11. Head And Neck Cancers

Question 1

Where are the tumour sub sites in head and neck?

Answer 1

Lip/oral cavity
Pharynx - oropharynx, nasopharynx, hypopahrynx
Larynx - supraglottis, glottis, subglottis
Nasal cavity/sinuses
Salivary glands
Thyroid

Question 2

What are the risk factors for head and neck cancers?

Answer 2

Smoking
Alcohol
Betal nut chewing
Dental hygiene 
Viruses - HPV
Premalignant

Question 3

What are the risk factors specific to thyroid cancer?

Answer 3

Irradiation exposure
Family history and certain inherited conditions
Young lumps (<20yrs) or old lumps (>70yrs) in thyroid glands more likely to be malignant

Question 4

What are the general principles of head and neck cancer management?

Answer 4

Medical - radiotherapy, chemotherapy
Surgery - assessment, biopsy, remove if possible, reconstruct
Supportive - swallowing, feeding, voice rehab, pain, supportive care

Question 5

How do cancers of the lip/oral cavity present?

Answer 5

Lump
Pain - also referred pain to ear
Fixation of tongue
Problems swallowing
Pain on swallowing

Question 6

What investigations are done for lip/oral cavity cancers?

Answer 6

Biopsy
CT/MRI
May need PET

Question 7

What is the treatment for lip/oral cavity cancers?

Answer 7

Small tumours excise and repair defect
Radiotherapy
Larger tumours that do not respond to RT may need extensive surgery

Question 8

What is the presentation of cancers of the pharynx?

Answer 8

Lump
Pain - referred pain to otalgia
Problems swallowing
Pain on swallowing
Weight loss

Question 9

What are the investigations for pharynx cancers?

Answer 9

CT and MRI
May need PET
Biopsy

Question 10

What is the treatment for pharynx cancers?

Answer 10

Small tumours excuse and repair the defect
Radiotherapy
Larger tumours that do not respond to RT may need extensive surgery

Question 11

What is the presentation for larynx cancers?

Answer 11

Dysphonia (voice change)
Dysphagia
Referred otalgia
Globus (feeling of lump in throat without one there)
Neck lump
Weight loss
Cachexia

Question 12

What are the investigations for cancers of larynx?

Answer 12

CT
MRI
May need PET
Biopsy

Question 13

What is the treatment for larynx cancers?

Answer 13

Small tumours may have laser resection or RT
Medium size tumours do well with RT and chemotherapy
Larger tumours that do not respond to RT may need extensive surgery (laryngectomy)

Question 14

What is the presentation fo thyroid cancer?

Answer 14

Lump in thyroid or neck nodal metastasis
Compressive symptoms - problems swallowing, feeling like they’re being strangled
Can have voice change

Question 15

What are the investigations for thyroid cancer?

Answer 15

Triple assessment - full history and examination, imaging (USS), needle testing of lumps via fine needle aspiration cytology (FNAC)

Question 16

What are the types of thyroid cancer?

Answer 16

Papillary adenocarcinoma (80%)
Follicular adenocarcinoma (10%)
Medullary carcinoma (5%)
Anaplastic carcinoma (5%)

Question 17

What is the treatment for thyroid cancer?

Answer 17

Thyroid to my
Radioactive iodine
Radiotherapy/chemotherapy