PATTERN OF HEAD AND NECK MALIGNANT TUMOURS IN A TUZLA ENT CLINIC – A FIVE YEAR EXPERIENCE

Head and neck neoplasia can aff ect certain fundamental functions, including eating, drinking, speaking and respiration. One overriding factor in deciding on treatment policy is the tendency for head and neck malignancy to be limited to the primary site and regional lymph nodes with surgery and chemotherapy and radiotherapy. Th e aim of the study was to analyze the occurrence of Head and Neck tumours operated at ENT clinic Tuzla, University Clinical Center Tuzla, Bosnia and Herzegovina. Medical records of patients with histopathologically confi rmed head and neck malignancies over a  year period (-) were analyzed. Eight hundred and eight one () cases, made up of  (,) males and  (,) females were found. Th e most common sites for head and neck malignancies were found to be in the larynx (,), oral cavity (,), the thyroid gland (, ) and the neck (,). A total of  patients were diagnosed with laryngeal carcinoma (M:; F:), showing the increasing number of female patients. Th e histopathological tumour types found in this work were mostly squamous cell carcinoma (,), papillary carcinoma (,), while many other minor histopathological variants accounted for . Th e most patients were presented with stage I and stage III of disease ( and ,), and , with stage IV. About  of patients did not have data about smoking habit and alcohol drinking. Th e incidence of head and neck tumours seems to be relatively high, but without signifi cant increase during investigated period. More investigation concerning risk factors, diagnostic procedures, and management strategies should be done in future.


Introduction
Head and neck neoplasia can aff ect certain fundamental functions including eating, drinking, speaking and respiration ().Head and neck tumours (HNT) consist of a diverse group of tumours that ranges from cutaneous, lip, salivary glands, sinuses, oral cavity, pharynx and laryngs.Presently, HNT is six most prevalent neoplasms in the world, with approximately . cases diagnosed worldwide per year.Prognosis has improved little in the past  years ().Males are approximately three times more likely to develop squamos cancers of the head and neck (oral cavity, pharynx and larynx) than females.Very few prospective studies have examined the association between cigarette smoking and cancer of the head and neck in women, even though the rates of smoking in women are increasing rapidly worldwide ().In the U.S., public health eff orts at tobacco control and education have successfully reduced the prevalence of cigarette smoking, resulting in a lower incidence of head and neck cancer ().Cancer rate of the head and neck are traditionally linked to public health issues.Alcohol use appears to be an independent risk factor and acts synergistically with tobacco use in causing HNT ().Chronic consumption of alcoholic beverages is an accepted social custom worldwide.In the upper aero digestive tract, local morphologic, metabolic and functional alterations are present due to alcohol consumption.A clinical link between the chronic consumption of alcohol and head and neck cancer has been observed for decades ().Other risk factors include HPV, poor diet, certain occupations and occupational exposures, low education and socioeconomic status, immunodefi ciency, poor oral hygiene, GERD, benign conditions, family history of cancer and other ().

Materials and Methods
Medical records of patients with hystopathologically confi rmed head and neck malignancies over a  year period (-) were analyzed according to: sex, location of tumour, histopathological type and stage of tumour.

Results
A total of  cases were recorded consisting  (,) males and  (,) females.The mean age of the patients was , years (Figure).The most common sites for head and neck malignancies were found to be in the larynx (,), oral cavity (,), the thyroid gland (, ) , skin (,) and the neck (,) (Figure ).Total of  patients was diagnosed with laryngeal carcinoma M:; F:), (showing the increasing number of female patients (Figure ).A total of  patients in  were recorded consisting of  males () and  females ().In  there were  (,) males and  (,) females of  operated patients.In  there were  operated tumour of the larynx, with  (,) males and  (,) females.From  to  there were increasing number of female patients, in  ( patients were operated) there were  (,) males and  (,) females, and  ( patients were operated) there were  (,) males and  (,) females.Thyroid gland tumours were presented at , of the all operated tumours with notable female predominance (Figure ).
The histopatological malignant tumour type found in this work were squamous cell carcinoma (,), papillary carcinoma (,), basocellular carcinoma (,), while many other minor histopathological variants accounted for   (Figure ).Squamous cell carcinomas were the most common malignancy.Sarcomas and lymphomas were typically rare.Squamos cell carcinomas continue to dominate head and neck cancer with notable male prevalence ().Malignant neoplasm's were ,  and benign neoplasm's were , of all operated head and neck tumours.Th e most patients were presented with stage I ().With stage II there were ,, stage III , and stage IV , (Figure ).Th yroid neoplasm's were mostly papillary car-cinoma at , or , of all operated thyroid tumours.Benign tumours, polyps were the most frequent (,).

Discussion
Th e geographical variations in incidence and mortality are indicative of diff erences in the prevalence of risk factors between countries.In the U.S. and France, public health eff orts at tobacco control and education have successfully reduce the prevalence of smoking, resulting in a lower incidence of laryngeal carcinoma (,).Compared with study of Davis () we have increasing incidence of the laryngeal carcinoma, and decreasing incidence of thyroid tumours.Although, the prevalence of laryngeal carcinoma is increasing among females than at males.Very few prospective studies have examined the association between cigarette smoking and laryngeal cancer in females, even though the rates of smoking in women are increasing rapidly worldwide.Comparing the analysis of Tumino () and our study, laryngeal carcinoma showed signifi cant increasing trend among females, trend is stable among males.Compared with patients in the Yemen (), our patients were typically female (, vs. ,), no signifi cant old at disease presentation (mean , vs.  years), had mainly tumour of the larynx (,  vs. ), and had less tumours of oral cavity (, vs. ).Th ere was no statistically signifi cant diff erence at incidence of thyroid tumours between our study and study of Th apa and al. ().Although, our patients had mainly papillary carcinoma.Our study confi rms that squamous cell carcinomas continue to dominate, and most common stages are stage I and stage III (,,,).

Conclusion
Th e analysis of  laryngeal carcinomas in period - shows diverging trend between sexes, in fact rates decrease signifi cantly among males and increase among females.Increasing number of women with laryngeal carcinoma correlate with their increasing use of cigarettes.Many head and neck tumours have changing incidence and mortality rates contrary to expected changes given trends in public health issues.Further investigation of risk factors, diagnostic practices, and management strategies is warranted.Th e prognosis in head and neck tumour patients depends on clinical stage at the time of diagnosis, therefore, identifi cation of high-risk population, precancerous lesions and early diagnosis decrease mortality.Nevertheless, the major eff ort must be on primary prevention.