Head and Neck Tumors

  • Franklin C. L. Wong
  • Xiaoyi Duan
  • E. Edmund Kim


Head and neck cancer is the sixth most common cancer worldwide and makes up 2–5 % of cancers in the population. In 2009, the estimated number of new diagnosed head and neck cancers was 35,720 in the US, which includes 10,530 tongue cancers, 10,750 mouth cancers, 12,610 pharynx cancers, and 1,830 other oral cavity cancers. (Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA: a cancer journal for clinicians. American Cancer Society. Published online May 2009.) Head and neck cancers are more common in men and account for 66–95 % of all cases. Most patients with head and neck cancer are between the ages of 50 and 70 years and the number increases with age, especially after 50 years of age. (Ridge JA, Glisson BS, Lango MN, et al. Head and neck tumors. Cancer management: a multidisciplinary approach. 11 ed. 2008.) Head and neck cancers are strongly associated with certain environmental and lifestyle risk factors, including tobacco smoking, alcohol consumption, occupational exposure, and certain strains of viruses, such as the sexually transmitted human papillomavirus (Maier et al. Clin Investig 70:320–7, 1992; Cauvin et al. Clin Otolaryngol Allied Sci 15:439–45, 1990; Gillespie et al. JSC Med Assoc 104:247–51, 2008).


Positron Emission Tomography Thyroid Cancer Neck Cancer Standard Uptake Value Thyroid Nodule 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA: a cancer journal for clinicians. American Cancer Society. Published online May 2009.Google Scholar
  2. 2.
    Ridge JA, Glisson BS, Lango MN, et al. Head and neck tumors. Cancer management: a multidisciplinary approach. 11 ed. 2008.Google Scholar
  3. 3.
    Maier H, Dietz A, Gewelke U, et al. Tobacco and alcohol and the risk of head and neck cancer. Clin Investig. 1992;70:320–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Cauvin JM, Guénel P, Luce D, et al. Occupational exposure and head and neck carcinoma. Clin Otolaryngol Allied Sci. 1990;15:439–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Gillespie MB, Smith J, Gibbs K, et al. Human papillomavirus and head and neck cancer: a growing concern. JSC Med Assoc. 2008;104:247–51.CrossRefGoogle Scholar
  6. 6.
    Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295:2164–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Hu MI, Vassilopoulou-Sellin R, Lustig R, et al. Head and neck tumors. Cancer management: a multidisciplinary approach. 11 ed. 2008.Google Scholar
  8. 8.
    Castelifns JA, Kaiser MC, Vakl J, et al. Magnetic resonance imaging of the laryngeal cancer. J Comput Assist Tomogr. 1987;11:134–40.CrossRefGoogle Scholar
  9. 9.
    Glazer HS, Nimyer JH, Balfe DM. Neck neoplasms: MR imaging. Part II. Posttreatment evaluation. Radiology. 1986;160:349–54.PubMedGoogle Scholar
  10. 10.
    Vogl TJ, Steger W, Balzer J, et al. MRI of the neck, larynx and hypopharynx. In: Hasso AN, Stark DD, editors. Spine and body MRI. Boston: ARKS; 1991. p. 99–110.Google Scholar
  11. 11.
    Mafee MF, Barany M, Gotsis ED, et al. Potential use of in vivo proton spectroscopy for head and neck lesions. Radiol Clin North Am. 1989;27:243–54.PubMedGoogle Scholar
  12. 12.
    King AD, Yeung DKW, Ahuja AT, et al. In vivo proton MR spectroscopy of primary and nodal nasopharyngeal carcinoma. AJNR Am J Neuroradiol. 2004;25:484–90.PubMedGoogle Scholar
  13. 13.
    Prayer L, Winkelbauer H, Gritzmann N, Winkelbauer F, Helmer M, Pehamberger H. Sonography versus palpation in the detection of regional lymph-node metastases in patients with malignant melanoma. Eur J Cancer. 1990;26:827–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Hwang HS, Perez DA, Orloff LA. Comparison of positron emission tomography/computed tomography imaging and ultrasound in staging and surveillance of head and neck and thyroid cancer. Laryngoscope. 2009;119:1958–65.PubMedCrossRefGoogle Scholar
  15. 15.
