the [[white blood cell]]s and the body's [[immune system]]; spreading to the [[circulatory system]] will prevent oxygen from being transported to all the cells of the body; and throat cancer can throw the [[nervous system]] into chaos, making it unable to properly regulate and control the body.
+! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
+! colspan="2" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
+! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign/
+Malignant
+! colspan="6" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestation
+! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Paraclinical findings
+! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
+! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
+|-
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
+! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
+! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
+|-
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
-==Prevention==
+|-
-Avoidance of recognised risk factors (as described above)is the single most effective form of prevention. Regular dental examinations may identify pre-cancerous lesions in the oral cavity.
+! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Neoplasm
-It will be interesting to see what effect the widespread use of HPV vaccines has on the incidence of HPV-related H&N cancers.
+! rowspan="5" align="center" style="background:#DCDCDC;" |[[Salivary gland neoplasm]]
+! align="center" style="background:#DCDCDC;" |[[Pleomorphic adenoma]]<ref name="pmid22190789">{{cite journal |vauthors=Debnath SC, Adhyapok AK |title=Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip |journal=J Maxillofac Oral Surg |volume=9 |issue=2 |pages=205–8 |date=June 2010 |pmid=22190789 |pmc=3244097 |doi=10.1007/s12663-010-0052-5 |url=}}</ref><ref name="pmid29845358">{{cite journal |vauthors=Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M |title=Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features |journal=Jpn J Radiol |volume=36 |issue=8 |pages=463–471 |date=August 2018 |pmid=29845358 |doi=10.1007/s11604-018-0747-y |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]]
+| align="left" style="background:#F5F5F5;" |
+* More common in females
+* [[Incidence]] increase with [[age]]
+* [[Incidence]]: 2-3.5 cases per 100,000 [[population]]
+| align="left" style="background:#F5F5F5;" |
+* History of [[swelling]]
+* [[Dysphagia]]
+* [[Hoarseness]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | +
+| align="left" style="background:#F5F5F5;" |
+* Palpable [[mass]] of deep [[lobe]] of [[parotid gland]]
+* Firm
+* Mobile
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* Proliferation of [[epithelial cells]] and [[stromal]] [[matrix]] in the [[ducts]]
+| align="left" style="background:#F5F5F5;" |
+* [[MRI]]: Homogenous on T1
+* Abundant myxochondroid [[stroma]] on T2
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]]
+| align="center" style="background:#F5F5F5;" | −
+|-
+! align="center" style="background:#DCDCDC;" |[[Warthin's tumor]]<ref name="pmid24376295">{{cite journal |vauthors=Chulam TC, Noronha Francisco AL, Goncalves Filho J, Pinto Alves CA, Kowalski LP |title=Warthin's tumour of the parotid gland: our experience |journal=Acta Otorhinolaryngol Ital |volume=33 |issue=6 |pages=393–7 |date=December 2013 |pmid=24376295 |doi= |url=}}</ref><ref name="urlWarthin tumor | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/8569/warthin-tumor |title=Warthin tumor &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]]
+| align="left" style="background:#F5F5F5;" |
+* [[Male]] to female ratio: 4:1
+* More common in people aged 60-70 years old
+| align="left" style="background:#F5F5F5;" |
+* History of [[Swelling|swollen]] [[salivary gland]]
+* [[Jaw]] pain
+* [[Tinnitus]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | +
+| align="left" style="background:#F5F5F5;" |
+* Non tender
+* Mobile
+* Firm
+* [[Solitary]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* [[Papillae]]
+* [[Fibrous]] [[capsule]]
+* [[Cystic]] spaces
+| align="left" style="background:#F5F5F5;" |
+*[[CT|Neck CT]]: [[Cystic]] lesion posteriorly within the [[parotid gland]]
+*[[MRI]]: B/L heterogeneous lesions
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]]
+| align="center" style="background:#F5F5F5;" | −
+|-
+! align="center" style="background:#DCDCDC;" |[[Oncocytoma]]
+<ref name="pmid277220032">{{cite journal |vauthors=Chen B, Hentzelman JI, Walker RJ, Lai JP |title=Oncocytoma of the Submandibular Gland: Diagnosis and Treatment Based on Clinicopathology |journal=Case Rep Otolaryngol |volume=2016 |issue= |pages=8719030 |date=2016 |pmid=27722003 |pmc=5045990 |doi=10.1155/2016/8719030 |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]]
+| align="left" style="background:#F5F5F5;" |
+*Race: [[Caucasian pop|Caucasian]] patients predilection
+*Gender: No gender preference
+*Age: 50–70 years
+| align="left" style="background:#F5F5F5;" |
+*Growing [[palpable]] painless mass
+*[[Facial swelling]]
+*[[Lymphadenopathy]] (if transformed to malignant)
+| align="center" style="background:#F5F5F5;" | ±
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+* [[Firm]], multilobulated
+* Mobile [[mass]]
+| align="left" style="background:#F5F5F5;" |
+*Normal
+*Redness
+*[[Swelling]]
+*Skin [[ulceration]]
+| align="left" style="background:#F5F5F5;" |
+*Normal
+*[[Anemia]]
+| align="left" style="background:#F5F5F5;" |
+* [[Epithelial cells]] with [[eosinophilic]]
+* Granular [[cytoplasm]]
+* Rich in [[mitochondria]]
+| align="left" style="background:#F5F5F5;" |
+*CT:
+**Isodense expansive mass
+**Enhancement after intravenous contrast
+**Hypodense areas
+*[[MRI]]:
+**Isodensties on T1
+**Mass is hyperintense on T2
+**Enhancement on contrast
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy|Incisional biopsy]] and [[histopathological]] examination
+| align="center" style="background:#F5F5F5;" |-
+|-
+! align="center" style="background:#DCDCDC;" |[[Monomorphic adenoma]] <ref name="pmid10889498">{{cite journal |vauthors=Kim KH, Sung MW, Kim JW, Koo JW |title=Pleomorphic adenoma of the trachea |journal=Otolaryngol Head Neck Surg |volume=123 |issue=1 Pt 1 |pages=147–8 |date=July 2000 |pmid=10889498 |doi=10.1067/mhn.2000.102809 |url=}}</ref><ref name="pmid24431845">{{cite journal |vauthors=Pramod Krishna B |title=Pleomorphic Adenoma of Minor Salivary Gland in a 14 year Old Child |journal=J Maxillofac Oral Surg |volume=12 |issue=2 |pages=228–31 |date=June 2013 |pmid=24431845 |pmc=3681990 |doi=10.1007/s12663-010-0125-5 |url=}}</ref><ref name="pmid30546932">{{cite journal |vauthors=Kessler AT, Bhatt AA |title=Review of the Major and Minor Salivary Glands, Part 2: Neoplasms and Tumor-like Lesions |journal=J Clin Imaging Sci |volume=8 |issue= |pages=48 |date=2018 |pmid=30546932 |pmc=6251244 |doi=10.4103/jcis.JCIS_46_18 |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]] or [[malignant]]
+| align="left" style="background:#F5F5F5;" |
+*Age: 26-76 years
+*Rare in children
+*Gender: No predilection
+| align="left" style="background:#F5F5F5;" |
