Introduction: Epidemiology, Risk Factors, Pathology, and Natural History of Head and Neck Neoplasms

Part of the Medical Radiology book series (MEDRAD)


This introductory chapter sets the scene for the book by defining the complex domain in which the head and neck radiologist is expected to make his diagnosis. The epidemiology of epithelial and non-epithelial head and neck tumors is discussed representing up-to-date frequency measures. The known risk factors are subsequently reported. After that the clinical and pathological specifics of the most frequent tumors are presented, along with the expected natural history, so that the head and neck radiologist is aware of the different stages of the disease and the radiological “snapshots” that can result from imaging at different points in the evolution of the disease. Both macroscopic and microscopic aspects are illustrated by to-the-point clinical and light-microscopical pictures.


Thyroid Cancer Human Papilloma Virus Fine Needle Aspiration Cytology Pleomorphic Adenoma Salivary Gland Tumor 



The author expresses his sincere gratitude to Raf Sciot, MD PhD, for providing the illustrative microscopic images corresponding to the clinical examples displayed in this chapter.


  1. Acheson ED, Cowdell RH, Hadfield E et al (1968) Nasal cancer in woodworkers in the furniture industry. Br Med J 2:587–596PubMedCrossRefGoogle Scholar
  2. Ang KK, Harris J, Wheeler R et al (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363:24–35PubMedCrossRefGoogle Scholar
  3. Armstrong JG, Harrison LB, Spiro RH et al (1990) Malignant tumors of major salivary gland origin: a matched-pair analysis of the role of combined surgery and postoperative radiotherapy. Arch Otolaryngol Head Neck Surg 116:290–293PubMedCrossRefGoogle Scholar
  4. Barnes L, Eveson JW, Reichart P et al (2005) Pathology and genetics of head and neck tumours. World health classification of tumours. ed IARC, 210. IARC press, LyonGoogle Scholar
  5. Batsakis JG (2003) Clinical Pathology of Oral Cancer. In: Shah JP, Johnson NW, Batsakis JG (eds) Oral Cancer, 1st edn. edn. Martin Dunitz, Taylor and Francis Group, London, pp 77–129Google Scholar
  6. Blot WJ, McLaughlin JK, Winn DM et al (1988) Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 48:3282–3287PubMedGoogle Scholar
  7. Boccia S, Hashibe M, Galli P et al (2009) Aldehyde dehydrogenase 2 and head and neck cancer: a meta-analysis implementing a Mendelian randomization approach. Cancer Epidemiol Biomarkers Prev 18:248–254PubMedCrossRefGoogle Scholar
  8. Brugere J, Guenel P, Leclerc A et al (1986) Differential effects of tobacco and alcohol in cancer of the larynx, pharynx, and mouth. Cancer 57:391–395PubMedCrossRefGoogle Scholar
  9. Colmenero C, Patron M, Sierra I (1991) Acinic cell carcinoma of the salivary glands: a review of 20 new cases. J Craniomaxillofac Surg 19:260–266PubMedCrossRefGoogle Scholar
  10. Conway DI, Hashibe M, Boffetta P et al (2009) Enhancing epidemiologic research on head and neck cancer: INHANCE—the international head and neck oncology consortium. Oral Oncol 45:743–746PubMedCrossRefGoogle Scholar
  11. Cooper DS, Doherty GM, Haugen BR et al (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109–142PubMedCrossRefGoogle Scholar
  12. Day GL, Blot WJ, Austin DF et al (1993) Racial differences in risk of oral and pharyngeal cancer: alcohol, tobacco, and other determinants. J Natl Cancer Inst 85:465–473PubMedCrossRefGoogle Scholar
  13. De Rienzo DP, Greenberg SD, Fraire AE (1991) Carcinoma of the larynx: changing incidence in women. Arch Otolaryngol Head Neck Surg 117:681–684CrossRefGoogle Scholar
