Head and Neck Tumor in Patients and its High Occurrence (A Case Study of Federal Medical Centre)
Head and Neck Tumor in Patients and its High Occurrence – Out of 2,300 histological cases that was reported to histopathology unit of Federal Medical Centre, 63 cases were head and neck tumor from the year 2002-2009 which noted that the record keeping were poorly done. The research revealed that there were 14 cases of head and neck tumor in 2008 which showed that the incidence was high and more than 75% of these head and neck tumors were at an advanced stage when discovered. Men are 80% more likely than women to be diagnosed with and are almost twice more likely to die of, these tumors. Abakaliki populace are disproportionately affected by head and neck tumor with middle ages of incidence, increased mortality and more advanced disease at presentation. Smoking and tobacco use are directly related to oro-pharangeal tumor. Head and neck tumor increases with age, especially after 50 years. During the diagnosis of these studies, hematoxylin and eosin stain was used so as to differentiate the morphological features of head and neck tumor.
1. To study from the existing samples and data, the incidence and prevalent pattern of head and neck tumor.
2. To study the microscopical features of individual cell that may occur, differentiate them accurately and search for new features and occurring morphological features in head and neck tumor.
3. To ascertain the best staining technique for the investigation.
4. To discover causative agents and their involvement, period and predisposing factors to head and neck tumors in Ebonyi state university teaching hospital.
This research was carried out in histopathology laboratory of Federal Medical Centre, Abakaliki. The samples used were gotten from previously used tissue blocks, stored by histopathology unit of the hospital for research purposes.
The term HEAD and NECK tumor refers to a group of biologically similar tumors originating from the upper aerodigestive tract, including the lip, oral cavity (mouth), nasal cavity, paranasal sinuses, pharynx and larynx. 90%of head and neck tumors are squamous cell carcinoma by (Jemal et al 2002) originating from the mucosal lining (Epithelium) of the regions. Head and neck tumor often spread to the lymph nodes of the neck and is strongly associated with certain environmental and lifestyle risk factors, including Tobacco smoking, alcohol consumption, ultra violent light and occupational exposures and also certain strains of viruses such as sexually transmitted diseases; Human papillomavirus. These tumors are frequently aggressive in their biologic behavior, patient with this type of cancer often develop a second primary tumor.
Head and neck squamous cell carcinoma make up the vast majority of head and neck cancers and arises from mucosal surfaces through out this anastomic region. These includes tumors of nasal cavities, paranasal sinuses, oral cavity, nasopharynx, oropharynx, hypopharynx and larynx.
Oral Cavity; Squamous cells are common in the oral cavity including the inner lip, tongue, floor of mouth, gingival and hard palate. Cancers of the oral cavity are strongly associated with tobacco use especially of chewing tobacco of ‘’dip’’, as well as heavy alcohol use.
Nasopharynx; this arises in nasopharynx, the region in which nasal cavities and Eustachian tubes connects with the upper part of the throat. While some nasopharyngeal tumors are biologically similar to head and neck squamous cell carcinoma, ‘’poorly differentiated’’ nasopharyngeal carcinoma is distinct in its epidemiology, biology and clinical behavior.
Oropharynx; oropharyngeal squamous cell carcinoma begins in the oropharynx, the middle part of the throat that includes the soft palate, the base of the tongue and tonsils. Squamous cell tumors of the tonsils are more strongly associated with human papillomavirus infection than are tumors of other regions of head and neck.
Signs and Symptoms
Neck cancers usually begins with symptoms that seem harmless enough, like an enlarged lymph node on the outside of the neck, a sore throat or a hoarse sounding voice, however, in the case of neck tumor, these conditions may persist and become chronic. There may be difficult or painful swallowing. Speaking may become difficult. There may be a persistent ear ache. Other presenting symptoms include; mass in the neck, sinus congestion, lump in the lip or gums, change in diet or weight loss, difficulty swallowing food.
Causes: alcohol and tobacco are likely synergistic in causing tumor of head and neck l smokeless tobacco is an etiologic agent for oral and pharyngeal cancers. Other environmental carcinogens include occupational exposures such as nickel refining, exposure to textile fibers wood working.
Dietary Factors: Excessive consumption of processed meat and red meat were associated with increased rates of tumor/cancer of head and neck while consumption of raw and cooked vegetable seemed to be protective but betel nut chewing is associated with an increased risk of squamous cell carcinoma of head and neck.
Human Papilloma Virus: is causal factor of squamous cell carcinoma which contains genomic DNA with the highest distribution in the tonsils.
Adenoid Cystic Carcinoma: Is an uncommon form of malignant neoplasm that arises within secretory glands also the major and minor salivary glands of head and neck tumors.
Differential Diagnosis: is largely that of benign and malignant neoplasms that arise in the above locations. In salivary gland, it include benign mixed tumor, mucoepidermoid carcinoma and polymorphous low grade adenocarcinoma by Ellis,G et al(1996) . The histologic differential diagnosis in the minor salivary glands is between adenoid cystic carcinoma and polymorphous low grade adenocarcinoma which share many features.
Signs and Symptoms: Early lesions of the salivary glands presents as painless masses of the mouth or face, usually growing slowly by (Fordice, J et al, 1996). Advanced tumor may present with pain / nerve paralysis,because tih neoplasm has a propensity to invade peripheral nerve.
Diagnosis: This is by resection specimen of a tumor mass. There are three major variant histologic growth patterns of adenoid cystic carcinoma; cribriform, tubular and solid. The solid pattern is associated with a more aggressive disease curse (Spiers et al, 1996).
Head and Neck Lymphoma: This is classified into hodgkin’s lymphoma and non Hodgkin’s lymphoma. These are tumors found in a type of white blood cell called lymphocytes. The symptoms of both are similar, but the conditions are still classified differently, depending on the type of abnormal cells found in cancerous material.
Symptoms: Hodgkin lymphoma is more likely to begin in the lymph nodes in the upper body, such as the neck,. However, both Hodgkin lymphoma and non Hodgkin lymphoma can be found any where in the body and symptoms of both include weight less, fevers and night sweats by medicineNet.com.
Papillary Carcinoma of the Thyroid
This is associated with adenomatous polyposis by (Lee S, 2004). This may be present with a variety other than benign thyroid lesions. There also appear to be increasing relation of alterations in cases of follicular variant of papillary carcinoma. (Hemminiki et al, 2005) in his study reported risk for papillary carcinoma when a parent and a sibling were diagnosed with thyroid cancer. Whether this is a true correlation, an association of familial nature in papillary thyroid carcinoma, or just a coincidence due to very high incidence of microscopic thyroid cancer, remains to be determined.
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This article was extracted from a Project Research Work/Material Topic “PREVALENCE OF HEAD AND NECK TUMOR IN PATIENTS ATTENDING FEDERAL MEDICAL CENTRE ABAKALIKI”