+*Growing [[palpable]] painless [[mass]] on jaw or in [[oral cavity]]
+*[[Facial swelling]]
+*[[Lymphadenopathy]] (if transformed to [[malignant]])
+*[[Ulceration|Pain and ulceration]] (in later stage)
+| align="center" style="background:#F5F5F5;" | ±
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+* [[Nodular]]
+* Fluctuant [[swelling]]
+| align="left" style="background:#F5F5F5;" |
+*Normal
+*Redness
+*Skin [[ulceration]]
+*May have [[lymphadenopathy]]
+| align="left" style="background:#F5F5F5;" |
+* Normal
+| align="left" style="background:#F5F5F5;" |
+*Straw colored fluid on [[aspiration]]
+| align="left" style="background:#F5F5F5;" |
+* [[Ultrasound]]:
+**Used to [[biopsy]] the [[lesion]]
+**May show cystic an solid components
+* [[Computed tomography|CT:]]
+**useful for [[lesions]] with [[calcification]] and venous phleboliths
+* [[Magnetic resonance imaging|MRI:]]
+**Test of choice
+**Differentiate [[benign]] from [[malignant]]
+**Defines [[tumor]] extent
+**Shows perineural spread
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy|Incisional biopsy]] and [[Histopathological|histopathological examination]]
+| align="center" style="background:#F5F5F5;" |-
+|-
+! align="center" style="background:#DCDCDC;" |[[Mucoepidermoid carcinoma]]
+<ref name="pmid21243374">{{cite journal |vauthors=Chenevert J, Barnes LE, Chiosea SI |title=Mucoepidermoid carcinoma: a five-decade journey |journal=Virchows Arch. |volume=458 |issue=2 |pages=133–40 |date=February 2011 |pmid=21243374 |doi=10.1007/s00428-011-1040-y |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+*Age: Mean age of 59
+*Female predilection
+| align="left" style="background:#F5F5F5;" |
+*Painlesss [[mass]]
+*[[Swelling]] in [[oral cavity]]
+*[[Lymphadenopathy]]
+| align="center" style="background:#F5F5F5;" | ±
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+* [[Cystic]] and [[Mass|solid mass]]
+| align="left" style="background:#F5F5F5;" |
+* May have [[lymphadenopathy]]
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* [[Gross examination|Gross findings]]:
+**Firm
+**Tan-white to yellow
+**Bosselated
+**Cystic
+* [[Microscopic]] findings:
+**Encapsulated
+**[[squamous]] and [[Glandular|glandular]] components
+| align="left" style="background:#F5F5F5;" |
+* Cystic and solid component with variable appearance on [[Computed tomography|CT]] and [[MRI]]
+| align="left" style="background:#F5F5F5;" |
+* Incisional [[biopsy]] and [[Histopathological|histopathological examination]]
+| align="left" style="background:#F5F5F5;" |
+* Association with [[CMV]]
+|-
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
+! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
+|-
+! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Neoplasm
+! rowspan="4" align="center" style="background:#DCDCDC;" |[[Salivary gland neoplasm]]
+! align="center" style="background:#DCDCDC;" |[[Adenoid cystic cancer|Adenoid cystic carcinoma]] <ref name="pmid17825603">{{cite journal |vauthors=Jones AV, Craig GT, Speight PM, Franklin CD |title=The range and demographics of salivary gland tumours diagnosed in a UK population |journal=Oral Oncol. |volume=44 |issue=4 |pages=407–17 |date=April 2008 |pmid=17825603 |doi=10.1016/j.oraloncology.2007.05.010 |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+* Age: 40s-60s
+* Gender: Female predominance
+| align="left" style="background:#F5F5F5;" |
+* Slow growing rare tumor with low [[Recurrence plot|recurrence]]
+| align="center" style="background:#F5F5F5;" | ±
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+* Solid [[mass]]
+| align="left" style="background:#F5F5F5;" |
+* Normal to [[Ulcerated lesion|ulcerated lesions]]
+* May have [[lymphadenopathy]]
+| align="center" style="background:#F5F5F5;" |−
+| align="left" style="background:#F5F5F5;" |
+* [[Gross]] findings:
+** Tubular
+** Cribriform
+** Solid pattern of growth
+* [[Microscopic]] findings:
+** Components of large cells with [[Pleomorphic|pleomorphic nuclei]]
+** Increased [[mitotic]] activity
+** Focal [[Necrosis|necrosis]]
+| align="left" style="background:#F5F5F5;" |
+* [[Imaging]] reveal dimensions of the [[tumor]], local spread, and [[Metastasis|distant metastasis]]
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]] and [[Histopathological|histopathological examination]]
+| align="center" style="background:#F5F5F5;" |−
+|-
+! align="center" style="background:#DCDCDC;" |[[Adenocarcinoma]]
+<ref name="pmid16487803">{{cite journal |vauthors=Beltran D, Faquin WC, Gallagher G, August M |title=Selective immunohistochemical comparison of polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma |journal=J. Oral Maxillofac. Surg. |volume=64 |issue=3 |pages=415–23 |date=March 2006 |pmid=16487803 |doi=10.1016/j.joms.2005.11.027 |url=}}</ref>
+| align="center" style="background:#F5F5F5;" |
+* [[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+* Age: young age predilection
+| align="left" style="background:#F5F5F5;" |
+* Its a [[tumor]] of minor [[salivary glands]]
+* May present as small [[ulceration]] or [[nodules]] in [[oral cavity]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* Small [[nodules]] in [[oral cavity]]
+* With or without [[lymphadenopathy]]
+| align="left" style="background:#F5F5F5;" |
+* Normal to [[Ulcerated lesion|ulcerated lesions]]
+* May have [[lymphadenopathy]]
+| align="left" style="background:#F5F5F5;" |
+* May be normal
+* Or may show [[anemia]] and [[blood cell]] disorders with distant bone [[invasion]]
+| align="left" style="background:#F5F5F5;" |
+* On [[histology]] it is confused with Adeocyctic [[carcinoma]]
+* Components of [[gland]] and [[cyst]] formations
+* More perineural [[invasion]]
+| align="left" style="background:#F5F5F5;" |
+* [[CT]] and [[MRI]]
+* [[MRI]] being more accurate for adjacent [[tissue]] involvement and [[lymphadenopathy]]
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]] and [[histopathological]] examination
+| align="center" style="background:#F5F5F5;" |−
+|-
+! align="center" style="background:#DCDCDC;" |[[Salivary gland cancer|Salivary duct cancer]]<ref name="pmid22434951">{{cite journal |vauthors=Mlika M, Kourda N, Zidi Y, Aloui R, Zneidi N, Rammeh S, Zermani R, Jilani SB |title=Salivary duct carcinoma of the parotid gland |journal=J Oral Maxillofac Pathol |volume=16 |issue=1 |pages=134–6 |date=January 2012 |pmid=22434951 |pmc=3303509 |doi=10.4103/0973-029X.92992 |url=}}</ref><ref name="pmid29103750">{{cite journal |vauthors=Schmitt NC, Kang H, Sharma A |title=Salivary duct carcinoma: An aggressive salivary gland malignancy with opportunities for targeted therapy |journal=Oral Oncol. |volume=74 |issue= |pages=40–48 |date=November 2017 |pmid=29103750 |pmc=5685667 |doi=10.1016/j.oraloncology.2017.09.008 |url=}}</ref><ref name="pmid23821208">{{cite journal |vauthors=Simpson RH |title=Salivary duct carcinoma: new developments--morphological variants including pure in situ high grade lesions; proposed molecular classification |journal=Head Neck Pathol |volume=7 Suppl 1 |issue= |pages=S48–58 |date=July 2013 |pmid=23821208 |pmc=3712088 |doi=10.1007/s12105-013-0456-x |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Malignant]]
