1 - ENT - Head and neck - Cancer and neck lumps - overview + HNSCC Flashcards
9 places/cancers that occur in the H+N
oral cavities nasal cavities larynx pharynx salivary glands thyroid gland lymphoma sarcoma (skin cancers)
HNSCC - 7 RF’s
tobacco betel nuts alcohol chemical/wood dust exposure sun exposure HPV infection Leukoplakia/erythroplakia
Leukoplakia - what? ass w? risk of?
white patch on mucosa - can’t be rubbed off
ass w chronic irritation (chewing tobacco)
risk of dysplasia and malignancy (1/3rd)
Erythroplakia - what? compare to leukoplakia?
similar to leukoplakia but red
less common
greater risk of SCC transformation
6 typical presentations of HNSCC
neck pain - ref to ear enlarging neck lump hoarse voice/sore throat odynophaga/dysphagia bleeding or numbness ulceration/leukoplakia/erythroplakia
what presentation is rare in HNSCC + more likely in other cancers
weight loss - present usually due to swallowing problems
more likely in GI lung systemic cancers
OTHER presentations of HNSCC
soft tissue swelling - dentures dont fit
difficulty moving jaw - (trismus)
feeling that something is stuck in throat
5 investigations for ?HNSCC
Panendoscopy (airodigestive tract) FNA CT/MRI (skull base) Biopsy under GA CT/CXR for ?mets
3 different types of H+N cancer
Oropharyngeal CA
Hypopharyngeal CA
Laryngeal CA
Oropharyngeal CA - incidence, sex
6-8 per mil/year
M:F = 5:1
Oropharyngeal CA - RFs
smoking alcohol radiation Fe def anaemia HPV infection
Oropharyngeal CA - % of different histology of tumours
90% SCC 8% non-hodgkins lymphoma 2% minor salivary gland tumours
Oropharyngeal CA - common sites
tonsils/lateral pharyngeal wall 60%
tongue base 25%
palate 10%
posterior pharyngeal wall 10%
Hypopharyngeal CA - incidence sex histology shows
10-20 per mil/year
more common in women - only H+NC that is
almost always SCC
Hypopharyngeal CA
- common sites + salient presentation feautures
- piriform fossae 70%
posterior pharyngeal wall 25% - post -cricoid area 5%
-weight loss if advanced - 45% metastatic at presentation
Hypopharyngeal CA
RFs
smoking alcohol radiation Fe def anaemia HPV infection
Plummer Vinson syndrome
Laryngeal CA - incidence, sex, RF’s
40 per mil/y
M:F - 4:1
FR - smoking alcohol radiation HPV infection
Laryngeal CA Histology %’s
95% SCC, some minor salivary gland tumours, NE tumours, sarcomas
Laryngeal CA common sites
glottis/true VCs 50% supraglottis 40% subglottis 5%
Laryngeal CA salient presentation features
voice change, dyspnoea/stridor
Two types of congenital neck lumps
Thyroglossal duct cyst
Branchial cyst
Thyroglossal cyst - found where + when? when present? how to differentiate from thyroid lumps?
midline of neck in children
80% present before 5y
move on swallowing AND tongue protrusion (thy lumps dont on protrusion)
Branchial cyst - where? caused by what? usually present when?
lump at anterior border of SCM - meeting od upper and middle 1/3rds
failure of 2nd branchial arch closure
usually present as tennagers/young adults