Chapter 5

The Diagnostic Tools for Head and Neck Cancer

Giacomo Spinato*, Paolo Boscolo Rizzo, Marco Salvatore, Simonetta Ausoni, Samuele Frasconi, Giuseppe Azzarello, Carlo Cavaliere, Liberatore Tramontano and Maria Cristina Da Mosto

Abstract

Diagnosis plays a key role in overall patient assessment and accurate staging of the malignancy. Diagnosis is the starting point to choose treatment strategies for the disease, as well as the basis upon which therapy success, prognosis and the patient’s quality of life will vary. Considering a high level of clinical suspicion of any mucosal alteration or laterocervical swelling is important until medical examinations provide evidence of the contrary. Diagnosis investigation continues with the search, among data collected on the patient's history, of objective signs on which clinical suspicions will focus through further medical and instrumental examinations. Imaging techniques that can be used are ultrasound scan, computerised tomography, magnetic resonance and, in the most complex cases, positron emission computerised tomography. Ultrasonography is the most commonly used imaging technique for head and neck mass, especially for the assessment of lymph nodes, thyroid glands and salivary glands. Magnetic resonance is also considered an important examination in the diagnosis of head and neck tumours, especially for lesions involving the oral cavity, oropharynx, nasopharynx and larynx. Computerised tomography (CT) scan is especially useful when assessing the skull base involvement and the morphology of laryngeal malignancies, for example when the tumour extends over the perichondrium of cartilage structures, as well as when assessing function, i.e. evaluating the degree of chordal motility. In head and neck cancers (HNC), predictive factors namely biological characteristics that can be used to predict tumor response to a specific treatment, are currently remarkably lacking. Conversely, some bio-molecular parameters are recognized as prognostic factors of the disease, since they indicate tumor characteristics that inform about cancer outcome, independently of treatment the patients will undergo. The most prominent prognostic factor for head and neck cancers is viral etiology, specifically HPV-mediated disease for oropharyngeal carcinomas and EBV-mediated disease for nasopharyngeal carcinoma.

Total Pages: 155-184 (30)

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