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Head and neck cancer


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]


Classification

Classification

  • Head and neck cancers comprise of a group of malignancies arising from the oral cavity, pharynx and larynx, paranasal sinuses, nasal cavity or salivary glands with squamous cell carcinoma representing the most common histology.

‘Head and neck squamous cell carcinomas (HNSCC’s) make up the vast majority of head and neck cancers, and arise from mucosal surfaces throughout this anatomic region. These include tumors of the nasal cavities, paranasal sinuses, oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx.

Oral cavity

Main article: Oral cancer

Squamous cell cancers are common in the oral cavity, including the inner lip, tongue, floor of mouth, gingivae, and hard palate. Cancers of the oral cavity are strongly associated with tobacco use, especially use of chewing tobacco or “dip”, as well as heavy alcohol use. Cancers of this region, particularly the tongue, are more frequently treated with surgery than are other head and neck cancers.

Surgeries for oral cancers include

  • Maxillectomy (can be done with or without Orbital exenteration
  • Mandibulectomy (removal of the mandible or lower jaw or part of it)
  • Glossectomy (tongue removal, can be total, hemi or partial)
  • Radical neck dissection
  • Moh’s procedure
  • Combinational e.g. glossectomy and laryngectomy done together.

The defect is covered/improved by using another part of the body and/or skin grafts and/or wearing a prosthesis.

Nasopharynx

Nasopharyngeal cancer arises in the nasopharynx, the region in which the nasal cavities and the Eustachian tubes connect with the upper part of the throat. While some nasopharyngeal cancers are biologically similar to the common HNSCC, “poorly differentiated” nasopharyngeal carcinoma is distinct in its epidemiology, biology, clinical behavior, and treatment, and is treated as a separate disease by many experts.

Surgeries for nasal cancer (cancer of the nose)

  • Surgery to removal the entire nose or part of the nose. Removal of all of the nose is called a total rhinectomy, for part of the nose it is called a partial rhinectomy. Afterwards to cover the defect, a new nose can be made by using another part of the body and/or a nose prosthesis is made.

Oropharynx

Oropharyngeal cancer begins in the oropharynx, the middle part of the throat that includes the soft palate, the base of the tongue, and the tonsils. Squamous cell cancers of the tonsils are more strongly associated with human papillomavirus infection than are cancers of other regions of the head and neck.

Hypopharynx

The hypopharynx includes the pyriform sinuses, the posterior pharyngeal wall, and the postcricoid area. Tumors of the hypopharynx frequently have an advanced stage at diagnosis, and have the most adverse prognoses of pharyngeal tumors. They tend to metastasize early due to the extensive lymphatic network around the larynx.

Larynx

Laryngeal cancer begins in the larynx or “voice box.” Cancer may occur on the vocal cords themselves (“glottic” cancer), or on tissues above and below the true cords (“supraglottic” and “subglottic” cancers respectively). Laryngeal cancer is strongly associated with tobacco smoking.

Surgeries can include partial laryngectomy (removal of part of the larynx) and total laryngectomy (removal of the whole larnyx). If the whole larynx has been removed the person is left with a permanent tracheostomy opening and learns to speak again in a new way with the help of intensive teaching and speech therapy and/or an electronic device.

Also anyone who has had a glossectomy (tongue removal) will be taught to speak again in a new way and have intensive speech therapy

Trachea

Cancer of the trachea is a rare malignancy which can be biologically similar in many ways to head and neck cancer, and is sometimes classified as such.

Most tumors of the salivary glands differ from the common carcinomas of the head and neck in etiology, histopathology, clinical presentation, and therapy, Other uncommon tumors arising in the head and neck include teratomas, adenocarcinomas, adenoid cystic carcinomas, and mucoepidermoid carcinomas. Rarer still are melanomas and lymphomas of the upper aerodigestive tract.

[1][2][3][4]

History and Symptoms

History and Symptoms

Throat Cancer usually begins with symptoms that seem harmless enough, like an enlarged lymph node on the outside of the neck, a sore throat or a hoarse sounding voice. However, in the case of throat cancer, these conditions may persist and become chronic. There may be a lump or a sore in the throat or neck that does not heal or go away. There may be difficult or painful swallowing. Speaking may become difficult. There may be a persistent earache. Other possible but less common symptoms include some numbness or paralysis of the face muscles.

Presenting symptoms include:

Other symptoms may include the following:

These symptoms may be caused by cancer or by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms.

