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3: Surgery Y3 - Cancer Care [1] (check ILOs) > [29] Head and Neck Cancer > Flashcards

[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

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2
Q

What % of cases of cancer in the UK are head and neck cancers?

A

4%

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3
Q

Which gender is head and neck cancer more common in?

A

Men

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4
Q

What % of cases of head and neck cancer occur in men?

A

65-90%

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5
Q

How does age affect the incidence of head and neck cancer?

A

The incidence increases with age, particularly over 50 years

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6
Q

What can head and neck cancer be classified into?

A
  • Oral cavity
  • Larynx
  • Pharynx
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7
Q

What % of head and neck cancers are in the oral cavity?

A

44%

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8
Q

What % of head and neck cancers are in the larynx?

A

31%

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9
Q

What % of head and neck cancers are in the pharynx?

A

25%

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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
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11
Q

Give an example of a severe social consequence to treatment of head and neck cancer

A

Loss of voice in laryngeal cancer

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12
Q

What are the most significant risk factors for head and neck cancers?

A
  • Smoking
  • Chewing tobacco or betel nuts
  • Alcohol consumption
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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

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14
Q

What are the other risk factors for head and neck cancers?

A
  • UV light exposure
  • Viral infections
  • Environmental exposure
  • Radiation
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15
Q

What type of head and neck cancer is UV light exposure a risk factor for?

A

Lip cancer

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16
Q

What viral infections are risk factors for head and neck cancer?

A
  • EBV

- HPV

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17
Q

What environmental exposures are risk factors for head and neck cancers?

A
  • Wood dust

- Nickel

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18
Q

What type of head and neck cancers is radiation a risk factor for?

A
  • Thyroid

- Salivary gland

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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

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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

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21
Q

What have case-controlled studies in Chinese patients suggested as having a link to nasopharyngeal cancer?

A

Salted fish consumption

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22
Q

What mutations are associated with head and neck cancer?

A

TP53 tumour suppressor gene

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23
Q

What type of cancers are the majority of head and neck cancers?

A

Squamous cell carcinomas

Except nasopharyngeal tumours

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24
Q

What % of head and neck cancers are squamous cell carcinomas?

A

90%

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25
Q

What type of cancers are most nasopharyngeal cancers?

A

Anaplastic

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26
Q

What are the rarer histological forms of head and neck cancer?

A
  • Adenoid cystic carcinoma
  • Plasmacytoma
  • Melanoma
  • Sarcoma
  • Lymphoma
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27
Q

What % of patients with head and neck cancers have multiple primary sites at presentation?

A

Up to 20%

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28
Q

What is the best means for detecting a cancer in the head and neck region?

A

Physical examination

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29
Q

What should be inspected in physical examination for head and neck cancers?

A
  • Teeth
  • Gingivae
  • Entire mucosal surface
  • Lymphoid tissue of tonsillar pillars
  • Tongue mobility
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30
Q

What should be noted when inspecting the lymphoid tissue of the tonsillar pillars?

A

Any asymmetry

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31
Q

What technique should be employed for palpation on examination of the head and neck?

A

Bimanual technique

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32
Q

What areas of the head and neck should be palpated when examining for cancer?

A
  • Mouth
  • Tongue
  • Cheeks
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33
Q

How is a bimanual technique carried out on examination of the head and neck?

A

One finger inside mouth, second hand under the mandible

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34
Q

Why should palpation be the last step in the examination of the head and neck?

A

Due to stimulation of the gag reflex

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35
Q

What do any suspicious lesions require when examining the head and neck?

A

Biopsy

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36
Q

What should be done if any mass is located on the neck?

A

Should document the location, and note it’s relationship to major structures, such as the salivary gland, thyroid, and carotid sheath

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37
Q

What structure in the neck should be palpated when examining for head and neck cancer?

A

Thyroid

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38
Q

How do cancers of the oral cavity present?

A

Non-healing ulcers

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39
Q

Describe the potential appearances of the ulcers in cancers of the oral cavity?

