FAQ : ENT cancer
What are ENT cancers?
ENT cancers, more commonly known as head and neck cancers, are cancers that develop in one of the organs of the upper aerodigestive tract (VADS, i.e. located in the digestive and upper respiratory systems). They therefore include cancers of the mouth (including lips and tongue), nasopharynx (cavum), hypopharynx, salivary glands, and larynx (more commonly referred to as throat cancer).
What are the biomarkers or genetic mutations involved in ENT cancers?
A biomarker, also called in some cases genetic mutations, is a measurable biological characteristic that is linked to a normal or non-normal process. In oncology, among biomarkers, certain abnormalities (often mutations) at the level of a gene can predict the action of a targeted drug. This information can be found in the molecular biology report (or NGS) or a consultation report. For ENT cancers, the most common biomarkers are the p16 protein, the epidermal growth factor receptor (EGFR), the HPV virus (human papilloma virus) and the TP53 gene.
Oral cavity
What is oral cancer?
Cancers of the oral cavity (or oral cancer) include cancers that develop in the lips, tongue, gums, palate or on the inside of the cheeks. Among these cancers, tongue cancer is the most common and the main histology for tongue cancers is squamous cell carcinoma.
What is the TNM score for tongue cancer?
The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.
Three parameters must be taken into account:
- The T describes the size and extent of the primary tumor
- The N indicates whether the cancer faces a regional lymph node extension
- The M indicates whether the cancer has spread to other parts of the body, called metastases.
TNM chart for tongue cancers
| T | Primary tumour |
|---|---|
| Tx | The primary tumor cannot be assessed |
| T0 | No detectable primary tumor |
| Tis | Carcinoma in situ |
| T1 | < 2 cm in its greatest dimension |
| T2 | Between 2 and 4 cm |
| T3 | > 4 cm in its greatest dimension |
| T4 | With extension to adjacent structures (bone, skin, muscle…) |
| N | Regional lymph node |
|---|---|
| Nx | Regional lymph nodes cannot be assessed |
| N0 | No lymph nodes |
| N1 | A single node < 3 cm |
| N2a | A single node between 3 and 6 cm |
| N2b | Multiple ipsilateral nodes < 6 cm |
| N2c | Multiple bilateral nodes < 6 cm |
| N3 | Node(s) > 6 cm in greatest dimension |
| M | Distant metastases |
|---|---|
| M0 | No distant metastases |
| M1 | Distant metastases present |
What are the main treatments for tongue cancer?
Various treatments can be put in place to treat tongue cancer. Surgery may be done to remove the tumor. Treatments by radiotherapyand Brachytherapyare also used.
Larynx
What is laryngeal cancer?
The larynx is part of the respiratory system. It connects the throat to the trachea. Laryngeal cancers start in squamous cells that line the inner part of the larynx. The most common histology is squamous cell carcinoma. Before becoming cancer, precancerous lesions in the larynx are called dysplasias.
What is the TNM score for laryngeal cancer?
The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.
Three parameters must be taken into account:
- The T describes the size and extent of the primary tumor
- The N indicates whether the cancer faces a regional lymph node extension
- The M indicates whether the cancer has spread to other parts of the body, called metastases.
TNM chart for laryngeal cancers
| T | Primary tumour |
|---|---|
| Tx | Tumor cannot be assessed |
| T0 | No evidence of a tumor |
| Tis | Cancer in situ |
| T1 | < 2 cm |
| T2 | Between 2 and 4 cm |
| T3 | > 4 cm |
| T4 | Invades adjacent structures |
| N | Regional lymph node |
|---|---|
| N0 | No lymph node |
| N1 | One lymph node < 3 cm |
| N2a | One lymph node between 3 and 6 cm |
| N2b | One or more lymph nodes on the same side < 6 cm |
| N2c | Several lymph nodes on both sides, none > 6 cm |
| N3a | Lymph node(s) on the same side of the neck < 6 cm |
| N3b | Bilateral lymph nodes |
| N3c | Contralateral lymph nodes > 6 cm |
| M | Distant metastases |
|---|---|
| M0 | No distant metastases |
| M1 | Presence of distant metastases |
What are the main treatments for laryngeal cancer?
If local treatment with surgery and/or radiation cannot be offered, chemotherapy is often used to treat laryngeal cancer.
In the first line, chemotherapy can be monotherapy (methotrexate, mitomycin, or cisplatin) or in combination of drugs. The TPF protocol (Taxoter, cisplatin, and 5-Fluorouracil) is often offered.
As a second line, other monotherapy drugs may be proposed such as docetaxel (Taxotere), gemcitabine (Gemzar) or vinorelbine (Navelbine).
Salivary glands
What is cancer of the salivary glands?
The salivary glands are the organs responsible for producing saliva. Tumors often form behind the mandible (at the back of the mouth) or in the palate. Common histologies include Adenoid cystic carcinomas.
What is the TNM score for salivary gland cancer?
The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.
Three parameters must be taken into account:
- The T describes the size and extent of the primary tumor
- The N indicates whether the cancer faces a regional lymph node extension
- The M indicates whether the cancer has spread to other parts of the body, called metastases.
