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Carcinomas of the Head and Neck

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International Manual of Oncology Practice

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Abstract

Head and Neck Carcinomas (HNCs) are a heterogeneous group of malignancies arising from the epithelium that covers the first respiratory and digestive tract. They account for almost 7 % of all neoplasms, thus representing a non-rare disease. Head and neck anatomical region may be the source of very different tumours, with regard to both etiology and pathophysiology.

The most frequent histological variant of head and neck tumors is the squamous carcinoma that represents almost 90 % of all HNCs, whereas adenocarcinoma, adenoido-cystic and undifferentiated carcinomas, as well as other rare histologies are much less frequent. Squamous cell carcinomas of the head and neck (SCCHN) often arise from oral cavity, larynx, oropharynx and hypopharynx, whereas adenocarcinomas occur more frequently in the salivary glands; on the other hand, undifferentiated tumours arise very frequently in nasopharynx, and mucoepidermoid carcinomas are often diagnosed in paranasal sinuses.

For many years, surgery has been the cornerstone of therapy for all the head and neck carcinomas, except for nasopharyngeal tumors, but lately more conservative and multidisciplinary approaches have been employed and are currently replacing the techniques of radical surgery. Both sequential and concomitant association of chemo and radiotherapy, for instance, have become the standard primary treatments for some categories of locally advanced SCCHN. On the other hand, when, upfront surgery is chosen, treatment strategy almost always consists in a multimodal approach in which radiation or chemo-radiation is administered after surgery.

Moreover, the identification of human papilloma virus (HPV) as the main promoter of carcinogenesis in oropharyngeal carcinomas has prompted the interest in several studies aimed at analyzing the impact of the tumor cell biology on the development, prognosis and treatment response in HNCs.

HPV positivity, for example, has been shown to be a good prognostic factor in oropharyngeal carcinoma and, potentially, a positive predictive marker of response to the induction chemotherapy. In contrast, tobacco and alcohol-related head and neck tumours, show a biological aggressive behavior, are not chemo- and radiosensitive, and are often characterized by HPV negativity and mutation in several genes, such as TP53. Nasopharyngeal carcinomas, especially those with undifferentiated histology, are strictly related to Epstein Barr Virus (EBV) infection. Considering the important role of this infection in the pathophysiology of nasopharyngeal carcinomas, the presence of the infection may lead to employ specific treatment strategies, such as immunotherapy, to take advantage of the high immunogenicity of EBV antigens.

Recently, a small group of SCCHN, mainly arising from oral cavity in young patients and typically characterized by poor prognosis and limited response to conservative therapies, has been associated with alterations in the NOTCH-1 pathway.

To date, HNCs prognosis is considered strongly related to histology, primary site, stage (classified according to TNM) and biological features. Importantly, in the last decade, many progress in both diagnostic workup and treatment strategies have been achieved.

Possible future strategies for a more effective therapeutic management of HNCs may be based on in-depth studies aimed at understanding tumor biology and developing tailored targeted treatments.

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Authors and Affiliations

  1. Department of Medical Oncology, POC SS Annunziata, Taranto, Italy

    Francesco Perri M.D. & Giuseppina Della Vittoria Scarpati

  2. Department of Radiation Therapy, University of Naples “Federico II”, Naples, Italy

    Giuseppina Della Vittoria Scarpati

  3. Lester and Sue Smith Breast Center, Baylor College of Medicine, University of Houston, College of Pharmacy, Houston, TX, USA

    Mario Giuliano

Authors
  1. Francesco Perri M.D.
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  2. Giuseppina Della Vittoria Scarpati
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  3. Mario Giuliano
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Correspondence to Francesco Perri M.D. .

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Editors and Affiliations

  1. Medical Oncology, University of Algarve, Faro, Portugal

    Ramon Andrade de Mello

  2. edificio 7, ala nascente, 3º andar, University of Algarve, Dept Cie Biomed edificio 7, ala nascente, 3º andar, Faro, Portugal

    Álvaro Tavares

  3. Medical Oncology, University of Athens, Athens, Greece

    Giannis Mountzios

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Perri, F., Scarpati, G.D.V., Giuliano, M. (2015). Carcinomas of the Head and Neck. In: de Mello, R., Tavares, Á., Mountzios, G. (eds) International Manual of Oncology Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-21683-6_26

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