11. H & N cancers

Question 1

what is the most common type of HCN

Answer 1

squamous cell carcinomas (90%)

Question 2

what are the 3 main locations affected by HCNs

Answer 2

1. oral cavity, e.g. tongue
2. larynx
3. oropharynx

Question 3

what are the main risk factors for HCNs

Answer 3

1. heavy alcohol and tobacco use
2. age (60+)
3. male
4. HPV infection - oropharyngeal cancer

Question 4

what is the common initial presentation of oral cavity cancer

Answer 4

unresolving painful lesion/ulceration in lips, mouth or tongue (e.g. leukoplakia, erythroplakia)

Question 5

what is the common initial presentation of pharyngeal/laryngeal cancer

Answer 5

• dysphagia
• odynophagia (painfull swallowing)
• otalgia - due to contribution of vagus n to sensory innervation of the ear
• hoarseness or dysphonia (voice change)
• metastatic cervical lymphadenopathy
• weight loss
• persistent cough - abnormal growth within larynx stimulates cough reflex

Question 6

which investigations should be performed in suspected HCN

Answer 6

1. USS and biopsy if neck lump (e.g. nodal metastases)
2. direct visualisation of larynx/pharynx (e.g. rigid laryngoscopy) to allow biopsy of lesion
3. further imaging (e.g. CT, MRI) to determine stage (spread and nodal involvement)

Question 7

what is the main staging system used for HCNs

Answer 7

TNM:

• T - tumour size and location
• N - degree of lymph node involvement
• M - presence of distant metastases

Question 8

what is the main presentation in thyroid cancer

Answer 8

• neck lump: in thyroid or nodal metastasis
• compressive symptoms, e.g. dysphagia
• hoarseness

Question 9

which type of biopsy is performed in thyroid cancer

Answer 9

FNAC: fine needle aspiration cytology

Question 10

what are the main treatment options for thyroid cancer

Answer 10

1- thyroidectomy (hemi- or more often total)
2- radioactive iodine (ablate any remaining thyroid tissue)
3- radio-/chemotherapy

Question 11

what are the 4 types of thyroid cancer, which is most common and which ones have good or bad prognoses

Answer 11

1. papillary adenocarcinoma
   
   • most common (esp. in women)
   • good prognosis as grows slowly and unlikely to spread haematologically
2. follicular adenocarcinoma
3. medullary cancer
   
   • v. rare, poor prognosis
4. anaplastic cancer
   
   • v. rare, v. poor prognosis

Question 12

what is the DDx for neck lumps

Answer 12

1. inflammatory cervical nodes (infection)
2. congenital lesions, e.g. thyroglossal cysts, branchial cysts
3. thyroid pathology - goitre that can be malignant or benign (e.g. Graves)
4. primary or secondary malignant disease (supraclavicular LNs drain thorax/abdomen too)
5. salivary gland pathology (calculus, infection, tumour)