+(Highly aggressive)
+| align="left" style="background:#F5F5F5;" |
+* [[Incidence]]: 1-3%
+* Gender: Male predilection
+* Mean age: 55-61 years old
+| align="left" style="background:#F5F5F5;" |
+* Rapidly growing [[mass]] with jaw involvement
+| align="center" style="background:#F5F5F5;" | ±
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+*Painless
+*Hard
+*Non-compressible [[mass]]
+| align="left" style="background:#F5F5F5;" |
+* Ulceration of [[mucosa]] and [[Ulceration|skin]]
+* May have [[lymphadenopathy]]
+* [[facial paralysis]] in case of [[facial nerve]] involvement
+| align="left" style="background:#F5F5F5;" |
+* Pathomorphologically [[tumor]] of [[Salivary gland|salivary ducts]] resembles tumor of [[breast]] ducts
+| align="left" style="background:#F5F5F5;" |
+* [[Gross examination|Gross]] findings:
+**Firm [[mass]]
+**[[Cystic|Cystic component]] of variable size and dimension
+*[[Microscopic|Microscopic finding]]:
+**Resembling ductal carcinoma of [[breast]]
+**Intraductal components invading surrounding tissue in several forms:
+***cribriform
+***[[papillary]]
+***Solid with comedo-like central [[necrosis]]
+| align="left" style="background:#F5F5F5;" |
+* Non-specific features on [[Computed tomography|CT]] and [[MRI]]
+* Shows [[neural]] and [[jaw]] involvement
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]] and [[histopathological]] examination
+| align="center" style="background:#F5F5F5;" |−
+|-
+! align="center" style="background:#DCDCDC;" |[[Squamous cell carcinoma]]<ref name="pmid25328317">{{cite journal |vauthors=Manvikar V, Ramulu S, Ravishanker ST, Chakravarthy C |title=Squamous cell carcinoma of submandibular salivary gland: A rare case report |journal=J Oral Maxillofac Pathol |volume=18 |issue=2 |pages=299–302 |date=May 2014 |pmid=25328317 |pmc=4196305 |doi=10.4103/0973-029X.140909 |url=}}</ref><ref name="pmid16475198">{{cite journal |vauthors=Ying YL, Johnson JT, Myers EN |title=Squamous cell carcinoma of the parotid gland |journal=Head Neck |volume=28 |issue=7 |pages=626–32 |date=July 2006 |pmid=16475198 |doi=10.1002/hed.20360 |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+* Incidence: rare
+* Age: Old age , 61-68 years
+* Male predilection
+| align="left" style="background:#F5F5F5;" |
+* Present as painful growing [[mass]] on [[jaw]]
+| align="center" style="background:#F5F5F5;" | +
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+*Teneder
+*Firm
+*[[Swelling|Solitary swelling]] on jaw
+| align="left" style="background:#F5F5F5;" |
+* [[Submandibular gland]] predilection
+* Thinning and discoloration of [[skin]]
+| align="left" style="background:#F5F5F5;" |
+* Past [[radiation]] exposure is a strong [[risk factor]]
+| align="left" style="background:#F5F5F5;" |
+* [[Gross]] findings: Thinning of [[skin]]
+* [[Microscopically]] findings: Nest and solid sheets of [[Tumor cell|tumor cells]] arranged in [[glandular]] pattern
+* [[Immunohistochemical staining]] can be used to mark the [[squamous]] and [[keratin]] component
+| align="left" style="background:#F5F5F5;" |
+* [[Tumor]] dimension can be delineated using both [[CT]] and [[MRI]]
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]] and [[histopathological]] examination
+| align="center" style="background:#F5F5F5;" |−
+|-
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
+! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
+|-
+! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Neoplasm
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Hypopharyngeal cancer]]<ref name="pmid12560383">{{cite journal |vauthors=Helliwell TR |title=acp Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx |journal=J. Clin. Pathol. |volume=56 |issue=2 |pages=81–5 |date=February 2003 |pmid=12560383 |pmc=1769882 |doi= |url=}}</ref><ref>{{cite journal|journal=International Journal of Recent Scientific Research|issn=09763031|doi=10.24327/IJRSR}}</ref><ref name="Maaslandvan den Brandt2014">{{cite journal|last1=Maasland|first1=Denise HE|last2=van den Brandt|first2=Piet A|last3=Kremer|first3=Bernd|last4=Goldbohm|first4=R Alexandra|last5=Schouten|first5=Leo J|title=Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck cancer: results from the Netherlands Cohort Study|journal=BMC Cancer|volume=14|issue=1|year=2014|issn=1471-2407|doi=10.1186/1471-2407-14-187}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+* More common in males
+* [[Age]]: 55-65 years old
+* [[Incidence]]: < 1/100,000 in U.S.
+* More common in Japan, India, Iran
+| align="left" style="background:#F5F5F5;" |
+* [[Tobacco]] use
+* [[Abuse|Abuse alcohol]] consumption
+* [[HPV infection]]
+* Lump in the [[neck]]
+* [[Odynophagia]]
+* [[Hoarseness]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | +
+| align="left" style="background:#F5F5F5;" |
+* Non tender [[Cervical|cervical node]]
+| align="left" style="background:#F5F5F5;" |
+* [[Lymphadenopathy]]
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* [[Spindle cells]]
+* [[Nuclear|Nuclear atypia]]
+* Basaloid [[cells]]
+* Abundant [[chromatin]]
+| align="left" style="background:#F5F5F5;" |
+* [[Neck]] [[CT]] scan:
+** [[Soft tissue]] mass
+** Irregular thickening of [[mucosa]]
+** [[Necrotic|Necrotic region]]
+* [[MRI]]:
+** [[Tumors]] are hypointense on T1 and hyperintense on T2
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]]
+| align="center" style="background:#F5F5F5;" | −
+|-
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Parathyroid cancer]]<ref name="pmid22327883">{{cite journal |vauthors=Wei CH, Harari A |title=Parathyroid carcinoma: update and guidelines for management |journal=Curr Treat Options Oncol |volume=13 |issue=1 |pages=11–23 |date=March 2012 |pmid=22327883 |doi=10.1007/s11864-011-0171-3 |url=}}</ref><ref name="pmid17713315">{{cite journal |vauthors=Sahasranam P, Tran MT, Mohamed H, Friedman TC |title=Multiglandular parathyroid carcinoma: a case report and brief review |journal=South. Med. J. |volume=100 |issue=8 |pages=841–4 |date=August 2007 |pmid=17713315 |doi=10.1097/SMJ.0b013e318073ca37 |url=}}</ref><ref name="pmid4886854">{{cite journal |vauthors=Holmes EC, Morton DL, Ketcham AS |title=Parathyroid carcinoma: a collective review |journal=Ann. Surg. |volume=169 |issue=4 |pages=631–40 |date=April 1969 |pmid=4886854 |pmc=1387475 |doi= |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+* [[Incidence]]: Rare
+* Mean age : 44-54 years old
+* Gender: Female predilection
+| align="left" style="background:#F5F5F5;" |
+*Presents with the [[hyperparathyroidism]]
+*[[Bone]] pains
+*[[Abdominal pain]]
+*[[Nausea and vomiting]]
+*[[Fatigue]]
+*[[Confusion]]
+| align="center" style="background:#F5F5F5;" | +
+| align="center" style="background:#F5F5F5;" | +
+| align="left" style="background:#F5F5F5;" |
+* Lower [[Neck masses|neck mass]]
+| align="left" style="background:#F5F5F5;" |
+*[[Tachycardia]]
+*[[Weight loss]]
+*[[Sweating]]
+*Neck [[swelling]]
+| align="left" style="background:#F5F5F5;" |
+*Low [[TSH]]
+*Increased [[T4]] and [[T3]]
+*[[Hypercalcemia]]
+| align="left" style="background:#F5F5F5;" |
+* [[Microscopic]] findings:
+** Trabecular [[Growth|growth pattern]]