Differentiating head and neck cancer from other diseases

Differentiating head and neck cancer from other diseases

Head and neck cancer must be differentiated from congenital abnormalities, and malignant lesions.

Category Diseases Benign/

Malignant

Clinical manifestation Paraclinical findings Gold standard diagnosis Associated findings
Demography History Symptoms Signs Lab findings Histopathology Imaging
Pain Dysphagia Mass exam Others
Neoplasm Salivary gland neoplasm Pleomorphic adenoma[5][6] − + − −
  • MRI: Homogenous on T1
  • Abundant myxochondroid stroma on T2
 −
Warthin’s tumor[7][8]
  • Male to female ratio: 4:1
  • More common in people aged 60-70 years old
 − + − − −
Oncocytoma

[9]

  • Race: Caucasian patients predilection
  • Gender: No gender preference
  • Age: 50–70 years
 ± ±
  • CT:
    • Isodense expansive mass
    • Enhancement after intravenous contrast
    • Hypodense areas
  • MRI:
    • Isodensties on T1
    • Mass is hyperintense on T2
    • Enhancement on contrast
 –
Monomorphic adenoma [10][11][12]
  • Age: 26-76 years
  • Rare in children
  • Gender: No predilection
 ± ±
  • Normal
 –
Mucoepidermoid carcinoma

[13]

  • Age: Mean age of 59
  • Female predilection
 ± ± −
  • Cystic and solid component with variable appearance on CT and MRI
  • Association with CMV
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Salivary gland neoplasm Adenoid cystic carcinoma [14]
  • Age: 40s-60s
  • Gender: Female predominance
 ± ± − −
Adenocarcinoma

[15]

  • Age: young age predilection
 − − −
Salivary duct cancer[16][17][18]

(Highly aggressive)

  • Incidence: 1-3%
  • Gender: Male predilection
  • Mean age: 55-61 years old
  • Rapidly growing mass with jaw involvement
 ± ±
  • Painless
  • Hard
  • Non-compressible mass
 −
Squamous cell carcinoma[19][20]
  • Incidence: rare
  • Age: Old age , 61-68 years
  • Male predilection
  • Present as painful growing mass on jaw
 + −
  • Tumor dimension can be delineated using both CT and MRI
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Hypopharyngeal cancer[21][22][23]
  • More common in males
  • Age: 55-65 years old
  • Incidence: < 1/100,000 in U.S.
  • More common in Japan, India, Iran
 − + − −
Parathyroid cancer[24][25][26]
  • Incidence: Rare
  • Mean age : 44-54 years old
  • Gender: Female predilection
 + +
Carotid body tumors[27][28][29][30]
  • Age: 26-55 years
  • Male predominance
 + − −
Paraganglioma[31][32][33]
  • Age 50-70 years
  • More in females
 − − − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Schwannoma[34][35][36]
  • Rare tumor
  • Incidence: 1-10%
 + ±
  • Multiple
  • Slow growing nodules on the skin
  • May be normal
  • Encapsulated neural tissue growth
Lymphoma [37][38][39][40][41][42]
  • Age: Predilection for older age
  • Mean age: 55
 − ±
  • On complete node analysis four patterns are described:
    • Nodular/follicular
    • Diffuse pattern
    • Transition from a nodular to a diffuse pattern in adjacent nodes
    • Transition from a lower to a higher grade of involvement within a single node
Liposarcoma [43][44][45][46]
  • Rare tumor
  • Age: Relatively in older age
  • Gender: No gender predilection
  • Mobile mass
  • Few symptoms until they grow enough to compress the surrounding structures
  • Symptoms of neural deficit, pain, tingling, or skin changes
 ± −
  • Intact skin and normal color
  • Normal
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Lipoma [47][48][49]
  • One or multiple soft, painless skin nodules
  • May causes pain or compressive symptoms
 ± −
  • Normal
  • Normal
  • Diagnoses is usually clinical
  • Tissue biopsy may show:
    • Bundle of well-demarcated lipocytes
    • Single nuclei aligned to the side
    • Intra-cytoplasimic fat granules
Glomus vagale, glomus jugulare tumors[50][51][52][53][54][55]
  • Rare tumor
  • Painless slowly enlarging mass in the neck
 − ±
  • Normal
 −
Metastatic head and neck cancer[56][57] − ±
  • Vary depending on the underlying cancer
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Other Laryngeal cancer[58][59] Benign/Malignant
  • Older males
  • Younger patients with HPV infection or smoking history
 ± ±

human papillomavirus (HPV) infection

−
Arteriovenous fistula

[60][61]

