1.What are the head and neck tumors? Incidence rate? Gender composition? Head and neck tumors include neck tumors, otorhinolaryngology tumors and oral and maxillofacial tumors. They involve nasal cavity, sinus, lip and oral cavity, oropharynx, laryngopharynx, larynx, thyroid, major salivary gland, nasopharynx. The incidence rate of head and neck malignant tumors is not high, accounting for about 5-7% of systemic malignant tumors. The incidence rate of head and neck malignant tumors in Shanghai in 2005 was 12.15/100,000 (standardized rate, excluding skin and lymphopoietic system diseases, the same below), while the incidence rate of systemic malignant tumors in the same period was 184.94/100,000, accounting for about 6.6%. The incidence of head and neck tumors varies in different parts of China due to different living environments and different pathogenic factors. For example, the incidence rate of nasopharyngeal cancer in 2005 was 3.8/100,000 and 1.8/100,000 for men and women respectively, ranking 9th in the incidence rate of systemic malignant tumors. In Shanghai, the incidence rate of thyroid cancer was 6.17/100,000, ranking 9th in the incidence rate of systemic malignant tumors, and 9.52/100,000 for women, ranking 6th. In terms of gender composition, except for thyroid cancer, which is more common in women than men, most of the other head and neck malignant tumors are more common in men than women. 2. What are the common causes of head and neck tumors? There is no conclusive evidence that a single factor causes the development of head and neck malignancies. Radiation exposure is the only important factor that is definitely associated with the development of differentiated thyroid cancer, including PTC. Most studies show that multiple factors increase the incidence of malignancy. These include chronic irritation (mechanical and chemical), radiation, viral infections, inflammation, and nutritional deficiencies. Some of the more noted ones are betel nut chewing and important factors for oral and laryngopharyngeal cancers; smoking and alcohol abuse are associated with oral, laryngopharyngeal and laryngeal cancers; viral infections such as human papillomavirus (HPV), especially high-risk subtype HPV16 infection and oral, oropharyngeal and laryngeal cancers; foreign body irritation (sharp crests, root remnants and poor restorations) and oral cancers; sunlight Sunlight and lip cancer; certain nutritional deficiencies and oral cancer and laryngopharyngeal cancer, such as cancer of the lower part of laryngopharynx and lack of vitamin C and iron; long-term inhalation of harmful substances and nasal paranasal sinus and larynx cancer, such as nasal paranasal sinus tumor may be related to wood dust, formaldehyde and other toxic and harmful gases. 3.How to prevent oral cancer? Besides lung cancer, tobacco is also a recognized carcinogenic factor of oral cavity and oropharynx cancer, and a possible carcinogenic factor of laryngopharyngeal cancer. The cancer-causing factor in tobacco is mainly the chemical benzopyrene, which may cause cancer in the whole upper digestive respiratory tract. Not only are smokers susceptible to oral cancer, but if they continue to smoke after the tumor has been cured, the chances of a second primary cancer are greatly increased. Alcohol itself has not been proven to be carcinogenic, but it can be used as a solvent for carcinogens, which can cause carcinogens to enter the oral and oropharyngeal mucosa and damage the liver, thus affecting the chemical detoxification and biotransformation of the liver; at the same time, a high degree of suppression of cellular immunity often occurs in heavy drinkers. Some data show that the incidence of oral cancer in those who have smoking and drinking habits is 15.5 times higher than that in those who do not smoke or drink. Therefore, quitting smoking and alcohol is an important measure to prevent head and neck cancer. 4.What are the head and neck lumps and how to identify them? How to detect head and neck tumors at an early stage? Early detection, early diagnosis and early treatment are the fundamental ways to cure malignant tumors and improve the quality of life. Early symptoms of head and neck tumors are often atypical, but neck masses are the most common. There are many kinds of head and neck masses, which can be divided into three major categories: first, inflammatory tissue, such as swollen lymph nodes in the neck caused by acute inflammation in the oral and maxillofacial areas and throat; specific infections such as cervical lymphatic tuberculosis, which require drug treatment. The second is congenital developmental abnormalities, such as thyroglossal cysts and parotid cleft cysts are caused by and can often be completely removed surgically. The third is tumor-like diseases, such as nodular goiter of the thyroid gland. (All three categories above are benign) Fourth, tumors, which can be classified as benign/malignant by nature and metastatic/primary tumors by origin. The distinction between benign and malignant masses is not based on the size of the mass or whether it will be painful or not. Some authors have used the age of the patient and the location of the mass to determine: in young children or adolescents, the first type of inflammatory disease and congenital developmental abnormalities are the most common, but they may also be benign tumors such as thyroid adenoma, or malignant tumors such as lymphoma. Both benign and malignant tumors are possible in middle-aged and elderly people, and one must be alert to the