+** High [[mitosis]]
+** Surrounding thick fibrotic bands
+** Capsular involvement
+** Vascular [[invasion]] is common
+| align="left" style="background:#F5F5F5;" |
+*[[Computed tomography|CT]] and [[MRI]] shows more frequent lower lobe involvement, vascular involvement , [[lymph node]] [[metastasis]], and perineural involvement
+*[[Bone scan]] may show decreasing [[bone density]]
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]] and [[histopathological]] examination
+| align="center" style="background:#F5F5F5;" |
+* Hereditary syndromes
+* [[Multiple endocrine neoplasia type 2|MEN-2B syndrome]]
+* [[Neurofibromatosis type 1]]
+* [[VHL syndrome|VHL]] disease
+|-
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Carotid body tumor|Carotid body tumors]]<ref name="pmid174004872">{{cite journal |vauthors=Sajid MS, Hamilton G, Baker DM |title=A multicenter review of carotid body tumour management |journal=Eur J Vasc Endovasc Surg |volume=34 |issue=2 |pages=127–30 |date=August 2007 |pmid=17400487 |doi=10.1016/j.ejvs.2007.01.015 |url=}}</ref><ref name="pmid158837112">{{cite journal |vauthors=Boedeker CC, Ridder GJ, Schipper J |title=Paragangliomas of the head and neck: diagnosis and treatment |journal=Fam. Cancer |volume=4 |issue=1 |pages=55–9 |date=2005 |pmid=15883711 |doi=10.1007/s10689-004-2154-z |url=}}</ref><ref name="pmid15063383">{{cite journal |vauthors=Pellitteri PK, Rinaldo A, Myssiorek D, Gary Jackson C, Bradley PJ, Devaney KO, Shaha AR, Netterville JL, Manni JJ, Ferlito A |title=Paragangliomas of the head and neck |journal=Oral Oncol. |volume=40 |issue=6 |pages=563–75 |date=July 2004 |pmid=15063383 |doi=10.1016/j.oraloncology.2003.09.004 |url=}}</ref><ref name="pmid28478173">{{cite journal |vauthors=Darouassi Y, Alaoui M, Mliha Touati M, Al Maghraoui O, En-Nouali A, Bouaity B, Ammar H |title=Carotid Body Tumors: A Case Series and Review of the Literature |journal=Ann Vasc Surg |volume=43 |issue= |pages=265–271 |date=August 2017 |pmid=28478173 |doi=10.1016/j.avsg.2017.03.167 |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]]
+| align="left" style="background:#F5F5F5;" |
+* Age: 26-55 years
+* Male predominance
+| align="left" style="background:#F5F5F5;" |
+*A slow growing [[Neck masses|neck mass]]
+| align="center" style="background:#F5F5F5;" | +
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+*Mobile
+*Non-tender [[Neck masses|neck mass]] (horizontally more than vertically)
+*[[Pulsatile Flow|Pulsatile]]
+*[[Bruit]] may be present
+| align="left" style="background:#F5F5F5;" |
+*Change in voice
+*[[Dizziness]]
+*[[Tinnitus]]
+*[[Headache]]
+| align="left" style="background:#F5F5F5;" |
+* Rasised [[catecholamine]] levels
+| align="left" style="background:#F5F5F5;" |
+* Microscopically they are extra-adrenal [[paragangliomas]]
+| align="left" style="background:#F5F5F5;" |
+*[[Doppler ultrasound]], [[Computed tomography|CT,]] [[MRI]] and [[angiography]] is used to visualize the [[tumor]]
+*[[Metaiodobenzylguanidine|Metaiodobenzylguanidine (MIBG)]] testing
+| align="left" style="background:#F5F5F5;" |
+* [[Histopathology]] analysis and [[catecholamine]] levels
+| align="center" style="background:#F5F5F5;" |−
+|-
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Paraganglioma]]<ref name="pmid15328326">{{cite journal |vauthors=Neumann HP, Pawlu C, Peczkowska M, Bausch B, McWhinney SR, Muresan M, Buchta M, Franke G, Klisch J, Bley TA, Hoegerle S, Boedeker CC, Opocher G, Schipper J, Januszewicz A, Eng C |title=Distinct clinical features of paraganglioma syndromes associated with SDHB and SDHD gene mutations |journal=JAMA |volume=292 |issue=8 |pages=943–51 |date=August 2004 |pmid=15328326 |doi=10.1001/jama.292.8.943 |url=}}</ref><ref name="pmid11701678">{{cite journal |vauthors=Erickson D, Kudva YC, Ebersold MJ, Thompson GB, Grant CS, van Heerden JA, Young WF |title=Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients |journal=J. Clin. Endocrinol. Metab. |volume=86 |issue=11 |pages=5210–6 |date=November 2001 |pmid=11701678 |doi=10.1210/jcem.86.11.8034 |url=}}</ref><ref name="pmid8678971">{{cite journal |vauthors=O'Riordain DS, Young WF, Grant CS, Carney JA, van Heerden JA |title=Clinical spectrum and outcome of functional extraadrenal paraganglioma |journal=World J Surg |volume=20 |issue=7 |pages=916–21; discussion 922 |date=September 1996 |pmid=8678971 |doi= |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]] (Majority)
+* [[Malignant]] (rare)
+| align="left" style="background:#F5F5F5;" |
+* Age 50-70 years
+* More in females
+| align="left" style="background:#F5F5F5;" |
+* May be an accidental finding depending on their secretory nature or present with following symptoms:
+** [[Palpitation]]
+**[[Tremor]]
+**Pulse-like vibratory sense
+**[[Headache]]
+**Change in voice
+**Vertigo
+*[[Catecholamine]] secreting [[paragangliomas]] presents with :
+**[[Hypertension]]
+**[[Headache]]
+**[[Sweating]]
+**[[Tachycardia]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* No visible [[mass]]
+* Located deep in the the [[neck]] along the [[glossopharyngeal nerve]]
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* [[Biochemical testing]] may show [[catecholamine]] metabolites in [[serum]] or [[urine]] samples
+| align="left" style="background:#F5F5F5;" |
+* Highly [[vascular tumors]] that involves [[nerves]] around [[vessels]]
+* [[Gross examination|Gross findings]]:
+**Fleshy [[tumor]]
+**Pink to red-brown to gray in color
+**Associated with [[hemorrhage]] or [[fibrosis]]
+* [[Microscopic|Microscopic findings]]:
+** Round or polygonal cells
+** Nests or trabecular structures inside the capsule
+| align="left" style="background:#F5F5F5;" |
+*[[Ultrasound]]
+*[[Computed tomography]]
+*[[Magnetic resonance imaging]]
+*[[Angiography]]
+*[[metaiodobenzylguanidine]] (MIBG)
+*18F-fluoro-2-deoxyglucose Positron emission tomography (FDG-PET)
+| align="left" style="background:#F5F5F5;" |
+* [[Imaging]] and [[Catecholamine|serum catecholamine analysis]]
+| align="center" style="background:#F5F5F5;" |−
+|-
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
+! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
+|-
+! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Neoplasm
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Schwannoma]]<ref name="pmid24450866">{{cite journal |vauthors=Hilton DA, Hanemann CO |title=Schwannomas and their pathogenesis |journal=Brain Pathol. |volume=24 |issue=3 |pages=205–20 |date=April 2014 |pmid=24450866 |doi=10.1111/bpa.12125 |url=}}</ref><ref name="pmid28237565">{{cite journal |vauthors=Albert P, Patel J, Badawy K, Weissinger W, Brenner M, Bourhill I, Parnell J |title=Peripheral Nerve Schwannoma: A Review of Varying Clinical Presentations and Imaging Findings |journal=J Foot Ankle Surg |volume=56 |issue=3 |pages=632–637 |date=2017 |pmid=28237565 |doi=10.1053/j.jfas.2016.12.003 |url=}}</ref><ref name="pmid27020268">{{cite journal |vauthors=Wong BLK, Bathala S, Grant D |title=Laryngeal schwannoma: a systematic review |journal=Eur Arch Otorhinolaryngol |volume=274 |issue=1 |pages=25–34 |date=January 2017 |pmid=27020268 |doi=10.1007/s00405-016-4013-6 |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]]