    Ogilvie JB, Piatigorsky EJ, Clark OH. Current status for fine needle aspiration for thyroid nodules. Adv Surg. 2006;40:223–38.PubMedCrossRefGoogle Scholar
  16. 16.
    Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1993;118:282–9.PubMedGoogle Scholar
  17. 17.
    van den Brekel MW, Castelijns JA, Stel HV, et al. Occult metastatic neck disease: detection with US and US-guided fine-needle aspiration cytology. Radiology. 1991;180:457–61.PubMedGoogle Scholar
  18. 18.
    Leitha T, Glaser C, Pruckmayer M, et al. Technetium-99 m-MIBI in primary and recurrent head and neck tumors: contribution of bone SPECT image fusion. J Nucl Med. 1998;39:1166–71.PubMedGoogle Scholar
  19. 19.
    Valdés Olmos RA, Balm AJ, Hilgers FJ, et al. Thallium-201 SPECT in the diagnosis of head and neck cancer. J Nucl Med. 1997;38:873–9.PubMedGoogle Scholar
  20. 20.
    Even-Sapir E, Lerman H, Lievshitz G, et al. Lymphoscintigraphy for sentinel node mapping using a hybrid SPECT/CT system. J Nucl Med. 2003;44:1413–20.PubMedGoogle Scholar
  21. 21.
    Wong K, Zarzhevsky N, Cahill JM, Frey KA, Avram AM. The value of diagnostic 131-I SPECT-CT fusion imaging in the evaluation of differentiated thyroid carcinoma. AJR Am J Roentgenol. 2008;191:1785–94.PubMedCrossRefGoogle Scholar
  22. 22.
    Leskinen-Kallio S, Lindholm P, Lapela M, Joensuu H, Nordman E. Imaging of head and neck tumors with positron emission tomography and [11C]methionine. Int J Radiat Oncol Biol Phys. 1994;30:1195–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Shields AF, Grierson JR, Dohmen BM, et al. Imaging proliferation in vivo with [F-18]FLT and positron emission tomography. Nat Med. 1998;4:1334–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Koh WJ, Rasey JS, Evans ML, et al. Imaging of hypoxia in human tumors with [F-18]fluoromisonidazole. Int J Radiat Oncol Biol Phys. 1992;22:199–212.PubMedCrossRefGoogle Scholar
  25. 25.
    Adams S, Baum R, Stuckensen T, et al. Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med. 1998;25:1255–60.PubMedCrossRefGoogle Scholar
  26. 26.
    Stokkel MP, ten Broek FW, Hordijk GJ, et al. Preoperative evaluation of patients with primary head and neck cancer using dual head 18 fluorodeoxyglucose positron emission tomography. Ann Surg. 2000;231:229–34.PubMedCrossRefGoogle Scholar
  27. 27.
    Wong RJ, Lin DT, Schoder H, et al. Diagnostic and prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma. J Clin Oncol. 2002;20:4199–208.PubMedCrossRefGoogle Scholar
  28. 28.
    Lowe VJ, Boyd JH, Dunphy FR, et al. Surveillance for recurrent head and neck cancer using positron emission tomography. J Clin Oncol. 2000;18:651–8.PubMedGoogle Scholar
  29. 29.
    Schöder H, Yeung HW, Gonen M, et al. Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology. 2004;231:65–72.PubMedCrossRefGoogle Scholar
  30. 30.
    Clarke JC. PET/CT “Cometh the hour, cometh the machine?”. Clin Radiol. 2004;59:775–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Barrington SF, Maisey MN. Skeletal muscle uptake of fluorine-18-FDG: effect of oral diazepam. J Nucl Med. 1996;37:1127–9.PubMedGoogle Scholar
  32. 32.