A
  • Raised
  • Ulcerated
  • Excavated
  • Pigmented
  • Well or poorly demarcated
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40
Q

Are the mouth ulcers caused by cancer of the oral cavity painful?

A

They may be

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41
Q

How are cancers of the oral cavity often diagnosed?

A

By dentists

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42
Q

What stage are cancers of the oral cavity often at diagnosis?

A

Advanced

43
Q

How are cancers of the oral cavity initially investigated?

A

By bimanual palpation

44
Q

How do cancers of the oral cavity progress?

A

They are often aggressive, and invade into the skull base before spreading to lymph nodes

45
Q

How does laryngeal cancer usually present?

A

As hoarseness

46
Q

What are the other symptoms of laryngeal cancer?

A
  • Dysphagia
  • Irritation
  • Coughing
47
Q

When should a patient with hoarseness be referred for an endoscope?

A

Any patient that has had hoarseness for >3 weeks

48
Q

Is lymph node involvement common with laryngeal cancer?

A

No, it is rare

49
Q

Why is lymph node involvement rare with laryngeal cancer?

A

Due to a poor lymphatic supply to the larynx

50
Q

What are the symptoms of nasopharyngeal cancer?

A
  • Unilateral nasal obstruction
  • Secretory otitis
  • Cranial nerve changes
51
Q

Describe the onset of nasopharyngeal cancer

A

It may have an insidious onset

52
Q

How does oropharyngeal cancer present?

A
  • Dysphagia
  • Pain
  • Aspiration of liquids
  • Dysarthria
53
Q

What might result from the anatomy of the oropharynx in oropharyngeal cancer?

A
  • Lymph nodes may be raised

- Tumours often only visible when tongue is fully retracted

54
Q

How might laryngopharyngeal cancer present?

A
  • Dyspnoea
  • Dysphagia
  • Anorexia
  • Irritation
  • Stridor
55
Q

What investigations can be used in head and neck cancers?

A
  • Indirect and direct laryngoscopy
  • Endoscopy and bronchoscopy
  • CT imaging
  • MRI scanning
56
Q

What is indirect laryngoscopy used for?

A

To examine the nasopharynx, hypopharynx, and larynx

57
Q

How can the vocal cords be assessed on indirect laryngoscopy?

A

They can be visualised, and their mobility evaulated

58
Q

What is the purpose of mirror examination when considering the vocal cords?

A

It provides at overall impression of mobility and symmetry

59
Q

What does direct laryngoscopy permit?

A

Inspection of the upper aerodigestive tract

60
Q

What can be viewed with direct laryngoscopy?

A
  • Piriform sinuses
  • Tongue base
  • Pharyngeal walls
  • Epiglottis
  • Arytenoids
  • True and false vocal cords
61
Q

Why is endoscopy and bronchoscopy useful in head and neck cancer?

A

As 5% of patients with head and neck cancer have a synchronous primary squamous cell cancer of the oesophagus or lung

62
Q

What is the purpose of CT imaging in head and neck cancer?

A
  • Delineate extent of disease
  • Determine presence of lymph node involvement
  • Distinguish solid from cystic lesions
63
Q

What might CT imaging of the chest, abdomen, and pelvis identify in head and neck cancer?

A

A primary site of an occult primary tumour, presenting with a lymph node in the neck

64
Q

What is the advantage of CT imaging in head and neck cancers?

A
  • It offers high spatial resolution
  • Can discriminate among fat, muscle, bone, and other soft tissues
  • Better than MRI in detection of bony erosions
65
Q

What is the purpose of MRI scanning in head and neck cancers?

A

It can provide accurate information regarding the size, location, and extent of the tumour

66
Q

What kind of head and neck cancers is MRI scanning better for?

A

Cancers of the nasopharynx and oropharynx

67
Q

What location would be considered to be ‘oral cancer’?

A

Anything rom lip to anterior 2/3 of the tongue

68
Q

What is the purpose of treatment of stage 1 oral cancers?

A

Curative intent

69
Q

How is stage 1 oral cancer treated?

A

Radiotherapy or excision, depending on location

70
Q

How is stage 2-4 oral cancer treated?