  14. De Stefani E, Ronco A, Mendilaharsu M et al (1999) Diet and risk of cancer of the upper aerodigestive tract-II nutrients. Oral Oncol 35:22–26PubMedCrossRefGoogle Scholar
  15. Delange F (2000) Iodine deficiency. In: Braverman LE, Utiger RD (eds) Werner and Ingbar’s the thyroid, 8th edn. edn. Lippincott, Williams and Wilkins, Philadelphia, pp 295–296Google Scholar
  16. Drozdovitch V, Khrouch V, Maceika E et al (2010) Reconstruction of radiation doses in a case-control study of thyroid cancer following the chernobyl accident. Health Phys 99:1–16PubMedCrossRefGoogle Scholar
  17. Ellis GL, Auclair PL (1996a) The normal salivary glands. In: Ellis GL, Auclair PL (eds) Tumors of the salivary glands. Armed Forces Institute of Pathology, Washington DC, pp 1–23Google Scholar
  18. Ellis GL, Auclair PL (1996b) Salivary gland tumors: general considerations: site specific tumor differences. In: Ellis GL, Auclair PL (eds) Tumors of the salivary glands. Armed Forces Institute of Pathology, Washington DC, p 32Google Scholar
  19. Eneroth CM, Zetterberg A (1974) Malignancy in pleomorphic adenoma: a clinical and microspectrophotometric study. Acta Otolaryngol 77:426–432PubMedCrossRefGoogle Scholar
  20. Ferlay J, Shin HR, Bray F et al (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917PubMedCrossRefGoogle Scholar
  21. Franceschi S, Munoz N, Bosch XF et al (1996) Human papillomavirus and cancers of the upper aerodigestive tract: a review of epidemiological and experimental evidence. Cancer Epidemiol Biomarkers Prev 5:567–575PubMedGoogle Scholar
  22. Franceschi S, Favero A, Conti E et al (1999) Food groups, oils and butter, and cancer of the oral cavity and pharynx. Br J Cancer 80:614–620PubMedCrossRefGoogle Scholar
  23. Frates MC, Benson CB, Charboneau JW et al (2005) Management of thyroid nodules detected at us: society of radiologists in utrasound consensus conference statement. Radiology 237:794–800PubMedCrossRefGoogle Scholar
  24. Galeone C, Tavani A, Pelucchi C et al (2010) Coffee and tea intake and risk of head and neck cancer: pooled analysis in the international head and neck cancer epidemiology consortium. Cancer Epidemiol Biomarkers Prev 19:1723–1736PubMedCrossRefGoogle Scholar
  25. Gallo O (2001) Aetiology and molecular changes in salivary gland tumours. In: Mc Gurk M, Renehan AG (eds) Controversies in the management of salivary gland tumours, 1st edn. edn. Oxford University Press, Oxford, pp 13–23Google Scholar
  26. Gallo O, Bocciolini C (1997) Warthin’s tumour associated with autoimmune diseases and tobacco use. Acta Otolaryngol 117:623–627PubMedCrossRefGoogle Scholar
  27. Gnepp DR (1993) Malignant mixed tumors of the salivary glands: a review. Pathol Annu 28:279–328PubMedGoogle Scholar
  28. Greenlee RT, Hill-Harmon MB, Murray T et al (2001) Cancer statistics. CA Cancer J Clin 51:15–36PubMedCrossRefGoogle Scholar
  29. Hashibe M, Brennan P, Strange RC et al (2003) Meta- and pooled analyses of GSTM1, GSTT1, GSTP1, and CYP1A1 genotypes and risk of head and neck cancer. Cancer Epidemiol Biomarkers Prev 12:1509–1517PubMedGoogle Scholar
  30. Hashibe M, Brennan P, Benhamou S et al (2007) Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the international head and neck cancer epidemiology consortium. J Natl Cancer Inst 99:777–789PubMedCrossRefGoogle Scholar
  31. Hay ID, Klee GG (1993) Thyroid cancer diagnosis and management. Clin Lab Med 13:725–734PubMedGoogle Scholar
  32. Healey WV, Perzin KH, Smith L (1970) Mucoepidermoid carcinoma of salivary gland origin. Classification, clinical-pathologic correlation, and results of treatment. cancer 26(2):368–388Google Scholar
