Epidemiologic trends in head and neck cancer and aids in diagnosis

Abstract

Head and neck squamous cell carcinoma is the sixth most common cancer worldwide predominately associated with tobacco use. Changing cause and increased incidence in oropharyngeal carcinomas is associated with high-risk types of human papilloma virus and has an improved survival. Optical devices may augment visual oral examination; however, their lack of specificity still warrants tissue evaluation/biopsy. Histologic factors of oral carcinomas are critical for patient management and prognostic determination. Clinical biomarkers are still needed to improve early detection, predict malignant transformation, and optimize therapies.

Keywords: Diagnosis; Epidemiologic trends; Head and neck cancer; Squamous cell carcinomas.

Figure 1

Autofluorescence visualization of tongue leukoplakias. (A) A 57-year old female with a history of cigarette smoking presented with a leukoplakia that is barely visible under white light. (B) Autofluorescence visualization revealed loss of fluorescence of this leukoplakia. Excisional biopsy of this leukoplakia revealed moderate epithelial dysplasia. (C) A 65-year old female with no history of tobacco use presented with a leukoplakia in her lateral surface of the tongue. Extent of the leukoplakia involvement is markedly different when examined under white light (C) compared to autofluorescence visualization (D). Incisional biopsy of the lesion revealed moderate epithelial dysplasia (Inset).

Figure 2

Benign alveolar ridge keratosis which resembles leukoplakia is noted in a 49-year old female (A). Autofluorescence visualization revealed no loss of fluorescence (B).

Figure 3

Proliferative leukoplakia in 82-year old female with no history of tobacco use. Initial biopsy performed 10-years ago was diagnosed as lichen planus.

Figure 4

A 52-year old male with a history betel quid chewing presented with submucous fibrosis involving bilateral buccal mucosa (A). Autofluorescence visualization showed enhanced fluorescence of the affected mucosa except for the erythematous area revealing loss of fluorescence (B). An incisional biopsy taken from the area with the loss of fluorescence revealed the presence of superficially invasive squamous cell carcinoma.

Figure 5

Ulcerative form of lichen planus involving the tongue of 57-year old female (A). Autofluorescence visualization demonstrates loss of fluorescence limited to the erythematous areas (arrows) due to inflammation (B).

Figure 6

HPV associated squamous cell carcinoma. (A) Low power view of the tumor arising in the tonsillar cryptic mucosa (arrow) deep to the surface mucosa, (B) Higher power of monotonous, non-keratinizing neoplastic cells typical of this phenotype, (C) Strong/over-expressed p16 immunohistochemical staining throughout the tumor, (D) HPV positive in situ hybridization staining of the tumor nuclei (arrow)

Figure 7

Histologic variants of squamous cell carcinoma. (A)Verrucous carcinoma showing a broad base, minimal cytologic atypia and exophytic spire growth;(B) Papillary squamous carcinoma showing exophytic growth of fibrovascular cores covered by full thickness neoplastic cells without keratinization; (C) Basaloid squamous carcinoma with high-grade features and scant cytoplasm often lacking keratinization as in this example; (D) Sarcomatoid (spindle cell) carcinoma haphazardly growing in sheets with pleomorphism and mitoses, often retaining cytokeratin expression detected by immunohistochemical staining (inset) which aids in differentiating from true sarcomas.