[29] Head and Neck Cancer Flashcards
1
Q
How common is head and neck cancer worldwide, compared to other cancers?
A
It is the 6th most common cancer worldwide
2
Q
What % of cases of cancer in the UK are head and neck cancers?
A
4%
3
Q
Which gender is head and neck cancer more common in?
A
Men
4
Q
What % of cases of head and neck cancer occur in men?
A
65-90%
5
Q
How does age affect the incidence of head and neck cancer?
A
The incidence increases with age, particularly over 50 years
6
Q
What can head and neck cancer be classified into?
A
- Oral cavity
- Larynx
- Pharynx
7
Q
What % of head and neck cancers are in the oral cavity?
A
44%
8
Q
What % of head and neck cancers are in the larynx?
A
31%
9
Q
What % of head and neck cancers are in the pharynx?
A
25%
10
Q
Why do patients with head and neck cancers have particular problems?
A
- Close proximity of the tumours to important structures in the head
- Severe social consequences to treatment
11
Q
Give an example of a severe social consequence to treatment of head and neck cancer
A
Loss of voice in laryngeal cancer
12
Q
What are the most significant risk factors for head and neck cancers?
A
- Smoking
- Chewing tobacco or betel nuts
- Alcohol consumption
13
Q
Which type of alcohol consumption in particular is a risk factor for head and neck cancer?
A
Spirits, which act synergistically with tobacco
14
Q
What are the other risk factors for head and neck cancers?
A
- UV light exposure
- Viral infections
- Environmental exposure
- Radiation
15
Q
What type of head and neck cancer is UV light exposure a risk factor for?
A
Lip cancer
16
Q
What viral infections are risk factors for head and neck cancer?
A
- EBV
- HPV
17
Q
What environmental exposures are risk factors for head and neck cancers?
A
- Wood dust
- Nickel
18
Q
What type of head and neck cancers is radiation a risk factor for?
A
- Thyroid
- Salivary gland
19
Q
Describe the geographical distribution of nasopharyngeal cancer
A
It is most common in Southeast Asia, and is seen in Arabs and Inuits, but worldwide is rare
20
Q
What proteins in the body have a strong association with head and neck cancer?
A
The major histocompatibility complexes H2B, BW46, and B17
21
Q
What have case-controlled studies in Chinese patients suggested as having a link to nasopharyngeal cancer?
A
Salted fish consumption
22
Q
What mutations are associated with head and neck cancer?
A
TP53 tumour suppressor gene
23
Q
What type of cancers are the majority of head and neck cancers?
A
Squamous cell carcinomas
Except nasopharyngeal tumours
24
Q
What % of head and neck cancers are squamous cell carcinomas?
A
90%
25
What type of cancers are most nasopharyngeal cancers?
Anaplastic
26
What are the rarer histological forms of head and neck cancer?
- Adenoid cystic carcinoma
- Plasmacytoma
- Melanoma
- Sarcoma
- Lymphoma
27
What % of patients with head and neck cancers have multiple primary sites at presentation?
Up to 20%
28
What is the best means for detecting a cancer in the head and neck region?
Physical examination
29
What should be inspected in physical examination for head and neck cancers?
- Teeth
- Gingivae
- Entire mucosal surface
- Lymphoid tissue of tonsillar pillars
- Tongue mobility
30
What should be noted when inspecting the lymphoid tissue of the tonsillar pillars?
Any asymmetry
31
What technique should be employed for palpation on examination of the head and neck?
Bimanual technique
32
What areas of the head and neck should be palpated when examining for cancer?
- Mouth
- Tongue
- Cheeks
33
How is a bimanual technique carried out on examination of the head and neck?
One finger inside mouth, second hand under the mandible
34
Why should palpation be the last step in the examination of the head and neck?
Due to stimulation of the gag reflex
35
What do any suspicious lesions require when examining the head and neck?
Biopsy
36
What should be done if any mass is located on the neck?
Should document the location, and note it's relationship to major structures, such as the salivary gland, thyroid, and carotid sheath
37
What structure in the neck should be palpated when examining for head and neck cancer?
Thyroid
38
How do cancers of the oral cavity present?
Non-healing ulcers
39
Describe the potential appearances of the ulcers in cancers of the oral cavity?
- Raised
- Ulcerated
- Excavated
- Pigmented
- Well or poorly demarcated
40
Are the mouth ulcers caused by cancer of the oral cavity painful?
They may be
41
How are cancers of the oral cavity often diagnosed?
By dentists
42
What stage are cancers of the oral cavity often at diagnosis?
Advanced
43
How are cancers of the oral cavity initially investigated?
By bimanual palpation
44
How do cancers of the oral cavity progress?
They are often aggressive, and invade into the skull base before spreading to lymph nodes
45
How does laryngeal cancer usually present?
As hoarseness
46
What are the other symptoms of laryngeal cancer?
- Dysphagia
- Irritation
- Coughing
47
When should a patient with hoarseness be referred for an endoscope?
Any patient that has had hoarseness for >3 weeks
48
Is lymph node involvement common with laryngeal cancer?
No, it is rare
49
Why is lymph node involvement rare with laryngeal cancer?
Due to a poor lymphatic supply to the larynx
50
What are the symptoms of nasopharyngeal cancer?
- Unilateral nasal obstruction
- Secretory otitis
- Cranial nerve changes
51
Describe the onset of nasopharyngeal cancer
It may have an insidious onset
52
How does oropharyngeal cancer present?
- Dysphagia
- Pain
- Aspiration of liquids
- Dysarthria
53
What might result from the anatomy of the oropharynx in oropharyngeal cancer?
- Lymph nodes may be raised
| - Tumours often only visible when tongue is fully retracted
54
How might laryngopharyngeal cancer present?
