Head and Neck Cancer

Nasal Cavity

Cancers in the nasal cavity occur around the nasal sinuses, thus termed paranasal sinus cancers. The most common presenting symptoms of cancer of the sinuses are facial or dental pain, epistaxis, or frequent nose bleeds, and persistent unilateral nasal obstruction. These cancers have a multitude of causation including occupational exposure to toxic vapors such as formaldehyde. In addition, genomic evidence of the presence of infectious agents such as human papillomavirus 16 and 18 and Epstein-Barr virus in biopsies of paranasal sinus cancers points to virus causality. Finally, cigarette smoke and air pollution are linked to cancers of the nasal cavity.

As in HNCs, the most common cancer of the nasal sinuses is squamous cell carcinoma. They are relatively slow growing and well differentiated.

Esthesioneurblastoma is a rare cancer of the nasal cavity involving the olfactory epithelium. This cancer is believed to derive from uncontrolled proliferation of neural progenitors.

Oral Cavity

Squamous cell carcinoma, a cancer that grows exophytically and is ulcerative, is the most common form of cancer found in the oral cavity. These cancers tend to occur later in life. Major predisposing factors leading to squamous cell cancers in the oral cavity include leukoplakia, infection with human papillomavirus (types 16, 18, and 33), alcohol abuse, and mechanical irritation.

It is common place for smokers to switch from cigarettes to chewing tobacco in an attempt to prevent lung cancer. What many do not realize, however, is that they are increasing the probability of inducing cancer of the mouth. Patients who have chewed large amounts of tobacco over long periods can develop leukoplakia, a precancerous lesion that presents as white plaques in the oral mucosa. These plaques are overgrowths of squamous epithelia and are usually dysplastic. Leukoplakia plaques, which are often multifocal, can be found on the vermilion border of the lower lip, buccal mucosa, hard or soft palates, as well as at the bottom of the mouth. While most are a result of long-term tobacco use (including that derived from smoking), they can also be a result of chronic friction (such as from braces or dentures), excessive alcohol consumption, and some foods. About 3 to 6 percent of leukoplakia lesions convert to squamous cell carcinoma.

Gingival cancers typically occur in women on the lower alveolar ridge or gum line around the sixth decade of life. Due to tight adherence between the gum and the mandibular periosteum, these cancers can invade the mandible leading to bone damage.

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