+| align="left" style="background:#F5F5F5;" |
+* Rare [[tumor]]
+* Incidence: 1-10%
+| align="left" style="background:#F5F5F5;" |
+* Slow growing [[mass]]
+* Localized neural deficit depending on the site of [[peripheral nerve]] involved
+* [[Vagus nerve]] or [[Sympathetic chain|superior cervical sympathetic chain]] involvement (most common locations)
+| align="center" style="background:#F5F5F5;" | +
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+* Multiple
+* Slow growing  [[nodules]] on the skin
+| align="left" style="background:#F5F5F5;" |
+* [[Vagal]] involvement:
+** [[Hoarseness]]
+** [[Dysphagia]]
+* [[Sympathetic nerve]] involvement may present as [[Horner's syndrome]]:
+**[[Dilated pupil]]
+** Decrease [[sweating]]
+** Dropping eyelid
+* [[Vestibular nerve]] involvement & [[Hearing impairment]] (most common)
+| align="left" style="background:#F5F5F5;" |
+* May be normal
+| align="left" style="background:#F5F5F5;" |
+* Encapsulated neural tissue growth
+| align="left" style="background:#F5F5F5;" |
+* Resembling [[Carotid body tumor]] on [[Computed tomography|CT]]
+* [[Magnetic resonance imaging|MRI]] and [[Angiography|MRI angiography]] confirm the diagnosis
+| align="left" style="background:#F5F5F5;" |
+* [[Imaging]]
+| align="left" style="background:#F5F5F5;" |
+* [[neurofibromatosis type II]]
+|-
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Lymphoma]] <ref name="pmid7139563">{{cite journal |vauthors=Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT |title=Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute |journal=Cancer |volume=50 |issue=12 |pages=2699–707 |date=December 1982 |pmid=7139563 |doi= |url=}}</ref><ref name="pmid71395632">{{cite journal |vauthors=Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT |title=Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute |journal=Cancer |volume=50 |issue=12 |pages=2699–707 |date=December 1982 |pmid=7139563 |doi= |url=}}</ref><ref name="pmid15185336">{{cite journal |vauthors=Negri E, Little D, Boiocchi M, La Vecchia C, Franceschi S |title=B-cell non-Hodgkin's lymphoma and hepatitis C virus infection: a systematic review |journal=Int. J. Cancer |volume=111 |issue=1 |pages=1–8 |date=August 2004 |pmid=15185336 |doi=10.1002/ijc.20205 |url=}}</ref><ref name="pmid2406917">{{cite journal |vauthors=Moormeier JA, Williams SF, Golomb HM |title=The staging of non-Hodgkin's lymphomas |journal=Semin. Oncol. |volume=17 |issue=1 |pages=43–50 |date=February 1990 |pmid=2406917 |doi= |url=}}</ref><ref name="pmid151853362">{{cite journal |vauthors=Negri E, Little D, Boiocchi M, La Vecchia C, Franceschi S |title=B-cell non-Hodgkin's lymphoma and hepatitis C virus infection: a systematic review |journal=Int. J. Cancer |volume=111 |issue=1 |pages=1–8 |date=August 2004 |pmid=15185336 |doi=10.1002/ijc.20205 |url=}}</ref><ref name="pmid71395633">{{cite journal |vauthors=Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT |title=Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute |journal=Cancer |volume=50 |issue=12 |pages=2699–707 |date=December 1982 |pmid=7139563 |doi= |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]] or [[malignant]]
+| align="left" style="background:#F5F5F5;" |
+* Age: Predilection for older age
+* Mean age: 55
+| align="left" style="background:#F5F5F5;" |
+* Insidious onset slow growing [[Lymph node|lymph nodes]]
+* Non-specific systemic [[B symptoms]]:
+** [[Fever]]
+** [[Night sweats]]
+** [[Weight loss]])
+** [[Rash]]
+* Waxing and waning [[lymphadenopathy]]
+* [[Abdominal fullness]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+* Multiple chain [[lymphadenopathy]]
+* [[Hepatosplenomegaly]]
+* [[Ascites]]
+* [[Crackles]] heard on [[Auscultation|chest auscultation]]
+| align="left" style="background:#F5F5F5;" |
+* [[Rash]] and [[pruritus]]
+| align="left" style="background:#F5F5F5;" |
+* [[Pancytopenia]]
+* [[Hypercalcemia]]
+* [[Hyperuricemia]] (increased cell turnover)
+* [[Immunoglobulin|Monoclonal immunoglobulin]] (M-spike)
+* Raised [[LDH]] levels
+| align="left" style="background:#F5F5F5;" |
+* On complete node analysis four patterns are described:
+** Nodular/follicular
+** Diffuse pattern
+** Transition from a nodular to a diffuse pattern in adjacent nodes
+** Transition from a lower to a higher grade of involvement within a single node
+| align="left" style="background:#F5F5F5;" |
+* Imaging to stage the disease
+* [[Positron emission tomography]] with computed tomography is preferred over [[MRI]]
+| align="left" style="background:#F5F5F5;" |
+* [[Lymph node]] biopsy coupled with [[cytometry]]
+| align="left" style="background:#F5F5F5;" |
+* [[Infections]] due to [[cytopenias]]
+* With acquired form of [[C1 inhibitor deficiency]] patients may develop [[angioedema]]
+|-
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Liposarcoma]] <ref name="pmid171979142">{{cite journal |vauthors=Evans HL |title=Atypical lipomatous tumor, its variants, and its combined forms: a study of 61 cases, with a minimum follow-up of 10 years |journal=Am. J. Surg. Pathol. |volume=31 |issue=1 |pages=1–14 |date=January 2007 |pmid=17197914 |doi=10.1097/01.pas.0000213406.95440.7a |url=}}</ref><ref name="pmid21253554">{{cite journal |vauthors=Conyers R, Young S, Thomas DM |title=Liposarcoma: molecular genetics and therapeutics |journal=Sarcoma |volume=2011 |issue= |pages=483154 |date=2011 |pmid=21253554 |pmc=3021868 |doi=10.1155/2011/483154 |url=}}</ref><ref name="pmid19194281">{{cite journal |vauthors=Alaggio R, Coffin CM, Weiss SW, Bridge JA, Issakov J, Oliveira AM, Folpe AL |title=Liposarcomas in young patients: a study of 82 cases occurring in patients younger than 22 years of age |journal=Am. J. Surg. Pathol. |volume=33 |issue=5 |pages=645–58 |date=May 2009 |pmid=19194281 |doi=10.1097/PAS.0b013e3181963c9c |url=}}</ref><ref name="pmid176106862">{{cite journal |vauthors=Serpell JW, Chen RY |title=Review of large deep lipomatous tumours |journal=ANZ J Surg |volume=77 |issue=7 |pages=524–9 |date=July 2007 |pmid=17610686 |doi=10.1111/j.1445-2197.2007.04042.x |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+* Rare [[tumor]]
+* Age: Relatively in older age
+* Gender: No gender predilection
+| align="left" style="background:#F5F5F5;" |
+* Mobile [[Mass|mass]]
+* Few symptoms until they grow enough to compress the surrounding structures
+* Symptoms of [[neural]] deficit, pain, [[tingling]], or [[skin]] changes
+| align="center" style="background:#F5F5F5;" | ±
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* Mobile soft [[mass]]
+* Intact overlying [[skin]]
+* Blue discoloration due to intra-lesion [[hemorrhage]]
+| align="left" style="background:#F5F5F5;" |
+* Intact [[skin]] and normal color
+| align="left" style="background:#F5F5F5;" |
+* Normal
+| align="left" style="background:#F5F5F5;" |
+* [[Gross examination]]:
+**Bulk of yellow colored [[fat tissue]]
+* [[Microscopic|Microscopic features]]:
+** [[Adipose tissue]] containing lipoblasts
+** Atypical [[nucleus]] pushed to side by intracytoplasmic vacuoles
+* Tissue [[biopsy]] may show [[histological]] sub-groups:
+** Well-differentiated
+** Myxoid/round cell
+** Pleomorphic liposarcomas
+| align="left" style="background:#F5F5F5;" |
+* [[Imaging]] not usually required for diagnosis
+* May show deeper [[invasion]]
+* [[Ultrasound]] shows homogeneous hyperechoic [[mass]]
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]] and [[Histopathology|histopathology analysis]]
+| align="center" style="background:#F5F5F5;" | −
+|-
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
+! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
+|-
+! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Neoplasm
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Lipoma]] <ref name="pmid24800932">{{cite journal |vauthors=de Bree E, Karatzanis A, Hunt JL, Strojan P, Rinaldo A, Takes RP, Ferlito A, de Bree R |title=Lipomatous tumours of the head and neck: a spectrum of biological behaviour |journal=Eur Arch Otorhinolaryngol |volume=272 |issue=5 |pages=1061–77 |date=May 2015 |pmid=24800932 |doi=10.1007/s00405-014-3065-8 |url=}}</ref><ref name="pmid6670522">{{cite journal |vauthors=Rydholm A, Berg NO |title=Size, site and clinical incidence of lipoma. Factors in the differential diagnosis of lipoma and sarcoma |journal=Acta Orthop Scand |volume=54 |issue=6 |pages=929–34 |date=December 1983 |pmid=6670522 |doi= |url=}}</ref><ref name="pmid7282321">{{cite journal |vauthors=Myhre-Jensen O |title=A consecutive 7-year series of 1331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas |journal=Acta Orthop Scand |volume=52 |issue=3 |pages=287–93 |date=June 1981 |pmid=7282321 |doi= |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]]
+| align="left" style="background:#F5F5F5;" |
+* [[Genetic predisposition]]
+* Unspecific gender or age association
+| align="left" style="background:#F5F5F5;" |
+* One or multiple soft, painless skin [[nodules]]
+* May causes pain or compressive [[symptoms]]
+| align="center" style="background:#F5F5F5;" | ±
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* Mobile soft [[nodule]]
+* Intact overlying [[skin]]
+| align="left" style="background:#F5F5F5;" |
+* Normal
+| align="left" style="background:#F5F5F5;" |
+* Normal
+| align="left" style="background:#F5F5F5;" |
+* Diagnoses is usually [[clinical]]
+* Tissue [[biopsy]] may show:
+** Bundle of well-demarcated lipocytes
+** Single [[nuclei]] aligned to the side
+** Intra-cytoplasimic fat granules
+| align="left" style="background:#F5F5F5;" |
+* Diagnosis is usually clinical
+* [[ultrasound]] is used to differentiate [[lipoma]] from other [[benign]] lesions such as:
+** [[Epidermoid cyst]]
+** A [[ganglion]]
+| align="left" style="background:#F5F5F5;" |
+* [[Clinical]] evaluation
+| align="left" style="background:#F5F5F5;" |
+* Multiple [[lipomas]]
+* Associated with [[familial multiple lipomatosis]]
+|-
+! colspan="2" align="center" style="background:#DCDCDC;" |Glomus vagale, [[Glomus jugulare tumor|glomus jugulare]] tumors<ref name="pmid8164483">{{cite journal |vauthors=Urquhart AC, Johnson JT, Myers EN, Schechter GL |title=Glomus vagale: paraganglioma of the vagus nerve |journal=Laryngoscope |volume=104 |issue=4 |pages=440–5 |date=April 1994 |pmid=8164483 |doi=10.1288/00005537-199404000-00008 |url=}}</ref><ref name="pmid6308990">{{cite journal |vauthors=Valavanis A, Schubiger O, Oguz M |title=High-resolution CT investigation of nonchromaffin paragangliomas of the temporal bone |journal=AJNR Am J Neuroradiol |volume=4 |issue=3 |pages=516–9 |date=1983 |pmid=6308990 |doi= |url=}}</ref><ref name="pmid81644832">{{cite journal |vauthors=Urquhart AC, Johnson JT, Myers EN, Schechter GL |title=Glomus vagale: paraganglioma of the vagus nerve |journal=Laryngoscope |volume=104 |issue=4 |pages=440–5 |date=April 1994 |pmid=8164483 |doi=10.1288/00005537-199404000-00008 |url=}}</ref><ref name="pmid1988766">{{cite journal |vauthors=Stein PP, Black HR |title=A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience |journal=Medicine (Baltimore) |volume=70 |issue=1 |pages=46–66 |date=January 1991 |pmid=1988766 |doi= |url=}}</ref><ref name="pmid17400487">{{cite journal |vauthors=Sajid MS, Hamilton G, Baker DM |title=A multicenter review of carotid body tumour management |journal=Eur J Vasc Endovasc Surg |volume=34 |issue=2 |pages=127–30 |date=August 2007 |pmid=17400487 |doi=10.1016/j.ejvs.2007.01.015 |url=}}</ref><ref name="pmid15883711">{{cite journal |vauthors=Boedeker CC, Ridder GJ, Schipper J |title=Paragangliomas of the head and neck: diagnosis and treatment |journal=Fam. Cancer |volume=4 |issue=1 |pages=55–9 |date=2005 |pmid=15883711 |doi=10.1007/s10689-004-2154-z |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]]
+| align="left" style="background:#F5F5F5;" |
+* Rare tumor
+| align="left" style="background:#F5F5F5;" |
+* Painless slowly enlarging [[Mass|mass]] in the [[neck]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+* Non-compressible
+* Firm
+* Non-tender [[swelling]]
+* No [[thrill]] or [[bruit]]
+* Normal overlying skin
+| align="left" style="background:#F5F5F5;" |
+* Secretory tumors
+* May have compressive signs such as:
+** [[Dysphagia]]
+** [[Hoarseness]]
+** [[Cranial nerves]] deficits
+** [[Horner's syndrome]]
+| align="left" style="background:#F5F5F5;" |
+* Normal
+| align="left" style="background:#F5F5F5;" |
+* [[Glomus tumor|Glomus tumors]] arise from Non [[Chromaffin cells]]
+* [[histopathology]] reveals "salt and pepper" [[chromatin]]
+* On [[immunohistochemistry]] [[Tumor cell|tumor cells]] show [[chromogranin]] and [[S-100]] positivity
+| align="left" style="background:#F5F5F5;" |
+* [[MRI]] ([[Imaging]] of choice): Typical appearance of the [[tumor]] along [[vagus nerve]]
+* [[Ultrasonography]] (early stage of diagnosis): Isoechoic to hypoechoic well defined [[tumor]]
+* [[CT-scans|CT]]: Vascularity of the [[tumor]]
+* Biochemical testing: Shows secretary nature of the [[tumor]]
+| align="left" style="background:#F5F5F5;" |
+* [[Imaging]] and [[Metaiodobenzylguanidine]] (MIBG) testing
+| align="center" style="background:#F5F5F5;" | −
+|-
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Head and neck cancer|Metastatic head and neck cancer]]<ref name="pmid2211107">{{cite journal |vauthors=Gluckman JL, Robbins KT, Fried MP |title=Cervical metastatic squamous carcinoma of unknown or occult primary source |journal=Head Neck |volume=12 |issue=5 |pages=440–3 |date=1990 |pmid=2211107 |doi= |url=}}</ref><ref name="pmid19841343">{{cite journal |vauthors=Waltonen JD, Ozer E, Hall NC, Schuller DE, Agrawal A |title=Metastatic carcinoma of the neck of unknown primary origin: evolution and efficacy of the modern workup |journal=Arch. Otolaryngol. Head Neck Surg. |volume=135 |issue=10 |pages=1024–9 |date=October 2009 |pmid=19841343 |doi=10.1001/archoto.2009.145 |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+* Depends on the nature of [[metastatic]] [[tumor]]
+| align="left" style="background:#F5F5F5;" |
+* Asymptomatic
+* Painless [[lymphadenopathy]]
+* Supra clavicular fullness in case of [[stomach cancer]] [[metastasis]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+* Non-[[Tenderness|tender]] [[mass]] in the [[neck]]