- Dyspnoea
- Dysphagia
- Anorexia
- Irritation
- Stridor
55
What investigations can be used in head and neck cancers?
- Indirect and direct laryngoscopy
- Endoscopy and bronchoscopy
- CT imaging
- MRI scanning
56
What is indirect laryngoscopy used for?
To examine the nasopharynx, hypopharynx, and larynx
57
How can the vocal cords be assessed on indirect laryngoscopy?
They can be visualised, and their mobility evaulated
58
What is the purpose of mirror examination when considering the vocal cords?
It provides at overall impression of mobility and symmetry
59
What does direct laryngoscopy permit?
Inspection of the upper aerodigestive tract
60
What can be viewed with direct laryngoscopy?
- Piriform sinuses
- Tongue base
- Pharyngeal walls
- Epiglottis
- Arytenoids
- True and false vocal cords
61
Why is endoscopy and bronchoscopy useful in head and neck cancer?
As 5% of patients with head and neck cancer have a synchronous primary squamous cell cancer of the oesophagus or lung
62
What is the purpose of CT imaging in head and neck cancer?
- Delineate extent of disease
- Determine presence of lymph node involvement
- Distinguish solid from cystic lesions
63
What might CT imaging of the chest, abdomen, and pelvis identify in head and neck cancer?
A primary site of an occult primary tumour, presenting with a lymph node in the neck
64
What is the advantage of CT imaging in head and neck cancers?
- It offers high spatial resolution
- Can discriminate among fat, muscle, bone, and other soft tissues
- Better than MRI in detection of bony erosions
65
What is the purpose of MRI scanning in head and neck cancers?
It can provide accurate information regarding the size, location, and extent of the tumour
66
What kind of head and neck cancers is MRI scanning better for?
Cancers of the nasopharynx and oropharynx
67
What location would be considered to be 'oral cancer'?
Anything rom lip to anterior 2/3 of the tongue
68
What is the purpose of treatment of stage 1 oral cancers?
Curative intent
69
How is stage 1 oral cancer treated?
Radiotherapy or excision, depending on location
70
How is stage 2-4 oral cancer treated?
Combination of surgery, radiotherapy, and chemotherapy
71
How can metastases be managed in oral cancer?
Radical dissection of the neck or radiotherapy to lymph nodes
72
What is the treatment of choice for oral cancer if local recurrence occurs?
Often surgery
73
What does a pre-malignant laryngeal lesion on the vocal cords present as?
Hoarseness
74
How can a pre-malignant laryngeal lesion on the vocal cords be managed?
Excised endoscopically
75
How are more established laryngeal cancers treated?
Radiotherapy is the best treatment
76
Why is radiotherapy the best treatment for laryngeal cancers?
Because squamous cells respond well to radiation
77
When can radiotherapy alone be curative in laryngeal cancer?
In stage 1-2 tumours
78
What can be used in combination with radiotherapy for laryngeal cancer?
Surgery
79
What is it important to consider during surgery for laryngeal cancer?
Close proximity of the tumour to the vocal cords, because of the potential for the loss of voice
80
What is the standard treatment for stage 3 and 4 laryngeal tumours?
Radiotherapy with adjuvant chemotherapy
81
How is nasopharyngeal cancer managed?
With radical radiotherapy and/or chemotherapy
82
What does radiotherapy for nasopharyngeal cancer require?
Precision in the delivery of treatment doses
83
Why does radiotherapy for nasopharyngeal cancer require precision in the delivery of treatment doses?
Due to the close relationship to the skull base and upper spinal cord
84
What is the 5 year survival of stage 1 nasopharyngeal cancer?
50%
85
What is the 5 year survival or stage 2 nasopharyngeal cancer?
30%
86
How is oropharyngeal cancer treated?
Surgical excision of the tumour and lymph nodes, followed by radiotherapy
87
How does the prognosis of oropharyngeal cancer differ from that of nasopharyngeal cancer?
It is better
88
Why is the prognosis better for oropharyngeal cancer than for nasopharyngeal cancer?
Because the tumour is accessible for resection
89
How is laryngopharyngeal cancer treated?
Radical surgery if there is no local spread, followed by radiotherapy
90
Can surgery and radiotherapy be curative for laryngopharyngeal cancer?
Yes, for early stage tumours
91
Other than curative treatment, what is radiotherapy useful for in laryngopharyngeal cancer?
Palliation in advanced or recurrent disease
92
What is the prognosis of laryngopharyngeal cancer?
Poor, with many patients dying from recurrent disease
93
What chemotherapy agents may be used in head and neck cancers?
- Carboplatin
- Paclitaxel
- Cisplatin
- Flurouracil
94
What is the purpose of chemotherapy in head and neck cancer?
Used as induction treatments for inoperable, locally advanced squamous cell head and neck cancers
95
What does the prognosis of head and neck cancers correlate with?
The stage at diagnosis
96
What is the survival rate of patients with stage 1 head and neck cancers?
80% +
97
What is the survival rate of patients with locally advanced head and neck cancers (stage 3-4) at the time of diagnosis?
40%
98
By how much does development of nodal metastases reduce the survival of head and neck cancers?
Approx 50%
99
What stage do most patients with head and neck cancer have at diagnosis?
3-4
100
Where do the majority of relapses of head and neck cancer occur?
Locoregional (within the head and neck)
101
What % of relapses of head and neck cancer occur locoregionally?
80%
102
What happens to the rate of distant metastases as head and neck cancer progresses?
It increases
103
Where do distant metastases from head and neck cancers most often involve?
- Lungs
- Bones
- Liver
104
What % of patients with head and neck cancer will have clinically detected distant metastases at the time of death?
10-30%