  • Depends on the risk factors
 − −
  • Varies depending on the etiology
 −
Thyroid nodule/ Goiter

[62][63][64][65]

  • Female predominance
  • Young age (benign causes)
  • Old age (malignant etiology)
 ± ±
  • Painless
  • Non-tender
  • Asymmetrical neck mass in front of neck
  • With smooth overlying skin
  • Nodular surface
  • Depending on the type:
  • Normal to low TSH levels in case of malignancy
  • High TSH levels in case of goiter
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Primary Prevention

Primary Prevention

  • Avoidance of recognised risk factors (as described above)is the single most effective form of prevention. Regular dental examinations may identify pre-cancerous lesions in the oral cavity.
  • It will be interesting to see what effect the widespread use of HPV vaccines has on the incidence of HPV-related H&N cancers.
  • People who have been treated for head and neck cancer have an increased chance of developing a new cancer, usually in the head and neck, esophagus, or lungs. The chance of a second primary cancer varies depending on the original diagnosis, but is higher for people who smoke and drink alcohol. Patients who do not smoke should never start. Those who smoke should do their best to quit. Studies have shown that continuing to smoke or drink (or both) increases the chance of a second primary cancer for up to 20 years after the original diagnosis.
  • Some research has shown that isotretinoin (13-cis-retinoic acid), a substance related to vitamin A, may reduce the risk of the tumor recurring (coming back) in patients who have been successfully treated for cancers of the oral cavity, oropharynx, and larynx. However, treatment with isotretinoin has not yet been shown to improve survival or to prevent future cancers.
References