+* Non-tender [[lymphadenopathy]]
+| align="left" style="background:#F5F5F5;" |
+* Majority of metastatic [[head and neck cancer]]
+* Metastatise from [[Gastrointestinal tract|GIT]] and lungs
+| align="left" style="background:#F5F5F5;" |
+* Vary depending on the underlying [[cancer]]
+| align="left" style="background:#F5F5F5;" |
+* [[Histology]] of primary cancer
+| align="left" style="background:#F5F5F5;" |
+* [[Computed tomography|CT]] and [[Magnetic resonance imaging|MRI]] to see extent of [[tumor]]
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]] and [[histopathology]] of the primary site of [[tumor]]
+| align="center" style="background:#F5F5F5;" | −
+|-
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
+! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
+|-
+! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Laryngeal cancer]]<ref name="pmid6639441">{{cite journal |vauthors=Feldman PS, Kaplan MJ, Johns ME, Cantrell RW |title=Fine-needle aspiration in squamous cell carcinoma of the head and neck |journal=Arch Otolaryngol |volume=109 |issue=11 |pages=735–42 |date=November 1983 |pmid=6639441 |doi= |url=}}</ref><ref name="pmid26237923">{{cite journal |vauthors=Grénman R, Koivunen P, Minn H |title=[Laryngeal cancer in Finland] |language=Finnish |journal=Duodecim |volume=131 |issue=4 |pages=331–7 |date=2015 |pmid=26237923 |doi= |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |[[Benign]]/[[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+* Older males
+* Younger patients with [[Human papillomavirus|HPV]] infection or smoking history
+| align="left" style="background:#F5F5F5;" |
+* [[Neck masses|Neck mass]]
+* [[Hoarseness]]
+* Throat pain
+* [[Snoring]]
+* [[Obstructive sleep apnea]]
+| align="center" style="background:#F5F5F5;" | ±
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+* Examination of [[neck]] and [[oral cavity]] may show :
+** [[mass]]
+** [[lymphadenopathy]]
+*Examination of [[laryngeal cancer]] is done using flexible [[laryngoscopy]] under [[anesthesia]].
+| align="left" style="background:#F5F5F5;" |
+* [[Smoking]] is the most common risk factor
+* [[Smoking]] with [[alcohol]] increases the risk
+* Oropharyngeal cancers presenting with [[neck masses]] are associated with
+[[Human papillomavirus|human papillomavirus (HPV)]]  infection
+| align="left" style="background:#F5F5F5;" |
+* [[Human papillomavirus|HPV testing]] may show [[HPV infection]]
+| align="left" style="background:#F5F5F5;" |
+* [[FNA]] of [[Neck masses|neck mass]]
+* Followed by [[biopsy]] of [[laryngeal cancer]]
+* Show type cancer cells
+| align="left" style="background:#F5F5F5;" |
+* [[Computed tomography|CT]], [[Magnetic resonance imaging|MRI]] and [[Positron emission tomography|PET]] are used to see local infiltration by [[cancer]]
+* Also to see distant [[metastases]].
+* Panendoscopy is done to see extent of the [[tumor]].
+| align="left" style="background:#F5F5F5;" |
+* [[Laryngoscopy]] and [[biopsy]]
+| align="center" style="background:#F5F5F5;" | −
+|-
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Arteriovenous fistula]]
+<ref name="pmid26972281">{{cite journal |vauthors=Guneyli S, Cinar C, Bozkaya H, Korkmaz M, Oran I |title=Endovascular management of congenital arteriovenous fistulae in the neck |journal=Diagn Interv Imaging |volume=97 |issue=9 |pages=871–5 |date=September 2016 |pmid=26972281 |doi=10.1016/j.diii.2015.08.006 |url=}}</ref><ref name="pmid8264877">{{cite journal |vauthors=Gobin YP, Garcia de la Fuente JA, Herbreteau D, Houdart E, Merland JJ |title=Endovascular treatment of external carotid-jugular fistulae in the parotid region |journal=Neurosurgery |volume=33 |issue=5 |pages=812–6 |date=November 1993 |pmid=8264877 |doi= |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]]/[[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+* Depends on the risk factors
+| align="left" style="background:#F5F5F5;" |
+* Expanding [[Neck masses|neck mass]]
+* [[Headaches]]
+* [[Dizziness]]
+* [[Neurological|Neurological sequels]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* Pulsating [[Neck masses|neck mass]]
+* [[Bruit]]
+| align="left" style="background:#F5F5F5;" |
+* May be associated with [[vasculopathies]]
+* [[metastatic]] invasion of vessels and neck surgery
+| align="left" style="background:#F5F5F5;" |
+| align="left" style="background:#F5F5F5;" |
+* Varies depending on the etiology
+| align="left" style="background:#F5F5F5;" |
+* [[MR angiography]]
+| align="left" style="background:#F5F5F5;" |
+* [[MR angiography]]
+| align="center" style="background:#F5F5F5;" | −
+|-
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Thyroid mass causes|Thyroid nodule]]/ [[Goiter]]
+<ref name="pmid7606997">{{cite journal |vauthors=Madjar S, Weissberg D |title=Retrosternal goiter |journal=Chest |volume=108 |issue=1 |pages=78–82 |date=July 1995 |pmid=7606997 |doi= |url=}}</ref><ref name="pmid11893102">{{cite journal |vauthors=Hedayati N, McHenry CR |title=The clinical presentation and operative management of nodular and diffuse substernal thyroid disease |journal=Am Surg |volume=68 |issue=3 |pages=245–51; discussion 251–2 |date=March 2002 |pmid=11893102 |doi= |url=}}</ref><ref name="pmid23145396">{{cite journal |vauthors=Hughes K, Eastman C |title=Goitre - causes, investigation and management |journal=Aust Fam Physician |volume=41 |issue=8 |pages=572–6 |date=August 2012 |pmid=23145396 |doi= |url=}}</ref><ref name="pmid10972051">{{cite journal |vauthors=Hermus AR, Huysmans DA |title=[Diagnosis and therapy of patients with euthyroid goiter] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=144 |issue=34 |pages=1623–7 |date=August 2000 |pmid=10972051 |doi= |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* [[Benign]]/ [[Malignant]]
+| align="left" style="background:#F5F5F5;" |
+* Female predominance
+* Young age (benign causes)
+* Old age ([[malignant]] etiology)
+| align="left" style="background:#F5F5F5;" |
+* Growing painless [[Neck masses|neck mass]] in front of neck
+* [[Weight loss]]
+* Palpitation
+* [[Hoarseness]]
+* [[Irritability]]
+| align="center" style="background:#F5F5F5;" | ±
+| align="center" style="background:#F5F5F5;" | ±
+| align="left" style="background:#F5F5F5;" |
+* Painless
+* Non-tender
+* Asymmetrical [[Neck masses|neck mass]] in front of neck
+* With smooth overlying skin
+* Nodular surface
+* Depending on the type:
+** May be mobile
+** Adherent to the underlying structure
+** [[Lymphadenopathy]] in case of [[malignant]] features
+| align="left" style="background:#F5F5F5;" |
+* [[Goiter]] is most commonly associated with [[iodine deficiency]]
+| align="left" style="background:#F5F5F5;" |
+* Normal to low [[TSH|TSH levels]] in case of malignancy
+* High TSH levels in case of [[goiter]]
+| align="left" style="background:#F5F5F5;" |
+* [[FNA]] is done in case of [[goiter]]
+* [[Biopsy|Core biopsy]] is performed if [[malignancy]] is suspected
+| align="left" style="background:#F5F5F5;" |
+* [[Ultrasonography|USG]]:
+** Shows nodular or non- nodular lesions in [[Thyroid]]
+** [[Ultrasonography|US]] is better than [[Computed tomography|CT]].