TNM chart for salivary gland cancers
| T | Primary tumour |
|---|---|
| Tx | Primary tumor not assessable |
| T0 | No detectable primary tumor |
| Tis | Carcinoma in situ (non-invasive) |
| T1 | Tumor ≤ 2 cm, without extraparenchymal extension |
| T2 | Tumor > 2 cm and ≤ 4 cm, without extraparenchymal extension |
| T3 | Tumor ≥ 4 cm and/or with extraparenchymal extension |
| T4a | Moderately advanced tumor: tumor invading the skin, the mandible, the ear canal and/or the facial nerve |
| T4b | Very advanced tumor: tumor invading the base of the skull, the pterygoid processes and/or encasing the carotid artery |
| N | Regional lymph node |
|---|---|
| Nx | Regional lymph node drainage areas not assessable |
| N0 | No lymph node metastasis |
| N1 | Single metastatic lymph node, ipsilateral, ≤ 3 cm without capsular rupture |
| N2a | Single metastatic lymph node, ipsilateral, > 3 cm and ≤ 6 cm, without capsular rupture |
| N2b | Multiple metastatic lymph nodes, ipsilateral, ≤ 6 cm, without capsular rupture |
| N2c | Bilateral or contralateral metastatic lymph nodes, ≤ 6 cm, without capsular rupture |
| N3a | Metastatic lymph node(s) > 6 cm without capsular rupture |
| N3b | Single metastatic lymph node > 3 cm with capsular rupture, or multiple with capsular rupture |
| M | Distant metastases |
|---|---|
| M0 | No distant metastases |
| M1 | Presence of distant metastases |
What are the main treatments for cancer of the salivary glands?
The most common treatment for salivary gland cancer is surgery, during which the entire affected gland is removed. In general, this surgery is complemented by a treatment of adjuvant radiation therapy.
Hypopharynx
What is hypopharyngeal cancer?
The tumors that cause this type of cancer are formed from cells in the hypopharynx. The hypopharynx is the lower part of the pharynx. It is a digestive tract that connects the larynx (throat) to the esophagus. It is involved in various actions including breathing and swallowing. The most common histology for this type of cancer is squamous cell carcinoma.
What is the TNM score for hypopharyngeal cancers?
The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.
Three parameters must be taken into account:
- The T describes the size and extent of the primary tumor
- The N indicates whether the cancer faces a regional lymph node extension
- The M indicates whether the cancer has spread to other parts of the body, called metastases.
TNM chart for hypopharyngeal cancers
| T | Primary tumour |
|---|---|
| T1 | ≤ 2 cm in its greatest axis |
| T2 | > 2 cm but ≤ 4 cm in its greatest diameter |
| T3 | > 4 cm in its greatest diameter or extension to the lingual surface or the epiglottis |
| T4a | Invading one of the following structures: the larynx, the deep or extrinsic musculature of the tongue (genioglossus, hyoglossus, palatoglossus, styloglossus muscles), the medial pterygoid muscle, the mandible |
| T4b | Invading one of the following structures: the lateral pterygoid muscle, the pterygoid processes, the lateral wall of the nasopharynx, the base of the skull, the carotid artery |
| N | Regional lymph node |
|---|---|
| N0 | No lymph node involvement |
| N1 | A single ipsilateral lymph node ≤ 3 cm |
| N2a | A single ipsilateral lymph node > 3 cm and ≤ 6 cm |
| N2b | Multiple ipsilateral lymph nodes ≤ 6 cm |
| N2c | Bilateral or contralateral lymph nodes ≤ 6 cm |
| N3a | Metastasis in a lymph node > 6 cm in its greatest dimension, without extranodal extension |
| N3b | Single or multiple lymph node metastasis(es) with clinical sign of extranodal extension |
| M | Distant metastases |
|---|---|
| M0 | No distant metastases |
| M1 | Presence of distant metastases |
What are the main treatments for hypopharyngeal cancer?
Several treatments can be put in place for these cancers:
- One surgery: It can be either total (i.e. the larynx and part of the hypopharynx are removed) or circular (all of the larynx and hypopharynx are removed).
- One radiotherapy: It is the most common treatment.
- One chemotherapy : The protocols most often used involve a combination of cisplatin and 5-fluorouracil (5-FU).
Cavum
What is cancer of the cavum?
The cavum (nasopharynx) corresponds to the upper part of the pharynx. There are three types of caval cancers. The keratinizing squamous cell carcinoma, the non-keratinizing squamous cell carcinoma And theUCNT (Undifferentiated Nasopharyngeal Carcinoma Type).
What is the TNM score for caval cancers?
The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.
Three parameters must be taken into account:
- The T describes the size and extent of the primary tumor
- The N indicates whether the cancer faces a regional lymph node extension
- The M indicates whether the cancer has spread to other parts of the body, called metastases.
TNM chart for caval cancers
| T | Primary tumour |
|---|---|
| T1 | Localized to a single site of the nasopharynx |
| T2 | Extended to the soft tissues of the oropharynx and/or the nasal cavities |
| T2a | Without parapharyngeal extension |
| T2b | With parapharyngeal extension |
| T3 | Invading the bony structures or the maxillary sinus |
| T4 | With intracranial extension and/or involvement of the cranial nerves, the temporal fossa, the nasopharynx and/or the orbit. |
| N | Regional lymph node |
|---|---|
| Nx | Cannot be assessed |
| N0 | No regional metastatic lymph nodes |
| N1 | Unilateral metastatic lymph nodes < 6 cm above the supraclavicular fossa |
| N2 | Bilateral metastatic lymph nodes < 6 cm above the supraclavicular fossa |
| N3 | Metastatic lymph node(s) |
| N3a | > 6 cm |
| N3b | at the level of the supraclavicular fossa |
| M | Distant metastases |
|---|---|
| M0 | No distant metastases |
| M1 | Presence of distant metastases |
What are the main treatments for caval cancer?
The most used treatments for this type of cancer are intensity-modulated conformal radiation therapy (RCMI) and chemotherapy. In chemotherapy, the BEC protocol (Bleomycin, Epirubicin, Cisplatin) is often offered.