References

  1. ↑ Howren MB, Christensen AJ, Karnell LH, Funk GF (2013). “Psychological factors associated with head and neck cancer treatment and survivorship: evidence and opportunities for behavioral medicine”. J Consult Clin Psychol. 81 (2): 299–317. doi:10.1037/a0029940. PMC 3587038. PMID 22963591.
  2. ↑ Giraldi L, Leoncini E, Pastorino R, Wünsch-Filho V, de Carvalho M, Lopez R; et al. (2017). “Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: a pooled analysis within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium”. Ann Oncol. 28 (11): 2843–2851. doi:10.1093/annonc/mdx486. PMC 5834132. PMID 28945835.
  3. ↑ Ojo B, Genden EM, Teng MS, Milbury K, Misiukiewicz KJ, Badr H (2012). “A systematic review of head and neck cancer quality of life assessment instruments”. Oral Oncol. 48 (10): 923–937. doi:10.1016/j.oraloncology.2012.03.025. PMC 3406264. PMID 22525604.
  4. ↑ Wen Y, Grandis JR (2015). “Emerging drugs for head and neck cancer”. Expert Opin Emerg Drugs. 20 (2): 313–29. doi:10.1517/14728214.2015.1031653. PMC 5678969. PMID 25826749.
  5. ↑ Debnath SC, Adhyapok AK (June 2010). “Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip”. J Maxillofac Oral Surg. 9 (2): 205–8. doi:10.1007/s12663-010-0052-5. PMC 3244097. PMID 22190789.
  6. ↑ Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M (August 2018). “Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features”. Jpn J Radiol. 36 (8): 463–471. doi:10.1007/s11604-018-0747-y. PMID 29845358.
  7. ↑ Chulam TC, Noronha Francisco AL, Goncalves Filho J, Pinto Alves CA, Kowalski LP (December 2013). “Warthin’s tumour of the parotid gland: our experience”. Acta Otorhinolaryngol Ital. 33 (6): 393–7. PMID 24376295.
  8. ↑ “Warthin tumor | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program”.
  9. ↑ Chen B, Hentzelman JI, Walker RJ, Lai JP (2016). “Oncocytoma of the Submandibular Gland: Diagnosis and Treatment Based on Clinicopathology”. Case Rep Otolaryngol. 2016: 8719030. doi:10.1155/2016/8719030. PMC 5045990. PMID 27722003.
  10. ↑ Kim KH, Sung MW, Kim JW, Koo JW (July 2000). “Pleomorphic adenoma of the trachea”. Otolaryngol Head Neck Surg. 123 (1 Pt 1): 147–8. doi:10.1067/mhn.2000.102809. PMID 10889498.
  11. ↑ Pramod Krishna B (June 2013). “Pleomorphic Adenoma of Minor Salivary Gland in a 14 year Old Child”. J Maxillofac Oral Surg. 12 (2): 228–31. doi:10.1007/s12663-010-0125-5. PMC 3681990. PMID 24431845.
  12. ↑ Kessler AT, Bhatt AA (2018). “Review of the Major and Minor Salivary Glands, Part 2: Neoplasms and Tumor-like Lesions”. J Clin Imaging Sci. 8: 48. doi:10.4103/jcis.JCIS_46_18. PMC 6251244. PMID 30546932.
  13. ↑ Chenevert J, Barnes LE, Chiosea SI (February 2011). “Mucoepidermoid carcinoma: a five-decade journey”. Virchows Arch. 458 (2): 133–40. doi:10.1007/s00428-011-1040-y. PMID 21243374.
  14. ↑ Jones AV, Craig GT, Speight PM, Franklin CD (April 2008). “The range and demographics of salivary gland tumours diagnosed in a UK population”. Oral Oncol. 44 (4): 407–17. doi:10.1016/j.oraloncology.2007.05.010. PMID 17825603.
  15. ↑ Beltran D, Faquin WC, Gallagher G, August M (March 2006). “Selective immunohistochemical comparison of polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma”. J. Oral Maxillofac. Surg. 64 (3): 415–23. doi:10.1016/j.joms.2005.11.027. PMID 16487803.
  16. ↑ Mlika M, Kourda N, Zidi Y, Aloui R, Zneidi N, Rammeh S, Zermani R, Jilani SB (January 2012). “Salivary duct carcinoma of the parotid gland”. J Oral Maxillofac Pathol. 16 (1): 134–6. doi:10.4103/0973-029X.92992. PMC 3303509. PMID 22434951.
  17. ↑ Schmitt NC, Kang H, Sharma A (November 2017). “Salivary duct carcinoma: An aggressive salivary gland malignancy with opportunities for targeted therapy”. Oral Oncol. 74: 40–48. doi:10.1016/j.oraloncology.2017.09.008. PMC 5685667. PMID 29103750.
  18. ↑ Simpson RH (July 2013). “Salivary duct carcinoma: new developments–morphological variants including pure in situ high grade lesions; proposed molecular classification”. Head Neck Pathol. 7 Suppl 1: S48–58. doi:10.1007/s12105-013-0456-x. PMC 3712088. PMID 23821208.
  19. ↑ Manvikar V, Ramulu S, Ravishanker ST, Chakravarthy C (May 2014). “Squamous cell carcinoma of submandibular salivary gland: A rare case report”. J Oral Maxillofac Pathol. 18 (2): 299–302. doi:10.4103/0973-029X.140909. PMC 4196305. PMID 25328317.