possibility of malignant tumors. This classification is only a guess as to the size of the chance of occurrence. If the head and neck lump is prolonged and still does not subside, whether it is painful or not, consult a head and neck surgeon as soon as possible. Usually the specialist will first understand the course of your medical history, lifestyle and previous diseases, then perform head and neck examination by palpation, ultrasound, blood sampling, endoscopy, X-ray, CT, magnetic resonance imaging (MRI), fine needle aspiration, etc. as needed to determine the nature of the disease and guide further treatment. Early detection of oral cancer The following conditions should be detected and treated in hospital as early as possible. Firstly, if the oral mucosa becomes white, brown or black, especially if the oral mucosa becomes rough, thick or hard, and white or red spots of oral mucosa appear, it is likely that cancer has occurred. Secondly, lumps in lips or mouth, early stage of oral cancer, only localized small lumps, often without special discomfort. Third, ulcers do not heal. The duration of oral ulcers usually does not exceed two weeks. If the symptoms such as burning sensation and pain do not improve after two weeks, it is necessary to be alert to the possibility of oral cancer. Oral cancer is often manifested in the form of ulcers with elevated surrounding edges and uneven center, covered with necrotic tissue and obvious pain. In the early stage, there is usually no pain or only a local abnormal rubbing sensation, and pain is obvious after ulceration. As the tumor further invades the nerve, it can trigger ear and throat pain. If the cancer invades the teeth, the patient often shows toothache. Fourthly, neck lump. This is also one of the common symptoms of oral cancer. Oral cancer mostly metastasizes to the nearby lymph nodes in the neck, and sometimes the primary lesion is small or even the symptoms are not obvious yet, but the metastatic cancer cells are found in the lymph nodes in the neck. Therefore, if the lymph nodes in the neck are suddenly enlarged, the oral cavity needs to be examined. Finally, there is dysfunction. The tumor may invade the muscles of opening and closing the mouth and the jaw joint, resulting in limited movement of opening and closing the mouth. Early symptoms of laryngeal cancer Hoarseness: Early stage is vocal fatigue or hoarseness without other discomfort, which is often mistaken for cold or laryngitis. Anyone over 40 years old, especially men and long-term smokers, with hoarseness for more than 3 weeks, which is not improved by vocal rest and general treatment, must go to hospital for laryngoscopy. Pharyngeal discomfort and foreign body sensation: this is the early symptom of supraglottic laryngeal cancer, but should be distinguished from the symptoms of chronic pharyngitis. Pharyngeal pain: When the tumor invades deeper, it is intermittent pain at first, then persistent pain, and causes simultaneous reflex ear pain and difficulty in swallowing due to pharyngeal pain. Cough and coughing blood: Early stage is mostly cough with no sputum or only a small amount of sputum and no coughing blood, with the development of lesion, blood in sputum or even coughing blood may appear. Swollen lymph nodes in the neck: Especially patients with supraglottic laryngeal cancer are prone to swollen lymph nodes in the neck in the early stage. 5.Misconceptions lead to ignoring the occurrence of head and neck tumor mainly because of ignoring some common triggering factors in life such as tobacco is also a recognized carcinogenic factor of oral cavity and oropharynx cancer, and a possible carcinogenic factor of laryngopharyngeal cancer. The cancer-causing factor in tobacco is mainly the chemical benzopyrene, which may cause cancer in the whole upper digestive respiratory tract. Not only are smokers susceptible to oral cancer, but if they continue to smoke after the tumor has been cured, the chances of a second primary cancer are greatly increased. Alcohol itself has not been proven to be carcinogenic, but it can be used as a solvent for carcinogens, which can cause carcinogens to enter the oral and oropharyngeal mucosa and damage the liver, thus affecting the chemical detoxification and biotransformation of the liver; at the same time, a high degree of suppression of cellular immunity often occurs in heavy drinkers. According to some data, the incidence of oral cancer is 15.5 times higher in those who have smoking and drinking habits than in those who do not smoke or drink. In addition to the bad habits of smoking and drinking for oral cancer, the lack of attention to oral hygiene creates conditions for the breeding and reproduction of bacteria or mycobacteria in the oral cavity, which can easily contribute to the formation and development of cancer; and the stimulation of long-term foreign bodies such as sharp crests, residual roots and bad prostheses (such as dentures), chewing irritating food and enjoying hot food on oral mucosa can induce cancer. 