    Palmedo H, Bucerius J, Joe A, et al. Integrated PET/CT in differentiated thyroid cancer: diagnostic accuracy and impact on patient management. J Nucl Med. 2006;47:616–24.PubMedGoogle Scholar
  33. 33.
    Beheshti M, Pöcher S, Vali R, et al. The value of 18F-DOPA PET-CT in patients with medullary thyroid carcinoma: comparison with 18F-FDG PET-CT. Eur Radiol. 2009;19:1425–34.PubMedCrossRefGoogle Scholar
  34. 34.
    Linecker A, Kermer C, Sulzbacher I, et al. Uptake of (18)F-FLT and (18)F-FDG in primary head and neck cancer correlates with survival. Nuklearmedizin. 2008;47:80–5.PubMedGoogle Scholar
  35. 35.
    Rajendran JG, Schwartz DL, O’Sullivan J, et al. Tumor hypoxia imaging with [F-18] fluoromisonidazole positron emission tomography in head and neck cancer. Clin Cancer Res. 2006;12:5435–41.PubMedCrossRefGoogle Scholar
  36. 36.
    Balogova S, Périé S, Kerrou K, et al. Prospective comparison of FDG and FET PET/CT in patients with head and neck squamous cell carcinoma. Mol Imaging Biol. 2008;10:364–73.PubMedCrossRefGoogle Scholar
  37. 37.
    Capoccetti F, Criscuoli B, Rossi G, et al. The effectiveness of 124I PET/CT in patients with differentiated thyroid cancer. Q J Nucl Med Mol Imag. 2009;53:536–45.Google Scholar
  38. 38.
    Wong KK, Zarzhevsky N, Cahill JM, et al. Incremental value of diagnostic 131I SPECT/CT fusion imaging in the evaluation of differentiated thyroid carcinoma. AJR Am J Roentgenol. 2008;191:1785–94.PubMedCrossRefGoogle Scholar
  39. 39.
    Lonneux M, Hamoir M, Reychler H, et al. Positron emission tomography with [18F]fluorodeoxyglucose improves staging and patient management in patients with head and neck squamous cell carcinoma: a multicenter prospective study. J Clin Oncol 2010;28(7): 1190–95.Google Scholar
  40. 40.
    Schoder H, Yeung HW, Gonen M, et al. Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology. 2004;231:65–72.PubMedCrossRefGoogle Scholar
  41. 41.
    Ishikita T, Oriuchi N, Higuchi T, et al. Additional value of integrated PET/CT over PET alone in the initial staging and follow up of head and neck malignancy. Ann Nucl Med. 2010;24:77–82.PubMedCrossRefGoogle Scholar
  42. 42.
    Gordin A, Golz A, Keidar Z, et al. The role of FDG-PET/CT imaging in head and neck malignant conditions: impact on diagnostic accuracy and patient care. Otolaryngol Head Neck Surg. 2007;137:130–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Ryan WR, Fee JR WE, Le QT, et al. Positron-emission tomography for surveillance of head and neck cancer. Laryngoscope. 2005;115:645–50.PubMedCrossRefGoogle Scholar
  44. 44.
    Piao Y, Bold B, Tayier A, et al. Evaluation of 18F-FDG PET/CT for diagnosing cervical nodal metastases in patients with oral cavity or oropharynx carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:933–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Schoder H, Carlson DL, Kraus DH, et al. 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med. 2006;47:755–62.PubMedGoogle Scholar
  46. 46.
    Chen W, Parsons M, Torigian DA, et al. Evaluation of thyroid FDG uptake incidentally identified on FDG-PET/CT imaging. Nucl Med Commun. 2009;30:240–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Karantanis D, Bogsrud TV, Wiseman GA, et al. Clinical significance of diffusely increased 18F-FDG uptake in the thyroid gland. J Nucl Med. 2007;48:896–901.PubMedCrossRefGoogle Scholar
  48. 48.
    Jeong HS, Baek CH, Son YI, et al. Integrated 18F-FDG PET/CT for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast-enhanced CT. Clin Endocrinol (Oxford). 2006;65:402–7.CrossRefGoogle Scholar
  49. 49.
