Head and Neck Squamous Cell Carcinoma: Update on Epidemiology, Diagnosis, and Treatment

Abstract

Squamous cell carcinoma arises from multiple anatomic subsites in the head and neck region. The risk factors for development of cancers of the oral cavity, oropharynx, hypopharynx, and larynx include tobacco exposure and alcohol dependence, and infection with oncogenic viruses is associated with cancers developing in the nasopharynx, palatine, and lingual tonsils of the oropharynx. The incidence of human papillomavirus-associated oropharyngeal cancer is increasing in developed countries, and by 2020, the annual incidence could surpass that of cervical cancer. The treatment for early-stage squamous cell cancers of the head and neck is generally single modality, either surgery or radiotherapy. The treatment for locally advanced head and neck cancers is multimodal, with either surgery followed by adjuvant radiation or chemoradiation as indicated by pathologic features or definitive chemoradiation. For recurrent disease that is not amenable to a salvage local or regional approach and for metastatic disease, chemotherapy with or without a biological agent is indicated. To date, molecular testing has not influenced treatment selection in head and neck cancer. This review will focus on the changing epidemiology, advances in diagnosis, and treatment options for squamous cell cancers of the head and neck, along with data on risk stratification specific to oropharyngeal cancer, and will highlight the direction of current trials.

An oncogenic function of retinoic acid receptor‑α in the development of laryngeal squamous cell carcinoma

“…Laryngeal carcinoma is one of the most aggressive malignant tumors out of all head and neck squamous cell carcinoma, and generally has a poor prognosis (2). The survival time of laryngeal cancer has not increased, despite substantial progress in the developments of surgery and radiotherapy (3,17).…”

“…Laryngeal carcinoma, of which >95% of cases are laryngeal squamous cell carcinoma (LSCC), is a prevalent malignancy of the head and neck, with an incidence of 3.5-5.5/100,000 people and a mortality rate of 2.1-2.4 per 100,000 people worldwide in 2008 (1,2). Although there have been significant improvements in terms of diagnosis and treatment, the clinical outcome of therapy for patients with LSCC, particularly those with advanced stages of the disease, remains poor (3).…”

The impact of Survivin, WRAP53β, and Hypoxia on treatment response in Head and Neck Cancer

“…However, in recent years there has been a notably increase of HNSCC in patients younger than 40 years (17,18). This development was highlighted by the absence of traditional risk factors in these younger patients and led to the identification of high-risk HPV as a cause of oropharyngeal cancer, and finally to the distinction between HPV + (HPV-positive) and HPV -(HPV-negative) oropharyngeal tumors as two clinically different entities (17). HPV + OPSCC (oropharyngeal SCC) is associated with a more aggressive phenotype, but also with a better response to radiotherapy and patient survival compared to HPV -tumors (19).…”

“…The main standard treatments are surgery and radiotherapy, either alone or in combination. Generally, low stage tumors (stage I-II) are treated with single modality therapy, either surgery or radiotherapy alone, whereas high stage tumors (III and IV) are treated with a multimodality approach including also chemotherapy and molecular targeted drugs (17). Treatment intention is either curative or palliative.…”

“…Both impaired organ function (e.g. dysphagia, hoarseness) and cosmetic deformity cause a tremendous decrease in quality of life (17). Another limitation is the relation to surrounding tissue, like perineural or perivascular growth, making the tumor inoperable and oncological treatment the only option.…”