SCCHN

SCCHN stands for squamous cell carcinoma of the head and neck, a group of malignant tumors arising from the squamous epithelium lining the mucosal surfaces of the upper aerodigestive tract. Most tumors occur in the oral cavity, oropharynx, hypopharynx, or larynx; nasopharyngeal tumors and other subsites are less common but included in the category. The disease is biologically heterogeneous, with distinct etiologies and prognostic implications, notably the better prognosis of HPV-associated oropharyngeal cancers.

Key risk factors include tobacco use and alcohol consumption, which have a multiplicative effect on risk. Human papillomavirus (HPV), especially HPV-16, is strongly associated with oropharyngeal cancers and marks a distinct clinical subset with better response to treatment. Other factors such as betel quid in some regions, poor oral hygiene, nutritional status, and immunosuppression can contribute to risk.

Clinical presentation varies by subsite but commonly includes a persistent mouth or throat lesion, a mass or ulcer, voice changes, difficulty swallowing, otalgia, or enlarged cervical lymph nodes. Diagnosis requires histologic confirmation by biopsy, with endoscopic evaluation to assess the primary tumor. Staging uses the AJCC TNM system; the 8th edition incorporates HPV/p16 status for oropharyngeal cancers, influencing prognosis and treatment planning.

Treatment is typically multimodal and depends on stage and subsite. Early-stage disease may be cured with surgery or radiotherapy alone; locoregionally advanced disease commonly requires concurrent chemoradiation, with surgery reserved for select cases. In selected sites, organ-preserving strategies are used. Recurrent or metastatic disease may benefit from targeted therapy or immunotherapy.

Prognosis varies by stage, site, and HPV status; overall, HPV-positive oropharyngeal cancers have a more favorable outlook than HPV-negative cases. Prevention focuses on tobacco and alcohol cessation, HPV vaccination, and addressing risk factors and oral health.