Head and neck cancers are typically squamous tumours that arise in the nasopharynx, hypopharynx and larynx.
They are most common in elderly males, but now occur with increasing frequency in a younger cohort, as well as in women, especially where oropharyngeal cancers are concerned. The rising incidence of oropharyngeal cancers, especially in the developed world, is thought to be secondary to HPV infection. Presentation depends on the location of the primary tumour and the extent of disease. For example, early laryngeal cancers may present with hoarseness, while more extensive local disease may present with pain due to invasion of local structures or with a lump in the neck.
Patients who present late often have pulmonary symptoms, as this is the most common site of distant metastases.
The tumours are strongly associated with a history of smoking and excess alcohol intake, but other recognised risk factors include Epstein–Barr virus for nasopharyngeal cancer and HPV infection for oropharyngeal tumours.
Careful inspection of the primary site is required as part of the staging process, and most patients will require endoscopic evaluation and examination under anaesthesia. Tissue biopsies should be taken from the most accessible site. CT of the investigation of choice for visualising the tumour, while
MRI may be useful in certain cases.
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