A

Combination of surgery, radiotherapy, and chemotherapy

71
Q

How can metastases be managed in oral cancer?

A

Radical dissection of the neck or radiotherapy to lymph nodes

72
Q

What is the treatment of choice for oral cancer if local recurrence occurs?

A

Often surgery

73
Q

What does a pre-malignant laryngeal lesion on the vocal cords present as?

A

Hoarseness

74
Q

How can a pre-malignant laryngeal lesion on the vocal cords be managed?

A

Excised endoscopically

75
Q

How are more established laryngeal cancers treated?

A

Radiotherapy is the best treatment

76
Q

Why is radiotherapy the best treatment for laryngeal cancers?

A

Because squamous cells respond well to radiation

77
Q

When can radiotherapy alone be curative in laryngeal cancer?

A

In stage 1-2 tumours

78
Q

What can be used in combination with radiotherapy for laryngeal cancer?

A

Surgery

79
Q

What is it important to consider during surgery for laryngeal cancer?

A

Close proximity of the tumour to the vocal cords, because of the potential for the loss of voice

80
Q

What is the standard treatment for stage 3 and 4 laryngeal tumours?

A

Radiotherapy with adjuvant chemotherapy

81
Q

How is nasopharyngeal cancer managed?

A

With radical radiotherapy and/or chemotherapy

82
Q

What does radiotherapy for nasopharyngeal cancer require?

A

Precision in the delivery of treatment doses

83
Q

Why does radiotherapy for nasopharyngeal cancer require precision in the delivery of treatment doses?

A

Due to the close relationship to the skull base and upper spinal cord

84
Q

What is the 5 year survival of stage 1 nasopharyngeal cancer?

A

50%

85
Q

What is the 5 year survival or stage 2 nasopharyngeal cancer?

A

30%

86
Q

How is oropharyngeal cancer treated?

A

Surgical excision of the tumour and lymph nodes, followed by radiotherapy

87
Q

How does the prognosis of oropharyngeal cancer differ from that of nasopharyngeal cancer?

A

It is better

88
Q

Why is the prognosis better for oropharyngeal cancer than for nasopharyngeal cancer?

A

Because the tumour is accessible for resection

89
Q

How is laryngopharyngeal cancer treated?

A

Radical surgery if there is no local spread, followed by radiotherapy

90
Q

Can surgery and radiotherapy be curative for laryngopharyngeal cancer?

A

Yes, for early stage tumours

91
Q

Other than curative treatment, what is radiotherapy useful for in laryngopharyngeal cancer?

A

Palliation in advanced or recurrent disease

92
Q

What is the prognosis of laryngopharyngeal cancer?

A

Poor, with many patients dying from recurrent disease

93
Q

What chemotherapy agents may be used in head and neck cancers?

A
  • Carboplatin
  • Paclitaxel
  • Cisplatin
  • Flurouracil
94
Q

What is the purpose of chemotherapy in head and neck cancer?

A

Used as induction treatments for inoperable, locally advanced squamous cell head and neck cancers

95
Q

What does the prognosis of head and neck cancers correlate with?

A

The stage at diagnosis

96
Q

What is the survival rate of patients with stage 1 head and neck cancers?

A

80% +

97
Q

What is the survival rate of patients with locally advanced head and neck cancers (stage 3-4) at the time of diagnosis?

A

40%

98
Q

By how much does development of nodal metastases reduce the survival of head and neck cancers?

A

Approx 50%

99
Q

What stage do most patients with head and neck cancer have at diagnosis?

A

3-4

100
Q

Where do the majority of relapses of head and neck cancer occur?

A

Locoregional (within the head and neck)

101
Q

What % of relapses of head and neck cancer occur locoregionally?

A

80%

102
Q

What happens to the rate of distant metastases as head and neck cancer progresses?

A

It increases

103
Q

Where do distant metastases from head and neck cancers most often involve?

A
  • Lungs
  • Bones
  • Liver
104
Q

What % of patients with head and neck cancer will have clinically detected distant metastases at the time of death?

A

10-30%

3: Surgery Y3 - Cancer Care [1] (check ILOs) (47 decks)

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