1 - ENT - Head and neck - Cancer and neck lumps - overview + HNSCC

Question 1

9 places/cancers that occur in the H+N

Answer 1

oral cavities
nasal cavities
larynx
pharynx
salivary glands
thyroid gland
lymphoma
sarcoma
(skin cancers)

Question 2

HNSCC - 7 RF’s

Answer 2

tobacco
betel nuts
alcohol
chemical/wood dust exposure
sun exposure
HPV infection
Leukoplakia/erythroplakia

Question 3

Leukoplakia - what? ass w? risk of?

Answer 3

white patch on mucosa - can’t be rubbed off
ass w chronic irritation (chewing tobacco)
risk of dysplasia and malignancy (1/3rd)

Question 4

Erythroplakia - what? compare to leukoplakia?

Answer 4

similar to leukoplakia but red
less common
greater risk of SCC transformation

Question 5

6 typical presentations of HNSCC

Answer 5

neck pain - ref to ear
enlarging neck lump
hoarse voice/sore throat
odynophaga/dysphagia
bleeding or numbness
ulceration/leukoplakia/erythroplakia

Question 6

what presentation is rare in HNSCC + more likely in other cancers

Answer 6

weight loss - present usually due to swallowing problems

more likely in GI lung systemic cancers

Question 7

OTHER presentations of HNSCC

Answer 7

soft tissue swelling - dentures dont fit
difficulty moving jaw - (trismus)
feeling that something is stuck in throat

Question 8

5 investigations for ?HNSCC

Answer 8

Panendoscopy (airodigestive tract)
FNA
CT/MRI (skull base)
Biopsy under GA
CT/CXR for ?mets

Question 9

3 different types of H+N cancer

Answer 9

Oropharyngeal CA
Hypopharyngeal CA
Laryngeal CA

Question 10

Oropharyngeal CA - incidence, sex

Answer 10

6-8 per mil/year

M:F = 5:1

Question 11

Oropharyngeal CA - RFs

Answer 11

smoking alcohol radiation Fe def anaemia HPV infection

Question 12

Oropharyngeal CA - % of different histology of tumours

Answer 12

90% SCC 8% non-hodgkins lymphoma 2% minor salivary gland tumours

Question 13

Oropharyngeal CA - common sites

Answer 13

tonsils/lateral pharyngeal wall 60%
tongue base 25%
palate 10%
posterior pharyngeal wall 10%

Question 14

Hypopharyngeal CA - incidence sex histology shows

Answer 14

10-20 per mil/year
more common in women - only H+NC that is
almost always SCC

Question 15

Hypopharyngeal CA

- common sites + salient presentation feautures

Answer 15

• piriform fossae 70%
  posterior pharyngeal wall 25%
• post -cricoid area 5%

-weight loss if advanced - 45% metastatic at presentation

Question 16

Hypopharyngeal CA

RFs

Answer 16

smoking alcohol radiation Fe def anaemia HPV infection

Plummer Vinson syndrome

Question 17

Laryngeal CA - incidence, sex, RF’s

Answer 17

40 per mil/y
M:F - 4:1
FR - smoking alcohol radiation HPV infection

Question 18

Laryngeal CA Histology %’s

Answer 18

95% SCC, some minor salivary gland tumours, NE tumours, sarcomas

Question 19

Laryngeal CA common sites

Answer 19

glottis/true VCs 50% supraglottis 40% subglottis 5%

Question 20

Laryngeal CA salient presentation features

Answer 20

voice change, dyspnoea/stridor

Question 21

Two types of congenital neck lumps

Answer 21

Thyroglossal duct cyst

Branchial cyst

Question 22

Thyroglossal cyst - found where + when? when present? how to differentiate from thyroid lumps?

Answer 22

midline of neck in children
80% present before 5y
move on swallowing AND tongue protrusion (thy lumps dont on protrusion)

Question 23

Branchial cyst - where? caused by what? usually present when?

Answer 23

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