    Kim TY, Kim WB, Ryu JS, et al. 18F-fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope. 2005;115:1074–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Eloy JA, Brett EM, Fatterpekar GM, et al. The significance and management of incidental [18F]fluorodeoxyglucose-positron-emission tomography uptake in the thyroid gland in patients with cancer. AJNR Am J Neuroradiol. 2009;30:1431–4.PubMedCrossRefGoogle Scholar
  51. 51.
    Diehl M, Risse JH, Brandt-Mainz K, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in medullary thyroid cancer: results of a multicentre study. Eur J Nucl Med. 2001;28:1671–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Szakall Jr S, Esik O, Bajzik G, et al. 18F-FDG PET detection of lymph node metastases in medullary thyroid carcinoma. J Nucl Med. 2002;43:66–71.PubMedGoogle Scholar
  53. 53.
    Kao CH, ChangLai SP, Chieng PU, Yen RF, Yen TC. Detection of recurrent or persistent nasopharyngeal carcinomas after radiotherapy with 18-fluoro-2-deoxyglucose positron emission tomography and comparison with computed tomography. J Clin Oncol. 1998;16:3550–5.PubMedGoogle Scholar
  54. 54.
    Anzai Y, Carroll WR, Quint DJ, et al. Recurrence of head and neck cancer after surgery or irradiation: prospective comparison of 2-deoxy-2-[F-18]fluoro-D-glucose PET and MR imaging diagnoses. Radiology. 1996;200:135–41.PubMedGoogle Scholar
  55. 55.
    Li P, Zhuang H, Mozley PD, et al. Evaluation of recurrent squamous cell carcinoma of the head and neck with FDG positron emission tomography. Clin Nucl Med. 2001;26:131–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Fukui MB, Blodgett TM, Meltzer CC, et al. PET/CT imaging in recurrent head and neck cancer. Semin Ultrasound CT MR. 2003;24:157–63.PubMedCrossRefGoogle Scholar
  57. 57.
    Zimmer LA, Snyderman C, Fukui MB, et al. The use of combined PET/CT for localizing recurrent head and neck cancer: the Pittsburgh experience. Ear Nose Throat J. 2005;84:108–10.Google Scholar
  58. 58.
    Castellucci P, Zinzani P, Pourdehnad M, et al. 18F-FDG PET in malignant lymphoma: significance of positive findings. Eur J Nucl Med Mol Imag. 2005;32:749–56.CrossRefGoogle Scholar
  59. 59.
    Pacini F, Agate L, Elisei R, et al. Outcome of differentiated thyroid cancer with detectable serum Tg and negative diagnostic 131I whole body scan: comparison of patients treated with high 131I activities versus untreated patients. J Clin Endocrinol Metab. 2001;86:4092–7.PubMedCrossRefGoogle Scholar
  60. 60.
    Dong MJ, Liu ZF, Zhao K, et al. Value of 18F-FDG-PET/PET-CT in differentiated thyroid carcinoma with radioiodine-negative whole-body scan: a meta-analysis. Nucl Med Commun. 2009;30:639–50.PubMedCrossRefGoogle Scholar
  61. 61.
    Wang W, Larson SM, Fazzari M, et al. Prognostic value of [18F]fluorodeoxyglucose positron emission tomographic scanning in patients with thyroid cancer. J Clin Endocrinol Metab. 2000;85:1107–13.PubMedCrossRefGoogle Scholar
  62. 62.
    Jereczek-Fossa BA, Jassem J, Orecchia R. Cervical lymph node metastases of squamous cell carcinoma from an unknown primary. Cancer Treat Rev. 2004;30:153–64.PubMedCrossRefGoogle Scholar
  63. 63.