  20. ↑ Ying YL, Johnson JT, Myers EN (July 2006). “Squamous cell carcinoma of the parotid gland”. Head Neck. 28 (7): 626–32. doi:10.1002/hed.20360. PMID 16475198.
  21. ↑ Helliwell TR (February 2003). “acp Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx”. J. Clin. Pathol. 56 (2): 81–5. PMC 1769882. PMID 12560383.
  22. ↑ International Journal of Recent Scientific Research. doi:10.24327/IJRSR. ISSN 0976-3031. Missing or empty |title= (help)
  23. ↑ Maasland, Denise HE; van den Brandt, Piet A; Kremer, Bernd; Goldbohm, R Alexandra; Schouten, Leo J (2014). “Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck cancer: results from the Netherlands Cohort Study”. BMC Cancer. 14 (1). doi:10.1186/1471-2407-14-187. ISSN 1471-2407.
  24. ↑ Wei CH, Harari A (March 2012). “Parathyroid carcinoma: update and guidelines for management”. Curr Treat Options Oncol. 13 (1): 11–23. doi:10.1007/s11864-011-0171-3. PMID 22327883.
  25. ↑ Sahasranam P, Tran MT, Mohamed H, Friedman TC (August 2007). “Multiglandular parathyroid carcinoma: a case report and brief review”. South. Med. J. 100 (8): 841–4. doi:10.1097/SMJ.0b013e318073ca37. PMID 17713315.
  26. ↑ Holmes EC, Morton DL, Ketcham AS (April 1969). “Parathyroid carcinoma: a collective review”. Ann. Surg. 169 (4): 631–40. PMC 1387475. PMID 4886854.
  27. ↑ Sajid MS, Hamilton G, Baker DM (August 2007). “A multicenter review of carotid body tumour management”. Eur J Vasc Endovasc Surg. 34 (2): 127–30. doi:10.1016/j.ejvs.2007.01.015. PMID 17400487.
  28. ↑ Boedeker CC, Ridder GJ, Schipper J (2005). “Paragangliomas of the head and neck: diagnosis and treatment”. Fam. Cancer. 4 (1): 55–9. doi:10.1007/s10689-004-2154-z. PMID 15883711.
  29. ↑ Pellitteri PK, Rinaldo A, Myssiorek D, Gary Jackson C, Bradley PJ, Devaney KO, Shaha AR, Netterville JL, Manni JJ, Ferlito A (July 2004). “Paragangliomas of the head and neck”. Oral Oncol. 40 (6): 563–75. doi:10.1016/j.oraloncology.2003.09.004. PMID 15063383.
  30. ↑ Darouassi Y, Alaoui M, Mliha Touati M, Al Maghraoui O, En-Nouali A, Bouaity B, Ammar H (August 2017). “Carotid Body Tumors: A Case Series and Review of the Literature”. Ann Vasc Surg. 43: 265–271. doi:10.1016/j.avsg.2017.03.167. PMID 28478173.
  31. ↑ Neumann HP, Pawlu C, Peczkowska M, Bausch B, McWhinney SR, Muresan M, Buchta M, Franke G, Klisch J, Bley TA, Hoegerle S, Boedeker CC, Opocher G, Schipper J, Januszewicz A, Eng C (August 2004). “Distinct clinical features of paraganglioma syndromes associated with SDHB and SDHD gene mutations”. JAMA. 292 (8): 943–51. doi:10.1001/jama.292.8.943. PMID 15328326.
  32. ↑ Erickson D, Kudva YC, Ebersold MJ, Thompson GB, Grant CS, van Heerden JA, Young WF (November 2001). “Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients”. J. Clin. Endocrinol. Metab. 86 (11): 5210–6. doi:10.1210/jcem.86.11.8034. PMID 11701678.
  33. ↑ O’Riordain DS, Young WF, Grant CS, Carney JA, van Heerden JA (September 1996). “Clinical spectrum and outcome of functional extraadrenal paraganglioma”. World J Surg. 20 (7): 916–21, discussion 922. PMID 8678971.
  34. ↑ Hilton DA, Hanemann CO (April 2014). “Schwannomas and their pathogenesis”. Brain Pathol. 24 (3): 205–20. doi:10.1111/bpa.12125. PMID 24450866.
  35. ↑ Albert P, Patel J, Badawy K, Weissinger W, Brenner M, Bourhill I, Parnell J (2017). “Peripheral Nerve Schwannoma: A Review of Varying Clinical Presentations and Imaging Findings”. J Foot Ankle Surg. 56 (3): 632–637. doi:10.1053/j.jfas.2016.12.003. PMID 28237565.
  36. ↑ Wong B, Bathala S, Grant D (January 2017). “Laryngeal schwannoma: a systematic review”. Eur Arch Otorhinolaryngol. 274 (1): 25–34. doi:10.1007/s00405-016-4013-6. PMID 27020268. Vancouver style error: initials (help)
  37. ↑ Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). “Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute”. Cancer. 50 (12): 2699–707. PMID 7139563.
  38. ↑ Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). “Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute”. Cancer. 50 (12): 2699–707. PMID 7139563.
