10.1 Surgical treatment of cancer Flashcards
What are risk factors for head and neck cancer?
- Poor OHI
- Low socioeconomic status
- Radiation
- Genetics
- Viruses and infection
- Tobacco and alcohol!
Name the major premalignant oral lesions for head and neck cancer.
- Leukoplakia
- Erythroplakia
- Submucous fibrosis
Name possible causes of neck lumps.
- Swollen lymph nodes
- Thyrdoid cancer
- Hodgkins disease
- Sialolith
- Strep throat
- Tonsillitis
- Abscessed tooth
- Mumps
What are the 3 treatments for cancer?
- Surgery
- Radiotherapy
- Chemotherapy
What are the factors behind choosing surgical treatment for cancer?
- Size of lump
- Site
- Psychological/socioeconomic needs of the patient
- Medical comorbidity
- Chance of cure
What is the typical presentation of a patient with head and neck cancer?
- Ulcer/lump
- Pain
- Dysphagia
- Changes to the voice or complete voice loss
- Weight loss
- Otalgia (ear pain)
- Dyspnoea (laboured breathing)
What should you enquire about with regards to the presenting patient’s history?
- Smoker? How long and how much
- Alcohol?
- Family/home circumstances
- Low socioeconomic group?
- Family history of cancer
What examinations may a head and neck cancer patient require?
- Examine general demenaour e.g. breathless, nicotine smell, difficulty walking
- Examine regional lymph nodes
- Nasendoscope
What special investigations may a head and neck cancer patient require?
- Radiographs
- Chest x-ray
- Biopsy+/- EUA (examination under anaesthetic)
- USS (ultrasound scan) +/- FNAC (fine needle aspiration cytology)
- CT scan
- MRI scan
- Angiograms
- Doppler ultrasound
- Bone scan / SPECT / PET (imaging modalities used to stage disease)
Where do most squamous cell carcinomas present?
- Lips and oral cavity (90%)
What is the typical presentation of an oral SCC patient?
- Non healing ulcer (6/12 duration)
- Smokes
- Drinks heavily and frequently
If oral SCC spreads to lymphatics, how does this affect cure rate?
Cure rate reduced by 50%
How is cancer staged?
Using the TNM system.
Describe the TNM system.
- Tumour size (T1-T4)
- Node involvement (N0=none, N1=single and smaller than 3cm, N2=multiple or node larger than 3cm)
- Metastasis (M0=no distant metastasis, M1=distant metastasis)
For cancer patients who cannot take food orally, what feeding methods might they use?
- Nasogastric tube
- PEG: percutaneous endodcopic gastronomy
- TPN: total parenteral nutrition