  33. Heck JE, Berthiller J, Vaccarella S et al (2010) Sexual behaviours and the risk of head and neck cancers: a pooled analysis in the international head and neck cancer epidemiology (INHANCE) consortium. Int J Epidemiol 39:166–181PubMedCrossRefGoogle Scholar
  34. Heller KS, Attie JN (1988) Treatment of Warthin’s tumor by enucleation. Am J Surg 156:294–296PubMedCrossRefGoogle Scholar
  35. Hoffman HT, Karnell LH, Funk GF et al (1998) The national cancer data base report on cancer of the head and neck. Arch Otolaryngol Head Neck Surg 124:951–962PubMedGoogle Scholar
  36. Hoffman HT, Karnell LH, Robinson RA et al (1999) National cancer data base report on cancer of the head and neck: acinic cell carcinoma. Head Neck 21:297–309PubMedCrossRefGoogle Scholar
  37. IARC (1997) Cancer incidence in five continents, vol VII. IARC Sci Publ (143): i–xxxiv, pp 1–1240Google Scholar
  38. IARC CancerBase N°4. EUCAN (1999) Cancer incidence, mortality and prevalence in the European Union 1997, version 4.0. IARC Press, LyonGoogle Scholar
  39. IARC (2008a). Non-melanoma skin cancer. World cancer report. Cancer site by site. Boyle P, Levin B (eds) international agency for research on cancer, Lyon, pp 398–403Google Scholar
  40. IARC (2008b). Head and neck cancers. World cancer report. Cancer site by site. Boyle P, Levin B (eds) international agency for research on cancer, Lyon, pp 331–337Google Scholar
  41. Jeannel D, Bouvier G, Hubert A (1999) Nasopharyngeal cancer. In: Newton R, Beral V, Weiss RA (eds) Infections and human cancer. Cold Spring Harbor Press, Plainview, New York, pp 125–156Google Scholar
  42. Kane WJ, McCaffrey TV, Olsen KD et al (1991) Primary parotid malignancies: a clinical and pathologic review. Arch Otolaryngol Head Neck Surg 117:307–315PubMedCrossRefGoogle Scholar
  43. Kopp P, Kimura ET, Aeschimann S et al (1994) Polyclonal and monoclonal thyroidnodules coexist within human multinodular goiters. J Clin Endocrinol Metab 79:134–139PubMedCrossRefGoogle Scholar
  44. La Vecchia C, Tavani A, Franceschi S et al (1997) Epidemiology and prevention of oral cancer. Oral Oncol 33:302–312PubMedCrossRefGoogle Scholar
  45. Lefebvre J, Lartigau E, Kara A et al (2001) Oral cavity, pharynx and larynx cancer. environment-related prognostic factors. In: Gospodarowicz MK, Henson DE, Hutter RVP, O’Sullivan BO, Sobin LH, Ch Wittekind (eds) UICC prognostic factors in cancer. Wiley-Liss, New York, pp 151–165Google Scholar
  46. Lydiatt WM, Lydiatt DD (2001) The larynx: early stage disease. In: Shah JP (ed) Cancer of the head and neck. BC Decker, Hamilton, London, pp 169–184Google Scholar
  47. Marron M, Boffetta P, Zhang ZF et al (2010) Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk. Int J Epidemiol 39:182–196PubMedCrossRefGoogle Scholar
  48. Medina JE, Dichtel W, Luna MA (1984) Verrucous-squamous carcinomas of the oral cavity: a clinicopathologic study of 104 cases. Arch Otolaryngol 110:437–440PubMedCrossRefGoogle Scholar
  49. Mehanna H, Paleri V, West CM et al (2010) Head and neck cancer—part 1: epidemiology, presentation, and prevention. BMJ 341:664–666Google Scholar
  50. Moley JF (1995) Medullary thyroid cancer. Surg Clin North Am 75:405–420PubMedGoogle Scholar
  51. Morris LG, Myssiorek D (2010) Improved detection does not fully explain the rising incidence of well-differentiated thyroid cancer: a population-based analysis. Am J Surg 200:454–461PubMedCrossRefGoogle Scholar
  52. Morse DE, Katz RV, Pendrys DG et al (1996) Smoking and drinking in relation to oral epithelial dysplasia. Cancer Epidemiol Biomarkers Prev 5:769–777PubMedGoogle Scholar