+* [[Thyroid]] [[radionuclide imaging]]:
+** Shows [[radioiodine]] uptake
+** Cold in case of [[malignancy]]
+** Cold or hot in case of [[goiter]].
+| align="left" style="background:#F5F5F5;" |
+* [[Biopsy]] and [[histopathology]] of nodules
+| align="center" style="background:#F5F5F5;" | −
+|-
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
+! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
+|}
-==Epidemiology==
+==Primary Prevention==
-The number of new cases of head and neck cancers in the United States was 40,490 in 2006, accounting for about 3% of adult malignancies. 11,170 patients died of their disease in 2006.<ref>{{cite journal |author=Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun M |title=Cancer statistics, 2006 |journal=CA Cancer J Clin |volume=56 |issue=2 |pages=106-30 |year= |pmid=16514137}}</ref> The worldwide incidence exceeds half a million cases annually. In North America and Europe, the tumors usually arise from the oral cavity, oropharynx, or larynx, whereas nasopharyngeal cancer is more common in the Mediterranean countries and in the Far East. In Southeast China and Taiwan, head and neck cancer, specifically Nasopharyngeal Cancer is the most common cause of death in young men.<ref>{{cite journal |author=Titcomb C |title=High incidence of nasopharyngeal carcinoma in Asia |journal=J Insur Med |volume=33 |issue=3 |pages=235-8 |year=2001 |pmid=11558403}}</ref>
-African Americans are disproportionately affected by head and neck cancer, with younger ages of incidence, increased mortality, and more advanced disease at presentation.<ref> {{cite journal |author=Gourin C, Podolsky R |title=Racial disparities in patients with head and neck squamous cell carcinoma |journal=Laryngoscope |volume=116 |issue=7 |pages=1093-106 |year=2006 |pmid=16826042}}</ref>
-* In the U.S. there were 28,900 people diagnosed with cancers of the throat and oral cavity in 2002.<ref name="ACS">''Cancer Facts and Figures'', http://www.cancer.org/downloads/STT/CancerFacts&Figures2002TM.pdf,, American Cancer Society 2002.</ref>
-* Seventy-four hundred Americans are projected to die of these cancers.<ref name="ACS">1</ref>
-* More than 70% of throat cancers are at an advanced stage when discovered.<ref name="NCH">''Throat Cancer'' patient information web page, http://cancer.nchmd.org/treatment.aspx?id=741, NCH Healthcare Systems, 1999</ref>
-* Men are 89% more likely than women to be diagnosed with, and are almost twice as likely to die of, these cancers.<ref name="ACS">1</ref>
-* African-American men are at a 50% higher risk of throat cancer than Caucasian males.<font color=red><sup></sup></font>
-* Smoking and tobacco use are directly related to Oro-pharangeal (throat) cancer deaths.<ref name="HHS">''Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General'', U. S. Department of Health and Human Services, Public Health Service,Centers for Disease Control and Prevention, 1989.sad</ref>
+* Avoidance of recognised risk factors (as described above)is the single most effective form of prevention. Regular dental examinations may identify pre-cancerous lesions in the oral cavity.
+* It will be interesting to see what effect the widespread use of HPV vaccines has on the incidence of HPV-related H&N cancers.
+* People who have been treated for [[head and neck cancer]] have an increased chance of developing a new [[cancer]], usually in the [[head]] and [[neck]], [[esophagus]], or [[lungs]]. The chance of a second primary cancer varies depending on the original [[diagnosis]], but is higher for people who smoke and drink alcohol. Patients who do not smoke should never start. Those who smoke should do their best to quit. Studies have shown that continuing to smoke or drink (or both) increases the chance of a second primary cancer for up to 20 years after the original [[diagnosis]].
+* Some research has shown that [[isotretinoin]] (13-cis-retinoic acid), a substance related to [[vitamin A]], may reduce the risk of the [[tumor]] recurring (coming back) in patients who have been successfully treated for [[cancers]] of the [[oral cavity]], [[oropharynx]], and [[larynx]]. However, treatment with [[isotretinoin]] has not yet been shown to improve survival or to prevent future [[cancers]].
 ==References==
 {{Reflist|2}}
-==See also==
+==Case Studies==
+[[Head and neck cancer case study one|Case#1]]
+==Related chapters==
 *[[oral cancer]]
 *[[cancer of the larynx]]
@@ Line 226: / Line 1,021: @@
 *Bobby Hamilton - a NASCAR driver who died of head and neck cancer
-==External links==
+==External Links==
 * [http://www.nlm.nih.gov/medlineplus/headandneckcancer.html Head and Neck Cancer - Learn more from MedlinePlus]
 * [http://www.health.am/cr/head-and-neck-cancer/ Head and Neck Cancer Information]
@@ Line 232: / Line 1,027: @@
 * [http://www.cancer.gov/cancertopics/treatment/head-and-neck Head and Neck Cancer: Treatment]
 * [http://www.radiologyinfo.org/en/info.cfm?pg=hdneck RadiologyInfo] - The radiology information resource for patients: Head and Neck Cancer
-* [http://www.spohnc.org] -- The website of an organization dedicated to supporting people with oral, head and neck cancers (includes a cancer information page)
-{{Tumors}}
-{{medicine}}
+{{WikiDoc Help Menu}}
-{{SIB}}
+{{WikiDoc Sources}}
-[[Category:Disease state]]
+[[Category:Disease]]
 [[Category:Otolaryngology]]
 [[Category:Oral and maxillofacial surgery]]
@@ Line 244: / Line 1,038: @@
 [[Category:Oncology]]
 [[Category:Mature chapter]]
-{{WikiDoc Help Menu}}
+ [[Category:Up-To-Date]]
-{{WikiDoc Sources}}
+[[Category:Oncology]]
+[[Category:Medicine]]