6.What are the treatment methods of head and neck? Due to the diversity of head and neck tumors and the special anatomy, treatment must take into account the preservation of function and appearance while curing the disease. Except for a few tumors (thyroid, nasopharyngeal carcinoma, etc.), single-approach treatment often cannot cure the disease. Different treatment plans must be given according to different anatomical sites, pathological types, tumor stages and even patient needs. Depending on the location and extent of primary tumor invasion and lymph nodes, lip and oral cancer can be treated by surgery alone, radiotherapy alone, or combination therapy. Early stage (stage I and II) lip, floor of mouth, and posterior triangle cancers have a high cure rate with surgery or radiotherapy. The choice of treatment modality should be individualized, taking into account functional and cosmetic restoration factors, and based on the expertise of the surgeon or radiation oncologist. Most patients with advanced (stages III and IV) tumors should be treated with a combination of surgery and radiation therapy. And because local recurrence and/or distant metastases are common in this group of patients, patients should be considered for entry into combined chemotherapy with surgery and/or radiation to improve local control while decreasing the rate of distant metastases. The unique nature of head and neck tumors requires different treatment modalities for different tumors. Please choose a hospital with a comprehensive treatment team for consultation and treatment to obtain the best individualized treatment. Fudan University Oncology is the first in China to use multidisciplinary treatment team model for diagnosis and treatment. 7. What are the special features of surgery? The incidence of head and neck malignant tumors is not high, but due to the complex anatomical sites, dense organs and many kinds of diseases, clinical treatment varies. And just from surgical operation, it involves various disciplines such as otolaryngology, oral and maxillofacial surgery, ophthalmology, general surgery, vascular surgery, orthopedics, cranial and neurosurgery. The treatment of tumors must balance the preservation of function and appearance while curing the disease, and this balance is especially important for head and neck tumors. Due to the unique anatomy of the head and neck, many patients with head and neck tumors cannot be cured by a single injury, or they can be cured by surgery but cause head and facial deformities or impairment of speech and eating functions. The treatment of head and neck tumors also involves multidisciplinary medical fields such as head and neck tumor surgery, medical oncology, radiotherapy, social work, nursing and rehabilitation. In recent years, the following features have emerged in the treatment of head and neck tumors: 1) Mostly functional preservation surgery is performed without compromising complete radical treatment; 2) For locally advanced tumors previously considered impossible to be resected, the use of radical resection combined with immediate repair of tissue defects not only completely removes the tumor and expands the indications for surgical treatment, but also improves the survival quality of patients; 3) In order to further improve the long-term efficacy of some tumors, more integrated treatment means of surgery, radiation, internal medicine and biological therapy are adopted. Tumors in certain areas require multidisciplinary and comprehensive treatment to effectively improve the therapeutic effect and make it possible to preserve function and appearance. (8) Myths, preparation and follow-up 1) Various treatments for head and neck tumors may cause corresponding functional and cosmetic damage, such as difficulty in eating, hoarseness, loss of speech function, facial paralysis, head and facial scars, pigmentation, and even deformity of head and eyes. Patients and their family members are often not fully aware of this. (2) The possibility of tumor recurrence and metastasis is not sufficiently estimated. The cure rate and survival rate can be improved through scientific and reasonable comprehensive treatment. However, the recurrence and metastasis of malignant tumor is determined by the biological behavior of tumor, and any malignant tumor has this possibility after treatment, so patients and family members must be fully aware of it. (3) The importance of follow-up. Patients often cannot obey medical advice to follow up on time after treatment (especially for tumors with better prognosis, such as papillary thyroid cancer). Postoperative follow-up of head and neck tumors is often done once every three months in the first year and once every six months from the next year. The purpose includes a early detection of tumor recurrence and metastasis and giving timely treatment. b for the management of complications after treatment, such as hypocalcemia after thyroid cancer surgery. c comprehensive treatment continues, such as endocrine treatment after thyroid cancer surgery. Due to the special nature of medical profession, many patients do not have professional knowledge in this area, and it is difficult to understand the introduction of the situation before treatment. It is necessary for medical and nursing staff to work in a patient and meticulous style and communicate in a more methodical way, to make accurate assessment and detailed explanation of various complications, accidents and follow-up treatment before treatment, and to fully communicate with patients and their families, which is conducive to creating a harmonious doctor-patient relationship and reducing Medical disputes. 9. Survival rate varies according to different primary organs and pathological types with or without high-risk factors, take thyroid cancer as an example. Papillary thyroid carcinoma: overall 10-year productivity 82-95%, 20-year 76-85%, high-risk cases only 60% in 10 years Follicular thyroid carcinoma: 10-year 65-79% Medullary carcinoma: 5-year 87%, 10-year 78% Undifferentiated carcinoma: 1-year survival rate 5%