5: Head and neck cancer

Question 1

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

Answer 1

Smoking

Alcohol

Viruses (HPV)

Question 2

Which strains of HPV cause papillomas and carcinomas?

Answer 2

Papillomas - HPV 6 and 11

Carcinomas - HPV 16 and 18

Question 3

Young people tend to develop head and neck cancers due to ___.

Answer 3

viral infection

HPV - oral sex

Question 4

What virus is linked to nasopharyngeal carcinoma?

Answer 4

Epstein Barr virus (EBV)

Question 5

Where do oral cancers tend to arise?

Answer 5

Buccal mucosa

Lateral borders of tongue

Question 6

What should you do if you find a dodgy lesion on oral examination?

Answer 6

Feel it

Question 7

How do

a) benign
b) malignant

oral lesions feel?

Answer 7

a) Soft

b) Firm

Question 8

What would you find on neck examination of someone with ENT cancer?

Answer 8

Enlarged lymph nodes

Thyroid lumps (which move up and down)

Question 9

What is used to look into the pharynx and larynx?

Answer 9

Endoscope

Question 10

How are biopsies taken from ENT tumours?

Answer 10

FNA

Question 11

Apart from endoscopy and biopsies, what other investigations are done for head and neck cancers?

Answer 11

Ultrasound

X-ray

MRI

CT

Question 12

Are blood tests done for head and neck cancers?

Answer 12

No

not many markers for these cancers

Question 13

Which scan is used for bony cancers?

Which scan is used for soft tissue cancers?

Answer 13

CT (hard)

MRI (soft)

Question 14

Why are CXRs commonly done in addition to investigations for head and neck cancers?

Answer 14

Risk factors for ENT / lung cancers are the same

So chances are they have primary / secondary lung cancers as well

Question 15

How are head and neck cancers managed?

Answer 15

MDT

Question 16

What is the most common form of ENT cancer?

Answer 16

Squamous cell carcinoma

because the cavities are lined by squamous epithelium

Question 17

Does hoarseness automatically mean a glottic tumour?

Answer 17

No

Question 18

Which cranial nerve is disrupted to cause hoarseness?

What are some possible causes?

Answer 18

CN X

Disruption to recurrent laryngeal nerve, so lung problems and aortic aneurysm

Question 19

Apart from CN X, which other cranial nerve can be damaged by ENT cancers?

Answer 19

CN VII

Question 20

Which lymph node becomes enlarged in a variety of different, diffuse cancers?

Answer 20

Virchow’s node

Left supraclavicular node

Question 21

Why might a patient become hypocalaemic following ENT surgery?

Answer 21

Removal of parathyroid glands

i.e glands can be gammied by cancer surgery

Question 22

What is the difference between wheeze and stridor?

Answer 22

Wheeze is EXPIRATORY, deep, best heard over the lung bases

STRIDOR is INSPIRATORY, high pitched, comes from the upper airways

(Stertor is the preceding sound)

Question 23

What may be compromised in ENT cancers?

Answer 23

Airway

Question 24

Why may a patient with ENT cancer experience dysphagia?

Answer 24

Compression of oesophagus

Question 25

Why is it important for cancer patients to see the same doctor on each visit?

Answer 25

Continuity of care - trust

Confidentiality

Question 26

If a relative asks to discuss a patient’s condition, what do you need?

Answer 26

Patient’s consent