  39. ↑ Negri E, Little D, Boiocchi M, La Vecchia C, Franceschi S (August 2004). “B-cell non-Hodgkin’s lymphoma and hepatitis C virus infection: a systematic review”. Int. J. Cancer. 111 (1): 1–8. doi:10.1002/ijc.20205. PMID 15185336.
  40. ↑ Moormeier JA, Williams SF, Golomb HM (February 1990). “The staging of non-Hodgkin’s lymphomas”. Semin. Oncol. 17 (1): 43–50. PMID 2406917.
  41. ↑ Negri E, Little D, Boiocchi M, La Vecchia C, Franceschi S (August 2004). “B-cell non-Hodgkin’s lymphoma and hepatitis C virus infection: a systematic review”. Int. J. Cancer. 111 (1): 1–8. doi:10.1002/ijc.20205. PMID 15185336.
  42. ↑ Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). “Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute”. Cancer. 50 (12): 2699–707. PMID 7139563.
  43. ↑ Evans HL (January 2007). “Atypical lipomatous tumor, its variants, and its combined forms: a study of 61 cases, with a minimum follow-up of 10 years”. Am. J. Surg. Pathol. 31 (1): 1–14. doi:10.1097/01.pas.0000213406.95440.7a. PMID 17197914.
  44. ↑ Conyers R, Young S, Thomas DM (2011). “Liposarcoma: molecular genetics and therapeutics”. Sarcoma. 2011: 483154. doi:10.1155/2011/483154. PMC 3021868. PMID 21253554.
  45. ↑ Alaggio R, Coffin CM, Weiss SW, Bridge JA, Issakov J, Oliveira AM, Folpe AL (May 2009). “Liposarcomas in young patients: a study of 82 cases occurring in patients younger than 22 years of age”. Am. J. Surg. Pathol. 33 (5): 645–58. doi:10.1097/PAS.0b013e3181963c9c. PMID 19194281.
  46. ↑ Serpell JW, Chen RY (July 2007). “Review of large deep lipomatous tumours”. ANZ J Surg. 77 (7): 524–9. doi:10.1111/j.1445-2197.2007.04042.x. PMID 17610686.
  47. ↑ de Bree E, Karatzanis A, Hunt JL, Strojan P, Rinaldo A, Takes RP, Ferlito A, de Bree R (May 2015). “Lipomatous tumours of the head and neck: a spectrum of biological behaviour”. Eur Arch Otorhinolaryngol. 272 (5): 1061–77. doi:10.1007/s00405-014-3065-8. PMID 24800932.
  48. ↑ Rydholm A, Berg NO (December 1983). “Size, site and clinical incidence of lipoma. Factors in the differential diagnosis of lipoma and sarcoma”. Acta Orthop Scand. 54 (6): 929–34. PMID 6670522.
  49. ↑ Myhre-Jensen O (June 1981). “A consecutive 7-year series of 1331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas”. Acta Orthop Scand. 52 (3): 287–93. PMID 7282321.
  50. ↑ Urquhart AC, Johnson JT, Myers EN, Schechter GL (April 1994). “Glomus vagale: paraganglioma of the vagus nerve”. Laryngoscope. 104 (4): 440–5. doi:10.1288/00005537-199404000-00008. PMID 8164483.
  51. ↑ Valavanis A, Schubiger O, Oguz M (1983). “High-resolution CT investigation of nonchromaffin paragangliomas of the temporal bone”. AJNR Am J Neuroradiol. 4 (3): 516–9. PMID 6308990.
  52. ↑ Urquhart AC, Johnson JT, Myers EN, Schechter GL (April 1994). “Glomus vagale: paraganglioma of the vagus nerve”. Laryngoscope. 104 (4): 440–5. doi:10.1288/00005537-199404000-00008. PMID 8164483.
  53. ↑ Stein PP, Black HR (January 1991). “A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution’s experience”. Medicine (Baltimore). 70 (1): 46–66. PMID 1988766.
  54. ↑ Sajid MS, Hamilton G, Baker DM (August 2007). “A multicenter review of carotid body tumour management”. Eur J Vasc Endovasc Surg. 34 (2): 127–30. doi:10.1016/j.ejvs.2007.01.015. PMID 17400487.
  55. ↑ Boedeker CC, Ridder GJ, Schipper J (2005). “Paragangliomas of the head and neck: diagnosis and treatment”. Fam. Cancer. 4 (1): 55–9. doi:10.1007/s10689-004-2154-z. PMID 15883711.
  56. ↑ Gluckman JL, Robbins KT, Fried MP (1990). “Cervical metastatic squamous carcinoma of unknown or occult primary source”. Head Neck. 12 (5): 440–3. PMID 2211107.
  57. ↑ Waltonen JD, Ozer E, Hall NC, Schuller DE, Agrawal A (October 2009). “Metastatic carcinoma of the neck of unknown primary origin: evolution and efficacy of the modern workup”. Arch. Otolaryngol. Head Neck Surg. 135 (10): 1024–9. doi:10.1001/archoto.2009.145. PMID 19841343.
  58. ↑ Feldman PS, Kaplan MJ, Johns ME, Cantrell RW (November 1983). “Fine-needle aspiration in squamous cell carcinoma of the head and neck”. Arch Otolaryngol. 109 (11): 735–42. PMID 6639441.
  59. ↑ Grénman R, Koivunen P, Minn H (2015). “[Laryngeal cancer in Finland]”. Duodecim (in Finnish). 131 (4): 331–7. PMID 26237923.
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