    Menda Y, Graham MM. Update on 18F-fluorodeoxyglucose/positron emission tomography and positron emission tomography/computed tomography imaging of squamous head and neck cancers. Semin Nucl Med. 2005;35:214–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Nanni C, Rubello D, Castellucci P, et al. Role of 18F-FDG PET-CT imaging for the detection of an unknown primary tumour: preliminary results in 21 patients. Eur J Nucl Med Mol Imag. 2005;32:589–92.CrossRefGoogle Scholar
  65. 65.
    Uchida Y, Minoshima S, Kawata T, et al. Diagnostic value of FDG PET and salivary gland scintigraphy for parotid tumors. Clin Nucl Med. 2005;30:170–6.PubMedCrossRefGoogle Scholar
  66. 66.
    Findlay M, Young H, Cunningham D, et al. Noninvasive monitoring of tumor metabolism using fluorodeoxyglucose and positron emission tomography in colorectal cancer liver metastases: correlation with tumor response to fluorouracil. J Clin Oncol. 1996;14:700–8.PubMedGoogle Scholar
  67. 67.
    Abe Y, Matsuzawa T, Fujiwara T, et al. Assessment of radiotherapeutic effects on experimental tumors using 18F-2-fluoro-2-deoxy-d-glucose. Eur J Nucl Med. 1986;12:325–8.PubMedCrossRefGoogle Scholar
  68. 68.
    Brun E, Kjellén E, Tennvall J, et al. FDG PET studies during treatment: prediction of therapy outcome in head and neck squamous cell carcinoma. Head Neck. 2002;24:127–35.PubMedCrossRefGoogle Scholar
  69. 69.
    Andrade RS, Heron DE, Degirmenci B, et al. Posttreatment assessment of response using FDG-PET/CT for patients treated with definitive radiation therapy for head and neck cancers. Int J Radiat Oncol Biol Phys. 2006;65:1315–22.PubMedCrossRefGoogle Scholar
  70. 70.
    Ong SC, Schöder H, Lee NY, et al. Clinical utility of 18F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for locoregional advanced head and neck cancer. J Nucl Med. 2008;49:532–40.PubMedCrossRefGoogle Scholar
  71. 71.
    Ciernik IF, Dizendorf E, Baumert BG, et al. Radiation treatment planning with an integrated positron emission and computer tomography (PET/CT): a feasibility study. Int J Radiat Oncol Biol Phys. 2003;57:853–63.PubMedCrossRefGoogle Scholar
  72. 72.
    Vernon MR, Maheshwari M, Schultz CJ, et al. Clinical outcomes of patients receiving integrated PET/CT-guided radiotherapy for head and neck carcinoma. Int J Radiat Oncol Biol Phys. 2008;70:678–84.PubMedCrossRefGoogle Scholar
  73. 73.
    Fu KK, Pajak TF, Trotti A, et al. A Radiation Therapy Oncology Group (RTOG) Phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: First report of RTOG 9003. Int J Radiat Oncol Biol Phys. 2000;48:7–16.PubMedCrossRefGoogle Scholar
  74. 74.
    Lee NY, Mechalakos JG, Nehmeh S, et al. Fluorine-18-labeled fluoromisonidazole positron emission and computed tomography-guided intensity-modulated radiotherapy for head and neck cancer: a feasibility study. Int J Radiat Oncol Biol Phys. 2008;70:2–13.PubMedCrossRefGoogle Scholar
  75. 75.
    Huang B, Law MW, Khong PL. Whole-body PET/CT scanning: estimation of radiation dose and cancer risk. Radiology. 2009;251:166–74.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Franklin C. L. Wong
    • 1
  • Xiaoyi Duan
    • 2
  • E. Edmund Kim
    • 3
    • 4
  1. 1.Departments of Nuclear Medicine and NeurooncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Nuclear Medicine, First Affiliated HospitalXìan Jiaotong University, College of MedicineShaanxiChina
  3. 3.Departments of Nuclear Medicine and Diagnostic RadiologyThe University of Texas MD Anderson Cancer Center and Medical SchoolHoustonUSA
  4. 4.Graduate School of Convergence Science and TechnologySeoul National UniversitySeoulSouth Korea

Personalised recommendations