  53. Pedersen E, Hogetveit AC, Andersen A (1973) Cancer of respiratory organs among workers at a nickel refinery in Norway. Int J Cancer 12:32–41PubMedCrossRefGoogle Scholar
  54. Robertson G, Greenlaw N, Bray CA et al (2010) Explaining the effects of socio-economic deprivation on survival in a national prospective cohort study of 1909 patients with head and neck cancers. Cancer Epidemiol 34:682–688PubMedCrossRefGoogle Scholar
  55. Russell WO, Ibanez ML, Clark RL (1963) Thyroid carcinoma: classification, intraglandular dissemination, and clinicopathologic study based upon whole organ sections of 80 glands. Cancer 16:1425–1460PubMedCrossRefGoogle Scholar
  56. Saku T, Hayashi Y, Takahara O et al (1997) Salivary gland tumors among atomic bomb survivors, 1950–1987. Cancer 79:1465–1475PubMedCrossRefGoogle Scholar
  57. Seifert G, Sobin LH (1992) The world health organization’s histological classification of salivary gland tumors. [A commentary on the 2nd edn.]. Cancer 70:379–385PubMedCrossRefGoogle Scholar
  58. Shaha AR, Loree TR, Shah JP (1995) Prognostic factors and risk group analysis in follicular carcinoma of the thyroid. Surgery 118:1131–1136PubMedCrossRefGoogle Scholar
  59. Silverman S Jr, Gorsky M, Kaugars GE (1996) Leukoplakia, dysplasia, and malignant transformation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82:117PubMedCrossRefGoogle Scholar
  60. Sipos JA, Mazzaferri EL (2010) Thyroid cancer epidemiology and prognostic variables. Clin Oncol (R Coll Radiol) 22:395–404CrossRefGoogle Scholar
  61. Spiro RH (1986) Salivary neoplasms: overview of a 35-year experience with 2, 807 patients. Head Neck 8:177–184CrossRefGoogle Scholar
  62. Spiro RH, Huvos AG (1992) Stage means more than grade in adenoid cystic carcinoma. Am J Surg 164:623–628PubMedCrossRefGoogle Scholar
  63. Spiro JD, Spiro RH (2001) Salivary Tumors. In: Shah JP, Patel SG (eds) Cancer of the Head and Neck. Decker BC, Hamilton, pp 240–250Google Scholar
  64. Spiro RH, Huvos AG, Strong EW (1978) Acinic cell carcinoma of salivary origin: a clinicopathologic study of 67 cases. Cancer 41:924–935PubMedCrossRefGoogle Scholar
  65. Tezelman S, Clark OH (1995) Current management of thyroid cancer. Adv Surg 28:191–221PubMedGoogle Scholar
  66. UNSCEAR (2000) The united nations scientific committee on the effects of atomic radiation. Health Phys 79:314Google Scholar
  67. Vander Poorten VLM, Balm AJM, Hilgers FJM et al (1999a) Prognostic factors for long term results of the treatment of patients with malignant submandibular gland tumors. Cancer 85:2255–2264CrossRefGoogle Scholar
  68. Vander Poorten VLM, Balm AJM, Hilgers FJM et al (1999b) The development of a prognostic score for patients with parotid carcinoma. Cancer 85:2057–2067Google Scholar
  69. Vander Poorten VLM, Balm AJM, Hilgers FJM et al (2000) Stage as major long term outcome predictor in minor salivary gland carcinoma. Cancer 89:1195–1204PubMedCrossRefGoogle Scholar
  70. Vander Poorten VL, Hart AA, van der Laan BF et al (2003) Prognostic index for patients with parotid carcinoma: external validation using the nationwide 1985–1994 dutch head and neck oncology cooperative group database. Cancer 97:1453–1463PubMedCrossRefGoogle Scholar
  71. World Health Organization Collaborating Centre for Oral Precancerous Lesions (1978) Definitions of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol 46:518–539CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2011

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospitals Leuven, Catholic University LeuvenLeuvenBelgium

Personalised recommendations